Archive for July, 2013

PostHeaderIcon New trend in medical billing – Watch your money


We all know the big changes in medical insurance and the effect of the Patient Protection and Affordability Care Act. (I still hesitate to call it Obamacare)
The new trend in the delivery of medical care is hospital based medical practices. Hospitals are buying large medical group practices.  On the surface nothing has changed; seeing the same doctor in the same office.  In actuality, there is a big change. The same practice now belongs to the hospital, where more administration, higher “standard of care”, accreditation and increased staffing levels take place.  The doctor’s equipment now belongs to the hospital.
The financial outcome:  patients treated by the doctor now receiving two bills, one for the doctor and one for the facility.  Why should you care?  The facility based bill can easily be 10 times higher than the doctor bill.  All this for the same service you may have received in the past.
Many people have high deductible medical insurance. Many of the small group and individual policies hide a significant amount of patient responsibilities in a small print.
I think the time have passed for most people to be shy about the cost of their medical care. Everyone has a right to know how much a medical procedure will cost them. Ask the receptionist when you make an appointment.  Don’t be shy.  Your doctor isn’t shy about collecting their payments.
The blueprint to do this:  when you are making an appointment as the receptionist a few questions:

  1. Is the doctor participating in my insurance network?
  2. Is the doctor owns the practice, or is the practice owned by a hospital?
  3. How much my visit will cost?
  4. What is the procedure(s) code for my visit?   (Usually a five digit number, but could be one letter and four numbers)
  5. Do I need prior authorization for this service?
  6. Then call your insurance, with the information you have at hand and find out how much they will pay.

I am not advocating abstaining from medical care. I simply advocate for you to know how much it will cost in advance.