the medical plan
Are you aware that the standard guide for medical rates begins with Medicare? Simply, Medicare adjusts prices for procedures on a regional basis taking into account various factors to determine a fair billing rate for that procedure. You can access CMS website to connect to the official Medicare site. The rates propagated here are referred to as the Official Medical Fee Schedule (OMFS). An easy example of how rates vary is to consider an MRI (Magnetic Resonance Image) of the knee. The fee includes the physician’s interpretation and technical imaging combined.
Location / OMFS / Standard Bill
New York $728 $2,912
Dallas $623 $2,377
Los Angeles $652 $2,608
Remember how this rate began from Medicare? When the 68 year old patient needs and MRI of the knee, Medicare may be billed the standard full price but they only pay based on OMFS. What do you pay through insurance or out of pocket if you are uninsured or if your plan refused to authorize the procedure?
Healthcare insurance plan have contracts with medical groups, hospitals and medical professionals to pay a specific negotiated price. Depending on if your plan is an HMO, PPO, 80/20 conventional policy, high deductible policy or uninsured; you may be required to pay in addition to what you carrier paid. How much? That is where the battles lie.
In my example you live in Los Angeles and after your insurance paid the provider you get a bill for the balance of $1,938. What will you do when you see the bill? Write a check for the full amount, pay by credit card in full, call and ask for a payment plan or call for a discount?
There are a number of other issues including the reasonable rate you insurance thinks the bill should be. You could get an EOB (explanation of benefits) from your insurance. The EOB will contain the amount billed $2,608, the amount they paid $670 and the reasonable retail price for the procedure $2,288. So you figure to deduct the $670 paid by insurance from $2,288 and you should pay $1,618. Wow, a 16% savings and I guarantee they will accept it as full payment.
The more reasonable amount you should pay is between an additional $130 to $280. Why, because an MRI should not cost more then $960.00.
Various sites and services exist that can help you work through maze of medical billing. Overall they will provide similar results saving you money. However, many work on a contingency fee based on what they save you, usually 30%. In our example, if your bill should be $960 from the original $1,938 saving you would pay them at least $293.00 and possibly and retainer of $250.00 and you still have to pay the MRI provider around $150 for a total cost of $693.
After you’ve checked into the usual contingency fee vendors, go to http://DiscountMyMedicalBill.com for flat fee pricing based on over 30 years of experience.
My next blog will be designed for the full uninsured consumer and people who have high deductibles.
Rich Davis is a partner with Medical Bill Consultants, Tarzana, Ca. Medical Bill Consultants provides medical bill review service to consumers of medical service who question the high bills they receive. Medical Bill Consultants works on a flat fee rather then a high contingency providing money back guarantee. Visit their site http://DiscountMyMedicalBill.com for more information.
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