I think this is a very important question that needs to be answered in our community. The number #1 problem I get with most individual cases, in regards to their billing, is bloodwork in particular.
Doctors jump to the idea of always doing labwork whenever they see a jump in their blood pressure. Eventhough, its usually because they're nervous about doctors or drank coffee etc. hence skewing the readings.
What carrier have you seen cover the labwork best? I know for group its UHC hands down. No Charge for lab & x-ray. But what about IFP? This week alone I have had Blue Cross, Nationwide & Aetna clients call me complaining about the cost.
The current bill that is on my desk (Aenta) is 9 lab services and 2 x-rays for over 1,500. Negotiated down to about 1,200 since he has a high deduct. All because of a high blood pressure reading.
Any other companies specifically IFP that have better UCR's to keep these bills lower would be greatly appreciated. Thanks for reading!
Doctors jump to the idea of always doing labwork whenever they see a jump in their blood pressure. Eventhough, its usually because they're nervous about doctors or drank coffee etc. hence skewing the readings.
I think you have answered your own question here. If doctors will order up thousands of dollars worth of labs because of these things, why would anyone expect the health insurer in a non-pooled market to pay first dollar on it? If they did, everyone would be getting all sorts of labs and x-rays routinely. Premiums would go way up.
Group is different, risk is pooled in the group and self-offsetting (I made that word up but you get the idea). Statistically, something like 70% of any given group will use less than $100 of benefit per year.
As to costs, the subscriber can shop different labs to get prices for those services. Just because the doctor fills out a lab slip for XYZ lab does not mean the patient has to use that lab. Search in-network labs and call for pricing. I mean, they do it to buy a muffler, why not for something like this?????
As to costs, the subscriber can shop different labs to get prices for those services. Just because the doctor fills out a lab slip for XYZ lab does not mean the patient has to use that lab. Search in-network labs and call for pricing. I mean, they do it to buy a muffler, why not for something like this?????
Extremely awesome point. I'm happy you replied. That makes total sense. I will shop around the 6 counties I do the most business with. I can add it to my value added service bag once the client gets approved for coverage or if they live out of my area I will just let them know they should be diligent in shopping around.
If I find a site, I'll let others know. I'm here to have clients for life and I'm sure everyone on board would like that too
Extremely awesome point. I'm happy you replied. That makes total sense. I will shop around the 6 counties I do the most business with. I can add it to my value added service bag once the client gets approved for coverage or if they live out of my area I will just let them know they should be diligent in shopping around.
If I find a site, I'll let others know. I'm here to have clients for life and I'm sure everyone on board would like that too
Thanks again Dave - Have a great weekend!
Here's something I came across when I was 1st researching HSA's.
I haven't had any direct experience with USBA, but I'd love to know if anybody else has used or recommended their services.
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[COLOR=#000066]"Tell me and I will forget. Show me and I will remember. Involve me and I will understand." Confucius
Plans have a deductible - which by definition is the amount you pay FIRST before your insurance kicks in. Prior on an in network PPO you will get negotiated rates on covered services.
Sure a customer wants an MRI for $30 co pay, they also want a family of 5 for $50/mo - the reality is this is just numbers and in order to make IFP affordable lab and xray is almost always towards the deductible.
Some companies allow same day or doctors lab / xray (little stuff) part of the co pay. By the way Aetna IFP will pay same day , doctor billed lab xray as well. Of course most lab xray is NOT done in docs office as it is not profitable for the doc to do a lab test that a huge lab farm can do for pennies on the dollar.
I guess my take is customers need to realize WHAT A DEDUCTIBLE TRULY IS. These other "perks" are really just that some add ons to make you feel warm and fuzzy or similar to group coverage.
Times are changing with H S A and higher deductibles - benefit rich plans are the #1 reason health costs in America are out of hand - people want the nickel and dime stuff covered which financially is absurd.
I had a customer call about 3 months ago - their COBRA was $1200/mo - their IFP was under $500 - i.e. $700/mo savings and they called to make stinker about a $150 lab bill - ummm you are saving $700/mo how about coming back to earth please?
I did tell him he can get back on his COBRA, pay all back premiums of $3000+ to get the $150 lab bill covered , but what a shock he didn't take up my suggestion!!!
I guess it is 2007, not 1957 and people need to put a few grand in the bank and you would be surprised how many of life's problems start to go away.
If I cut coupons on Sundays, and have an old computer and outdated cell phone so can they...
P.s. I have found virtually ALL BLUE'S beat everyones negotiating power by a large margin in most markets if that interests you - however on the front end the customer could care less this is not sellable in the least bit, and most states Blues pay lower than industry average commissions as most of us are aware.
I haven't had any direct experience with USBA, but I'd love to know if anybody else has used or recommended their services.
I used usba for myself and suggested to my clients and I was extremely please at how easy it was sign up for the test online go to the place and get your lab work done. Its amazing that most of the places are where you go for your major medical insurance plans anyway. Great service.
I know this sounds absurd...but it is true. We have an Anthem BC HSA. On a typical lab test of about $150, after the Network negotiated price is applied, our portion is about $40. Crazy, but true.
It appears USBA has a referral program for agents. Do you have any information on that?
I haven't had a chance to contact the folks over at USBA yet, but I will next week. I'm curious to find out what the codes in the search directory mean as there are no names or address for facilities in their network. It also seems odd that their is not a contact us option on their website.
I know this sounds absurd...but it is true. We have an Anthem BC HSA. On a typical lab test of about $150, after the Network negotiated price is applied, our portion is about $40. Crazy, but true.
Not absurd at all for a BLUE. I am amazed around the country how much better negotiating power they have.
Almost TOO much power sometimes. They virtually shut down a lot of the health providers in this area for a few months a few years ago when they were negotiating a deal.
Excellent thread. I make sure that the customer is aware of and understands that x-ray and lab are usually their responsibility to pay toward deductible/co ins. The two major services that do lab work in CO are Quest Diagnostics and Lab One. They have merged but remain separate entities. A number of private labels now include a Lab One card that will reduce the lab costs down to about 1/3 of what they would be if using Quest Dia or some other lab co.
I have seen people complain that they don't want to go through the extra hassel of having to show the Lab One card and request that the blood work be sent there or that they don't want to go to a facility to have it done. That's fine, I let them know that they are not required to use it - just let the Doc send it out where ever they want and pay the normal price. They look shocked - people need to accept the fact that they are responsible for keeping their health care costs down. If it's too much of a hassel for them to take a financial interest in themselves, that's their problem not mine.
The other issue I have seen is when the client receives an EOB for lab work, it does not necessarily have a network discount applied. I think I read on this forum that 90% of all claims need to be resubmitted for billing issues. I am starting to believe that it is a normal ploy by the carriers to overbill, knowing that very few clients will request that the bill be resubmitted. Most people will just pay whatever the charges are and complain about it to the next person who doesn't know anything about it either. Misery loves company.
Like most of you, I always let them know to contact me and discuss anything they have questions about - I wonder how many people can call Ehealth and receive personal attention when they have questions.
I have confirmed with Aetna - that if a person receives service at an Urgent Care Center, the $50 co pay will cover all services rendered including X-rays. Lab work would be billed separate if sent out. One of the first things I teach clients to do is know where the nearest Urgent Care centers are - never go to an emergency room if you have a choice. The same services received at an emergency room could easily run a couple thousand bucks - applicable toward deductible. Much better to pay $50 and receive the same care. I'm not talking about heart attacks or strokes - just normal run of the mill things like broken bones, dog bites, cuts etc.
Anthem BC/BS is not much of a player here. I am appointed with them but have not placed anyone into any of their plans. I usually take people off of their plans. The Anthem plans are weaker than most others and charge 30 - 50% more. Easy money.
people need to accept the fact that they are responsible for keeping their health care costs down.
Most people are very poor consumers of health care. The copay has made everyone brain dead.
I read something not too long ago about extending copays to clothing. The article speculated that if clothing were converted to copays it wouldn't take long before people forgot just how much a suit or shirt cost.
Give a $10 shirt and a $20 shirt. Throw in a $40 suit while you are at it. Bill my clothing carrier for the balance.
We live in a monthly payment, copay world.
While on the topic of labs, a buddy sent me this a few weeks back. Forgot about it until this thread.
If a patient when he goes to a DR's office requests in his paperwork that any lab work sent out be sent to Direct Labs it will save them a ton. Direct Labs, discount prices
I did it myself.
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"The trouble ain't that there is too many fools, but that the lightning ain't distributed right."
~ Mark Twain
Excellent thread. I make sure that the customer is aware of and understands that x-ray and lab are usually theirresponsibility to pay toward deductible/co ins. The two major services that do lab work in CO are Quest Diagnostics and Lab One. They have merged but remain separate entities. A number of private labels now include a Lab One card that will reduce the lab costs down to about 1/3 of what they would be if using Quest Dia or some other lab co.
I always do this but it doesn't keep the client from acting all surprised when they get their bills. Just had a client call me last week asking how come this wasn't covered? I tell them it was, if it paid down their deductible then it was a covered service.
Ironically, I went into a Walmart the other day (first time in about 4 years, I hate shopping). They had doctors in the store. A doctor visit? $49. Physical Exam? $99.
They could do various tests (I don't read 'medical', outside of some routing things, couldn't tell how complete they got), all at very good rates.
I was thinking to myself, now, I've sold plans with $40 doctor visit copays, but here, you can just walk in, no insurance (or no office visit coverage) and pay $49 and get your cold/sniffle/flu checked and treated.
What a bargain. Chalk one up for Walmart.
My other alternative is to go to the medical clinic down the street. If I didn't have insurance, I'd have to put $300 cash down as a deposit, they send me back whatever they don't use, or a bill if it goes over this. I think walking in the front door is $150.
Hmm, take one away from traditional medicine. Of course, they do the labs right there, xrays, etc. Anything you need, one stop shop for medicine. With doctors visits covered (I'm on my wifes excellent group plan) I can still avoid Walmart, pay my $10, and get whatever I need done.
There are a lot of alternatives out there, depending on your neighborhood. Helping your clients shop is a great idea.
There are a lot of alternatives out there, depending on your neighborhood. Helping your clients shop is a great idea.
Quite a few options, particularly with primary care.
Most consumers are lazy and/or misinformed about health care. They make foolish choices based on a copay mentality.
Odd thing is, many generics & older (less expensive) meds work just as well (sometimes better) than newer (more expensive) meds.
Also, you don't always need a pill. Many conditions such as cholesterol, HTN, diabetes, anxiety/depression can be treated/prevented with proper diet & exercise.
Yes, exercise can prevent/treat anxiety & depression.
Of course it is way easier to take a pill . . . especially when it only costs $30.
Keep your BMI under 27 or so, exercise (even if it is only a daily brisk walk), eat healthy. Lot's we can do to avoid pill dependence.
In addition to WM, many Rx stores have walk in mini-clinics. Most folks can take care of primary needs, including meds if needed, for a lot less than they are paying carriers to provide them a copay plan.
I have found that UHC has the best plan for Labs &Xrays along with MOST HMOS. There are a lot of Docs that write for test to cover themselves in this lawsuit happy world of ours. A sinus infection could indicate something more etc. Most clients need to be told they can have the Doc write the labs shop around for prices then have them drawn according to price. There soo many besides the big ones that offer discount prices
Lab & X-Rays (Best Insurer)
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