Discounting Medical Costs For Uninsured and Underinsured
Discounting Medical Costs For Uninsured and Underinsured
Did you know that a simple diagnostic test like an MRI is usually billed from $1,250 - $2,100. The actual value paid by insurance companies is about $640. It is rare that you can negotiate the bills in advance of the service but after your MRI is completed and billed to you, you are able to negotiate your bill with the billing department of the medical facility.
About one year ago, my uninsured son had a 5 hour emergency room visit for food poisoning. He got sick when his bills came. Yes, bills! He got a bill from the hospital for using the ER (facility bills), a bill from the company the contracts with the hospital for the doctor (professional bills) and another bill for his lab work from the hospital.
He was able, with my guidance, to negotiate and reduce the hospital bill for a 60% reduction. The physician bill he paid 50% while the final bill for the labs remains unpaid because they refuse to provide recognized professional billing codes. WHY? Because with the codes a person can discover the real value of the service.
This is what most people experience. Over billing and billing in nonprofessional standards.
Let me know if you have other tales off sorrow in dealing with medical bills. This article is intended to let you know that the uninsured and under insured person has an alternative to paying the full value of hospital and medical bills. Discounts are available for your hospital and medical bills!
According to a Harris Interactive poll, more than sixty percent of people who negotiate their medical bills get a discount. Hospitals and doctors are willing to negotiate because their retail rates bear little relation to the cost of providing care -- typical markups range from 200 to 600 percent.
I'm sure you are aware that health care and it's related costs are a national issue. Regardless of which side of the political fence you are on, you or someone you know has felt the sting of medical bills.
For the 46 million American's who live without medical insurance, they know how it can devastate a families finances. The rest of us who own policies with large deductibles and co-pays, you too know how stressful medical bills can be. Once you see the bill you get sick to you stomach because you cannot envision how you will pay it.
Hospitals, like most health care providers, have a series of prices structures that apply to different types of patients. Uninsured patients pay the highest rate. Discounts go to the HMOs, PPOs and other private insurance vendors.
The personal stories that you have heard or experienced are true. What you are unaware of is that you can get those medical bills discounted with knowledge and negotiating.
For example, you have knee pain. You go to the doctor on your plan and he takes an x-ray, tells you it looks normal, take some anti-inflammatory medication and do not over-use it. You ask about an MRI. He requests a referral through insurance and it is denied. You decide to get one on you own because of the pain you have when walking.
A normal medical bill such as an MRI being billed to you around $2,000 depending on where you live and the profit margins the facility wants to maintain. I live in Southern California the "retail" price of an MRI is never less then $1,860 for one film.
The Federal Government through Medicare has created an official fee schedule for doctors, hospital and procedures called CMS that prices the billing rate at Medicare rate by zip code. Here, it's $668.00, $1,200 less then the bill. So how do I get the bill discounted?
Assuming you have the bill with CPT billing code and you go to access the CMS site, you could figure it out, but it is not easy. I have been adjusting medical claims, reading physician report and reviewing for 18 years and CMS is not an easy tool but it can be conquered.
There are professional bill reviewers, who for a fee will price your bill to professional guidelines and tell you how much the bill should be discounted and what you should pay.
Continuing with my example, although the "official" fee is $668, which is what Medicare would pay. A reasonable payment that an insurance company would pay ranges $742 to $835, much less then the $2,000 billed. Could you really get your bill discounted and reduced to $800? Maybe, but even if you can only get a 50% discount you will have saved $1,000.
It almost sounds too good to be true but this article started with the belief that medical bills were too expensive for uninsured and underinsured people. The bills are to expensive but discounts and reductions are always possible.
What's your next move?
Ask your doctor for the CPT codes on procedures the doctor ordered for you. These are the numeric codes used by the American Medical Association to identify health services. Use the code to look up the Medicare reimbursement rate for the procedure in your area at http://www.cms.hhs.gov/apps/pfslookup/step1.asp. Consider offering to pay the CPT price plus a reasonable amount, such as 10% of the CPT price.
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