Pay Close Attention!!! You're Probably Being Overbilled For All Things Medical!!

Billing!!  Yes, billing is what's bothering me today.  I had an episode with poison ivy that landed me in the emergency room on Memorial Day.  I went in, saw a doctor for approximately 5 minutes - he looked at me, pulled out a prescription pad & wrote a scrip for prednisone.  I walked out & that was it.

When I received the hospital facility bill, the billed amount was $2,115.75!  They made a 'contractual adjustment' of $1,344.14.  The insurance company paid $498.09, and my portion was $274.52.

Then the separate bill for the physician arrived.  That bill was $440.00.  Insurance paid $352.00 and my portion is supposed to be the remaining $88.00.

When I called the hospital to ask if I could have an itemized breakdown of how 5 minutes translated into $2,115.75 I was put on hold for a long time.  I told them I had a right to understand exactly how anything could cost that much.  Was it $1000 for the doctor to stare at me?  Maybe $1100 to pull out a pad to write the prescription on?  What exactly is the breakdown?

I was then told that they probably overbilled me!  (ya think?)  Turns out that these bills are coded according to a "level" scheme that is used as a guideline from the American College of Emergency Physicians.  My hospital bill was coded as a level 4, while the doctor bill was coded as a level 3.

When I asked what a level 4 encompassed, they said they couldn't share that with me.  Why, exactly, I don't know - but apparently everything is a big secret.  We're all just supposed to pay & shut up.

I asked her what level it would be if I had presented in the emergency room with a heart attack & she said level 5.  So, I asked how poison ivy could possibly be only one level below a life threatening condition like a heart attack & she said, again - that I was probably over billed.

I looked up the levels myself (www.ACEP.org), and it turns out that my bills most likely should have been coded as a level 2, which encompasses things like "rashes, sunburn, etc.".  Also, probably for a much more reduced charge.

I then called the insurance company so that they can flag the account, since I'm now having both bills audited.  Insurance technically should have examined it & potentially denied the claim, but the answer I got from them is that since they didn't know exactly what took place in the emergency room, they often simply pay the bill. And yes, it's true - how would they know exactly what services were provided?  They have to trust the provider to some degree, since they are administering the medical care & should be allowed to proceed as needed in an emergency situation.

So, ever wonder why everything is so expensive?  The providers are robbing the insurance companies blind, and then that cost is being passed along to YOU the consumer of health care - both in the form of higher premiums and in the form of higher portions of co-insurance.  Shameful!! 

Take this as a warning - Pay very close attention to any billing you receive - you may not owe as much as you think you do.

Health Insurance Exchange Subsidies Will Be Granted on the Honor System!––Is There Something Wrong With "ObamaCare's" Federal Data Hub?

Author of the "Health Care Policy and Marketplace Review" blog, Bob Laszewski has reported a whopper of a story on his blog about a little known change to the requirements for determining whether or not an individual applying for health insurance through the exchanges will qualify for a subsidy.  Information on income for individuals was supposed to come from the Federal Data Hub, but now that information can effectively be "ignored" if it conflicts with what the applicant is telling the navigator at the exchange!  In other words, if I think I need/qualify for a subsidy, they'll just 'take my word for it'. . . .

I think everyone really needs to know & understand that the average, honest tax payer will end up paying for the "free money" that is sure to be given out once some people understand how to manipulate the system.  No subsidy money should be given unless incomes & eligibility can be accurately verified.

Read Bob's Post on his "Health Care Policy and Marketplace Review" blog . . .

Income -- Not Assets -- Will Determine Subsidies In Online Insurance Marketplaces

As the enrollment for health insurance plans that will begin in January 2014 rapidly approaches, information about subsidies to purchase the insurance that will be offered in the new insurance exchanges that the federal & state governments are setting up, is being clarified.

Kaiser foundation published a helpful blog entry today regarding that subject.  You can read more about it here:  Questions Regarding Subsidy Eligibility

The links within the article are "live", so further information is available there.

Keep in mind that the health insurance plans referenced are for individuals and families- not businesses or people who have Medicare coverage.

There will be plans offered outside of the exchanges or "marketplaces" provided by the government, but if you need to obtain a subsidy to pay for your insurance, you have to buy the insurance through the government run marketplace.