August 5, 2015

Faced with Outrageous Out-of-Pocket Healthcare Costs?

With the recent passing of “Obamacare” all individuals in the United States must have a form of health insurance, or risk high penalties. For families that elect to avoid health insurance, an annual fee of the greater of 2% of your yearly household income or $325 per person ($162.50 per child under 18) for the year will be applied. However, some families still choose to pay the penalty and avoid paying monthly premiums, leaving them stuck with high bills when a health incident occurs.

More commonly, many individuals do not have the luxury of employer-provided insurance, and are faced with paying hundreds and even thousands of dollars in monthly premiums, only to be charged with absurdly high out-of-pocket deductibles and other expenses once an incident occurs. Regardless of whether you carry insurance or not, working with a medical billing negotiator severally can cut down your out-of-pocket costs. Here’s why:


Cost savings have to go somewhere.

I recently took a look at one of my explanation of benefits reports and was astonished to see just how much of a discount my insurance company negotiates. I had a baby last year and was billed $4,505 for the delivery. Of that bill, $3,013.42 was labeled as a plan discount, $892.42 was paid for by my insurance company and my portion, which was applied to my deductible, was $599.16. Taking a step back, it’s pretty clear to see that of the $4,505 bill, only $1,491.58 went to the doctors. The additional $3,013.42 was what I like to call “funny money” that the hospital bills but rarely receives.

So does that mean that an uninsured patient would have been charged the full $4,505 and paid the “funny money balance of $3,013.42, not knowing the wiser? To be honest, we will never know because I did not ask for a cash discount bill and didn’t know what they really would have charged me. But the point is that money is going somewhere, and healthcare providers should not be the ones receiving it. It’s clear that these services are significantly marked up, and it’s up to trained medical billing negotiator to decipher which portion of your bill is negotiable and which portion you have to pay.


Let the time value of money work for you.

The concept of time value of money is a valuable negotiation tool when dealing with medical billing disputes. All healthcare providers want to get paid, but the smart ones realize that everyday people often cannot afford a large sum payment all at once. Let a skilled medical billing negotiator work for you to secure a structured payment plan to lower your monthly payments. By extending a high out-of-pocket cost over an extended period of time, you take the savings of the time value of money from the healthcare provider and stick it in your pocket. As medical debt always is interest-free, this is a smart way to structure your debt.


Avoid errors

Many people don’t realize that healthcare provider billing departments are run by everyday people who make mistakes just like you or me. Sometimes you can catch them, but more times than not, the mistakes slip through the cracks. For example, when I had my daughter last winter, I was initially scheduled for a caesarian section. Days before my scheduled C-section, my breach baby flipped around, I was able to have a traditional delivery. However, the paperwork had already been submitted to my insurance company, and the bill was sent out as a C-section. Fortunately, I was paying attention to my bill and caught the error. I contacted the medical provider, requested a new copy of the bill and a refund for the overpayment. Several months later, I received a refund for the overpayment. Had I not been paying attention, I would have missed this mistake.

However, what about the instances when you get billed for services you may not know you received? It’s pretty easy to know if you had a traditional delivery or a C-section, but most everyday people do no have training in the intricacies of double bypass surgery, knee replacement surgery, or other complicated procedures. A medical billing negotiator is trained to understand what you should and shouldn’t be billed for, and spot the areas where you may have been over billed.  Dispute finds errors in over 90% of the bills they review.

At the end of the day, you can’t save money if you don’t try. By allowing a trained medical billing negotiator dispute your medical bills, you can save time, money and effort getting what is rightfully yours.

Katie Shaykin
About the Author
Katie Shaykin

Katie Shaykin is a freelance writer with nearly a decade of experience writing for the healthcare industry. Shaykin earned her ungraduated degree in Integrated Marketing Communications from Illinois State University and spent six years in Corporate America, writing for two industry-leading healthcare and healthcare technology companies.