At Zayo, ADPTotalsource (our PEO) manages our employee benefits. We chose United Healthcare as our provider because we have employees all over the country and United has an extensive national network (560,000 physicians. 4,800 hospitals. 60,000 pharmacies).
I recently heard a horror story about a sneaky practice called Balance Billing, where after the insurance company pays the pre-negotiated rate, the doctor then bills the patient for the difference between the negotiated rate and retail price. Retail price is what you pay when you go to an “out- of-network” provider. If you go to an “in- network” provider, United Healthcare has negotiated a discounted rate for services (the discount can be in the 50% range)
This practice of Balance Billing is illegal, as Business Week reports:
Most consumers don’t realize it, but this common practice, known as balance billing, often is illegal. When doctors or hospitals think an insurer has reimbursed too little, state and federal laws generally bar the medical providers from pressuring patients to pay the difference. Instead, doctors and hospitals should be wrangling directly with insurers. Economists and patient advocates estimate that consumers pay $1 billion or more a year for which they’re not responsible.
How unfortunate! When caught between a collection agent and dealing with the insurance company, most consumers are confused and aggravated and just end up paying.
The HR Capitalist wrote:
Who gets blamed? A combination of the insurance provider and the HR team, for obtaining a provider who couldn’t give them cost certainty. Especially troublesome is the fact that doctor’s will often go after balance billing of less than $1,000 since they know the pay rate for these will be higher. After all, if you’re threatened with a $500 bill hurting your credit rating and don’t have the time or knowledge to research it, many of us are apt to dig deep, pay the bill and move on.
Over the past two years, I’ve witnessed a number of unfortunate situations where our employees are left spending more than they thought they would have to on health care. The best advice I can give you is to be a good consumer. Healthcare is a big ticket item and should be treated like any other big ticket item.
I try to follow Zayo’s Payroll Manager, Bonnie Peterson’s advice. Before going in for a procedure, Bonnie asks the doctor exactly who will be providing what service and what medication. She documents, then calls United Health Care to make sure that the service is covered. In her experience, there are choices that your doctor can make, some are much more expensive than others. You should be involved in the decision, if you are paying the bill.
You wouldn’t buy a car or a TV without doing a little research. Why wouldn’t you do the same for health care?
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