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Tuesday, October 1, 2013
How to Optimize Your Health Insurance Plan
Q: Its open enrollment season for health insurance. What should I compare policies on to make sure I get the best one for the price?
A: Generally, you want to look at price, coverage, and ease of use. Clearly, affordability should weigh heavily in your decision, but don't let that be the sole criteria. "Costs are much more than premiums," says Leslie Fried, director of the National Center for Benefits Outreach and Enrollment and director of policy and programs for the National Council on Aging.
If you have a preferred doctor, make sure he or she accepts the plan you're considering, says Frederic Riccardi, director of Client Services at the Medicare Rights Center. Also, look at the prescription drug costs in the plan and whether the drugs you take are actually covered, the deductible you have to pay before benefits kick in, and the overall amount you can be expected to shell out in any given year.
If youre in good health and single, you can save money by picking a low-cost, high-deductible plan that will cover you mainly for major procedures. However, if you go to the doctor a lot or have kids, dont make the mistake of picking a cheap policy only to later discover that it only covers major injuries or catastrophic illnesses. In the new Insurance Marketplace, established as part of the Affordable Care Act, the Platinum Plan offers the highest premium with the highest coverage. The Bronze Plan offers the lowest premium but also the least amount of coverage, with the individual paying 40% of medical services, says Fried.
On the coverage front, find out what services and procedures are included—as well as which treatments are excluded. Then, figure out how you would fare in a typical year, based on your expected use of benefits, the premiums, co-pays, and prescription drugs you may need. For instance, if you take specific medications, you might choose a plan with higher premiums if the drug costs were low enough to offset it.
Finally, check how easy it is for you to access benefits: How do you submit claims? Is phone or online assistance readily available? And whats the process for seeing specialists or consulting doctors of your choice? Weigh all three of these areas—cost, coverage, and ease of use—on what your likely medical needs will be for the upcoming year, then go with the plan that has the best fit.
And open enrollment happens every year, it's important to review your coverage every year. "If your health status changes, you're going to want to revisit your choices," says Fried.
5 Proven Ways to Reduce Your Medical Bills
Few people realize that in the murky world of medical billing, there is often room for negotiation. If youre paying providers from your own pocket—because you have no insurance, have maxed out your insurance, or are seeking treatment out-of-network—its worth asking for a discount on services. Hospitals and doctors will sometimes consider accepting less than the full list price—after all, they routinely give substantial discounts when the payer is Medicare, Medicaid, or an insurance company. Even with an overdue bill, the provider may be persuaded to be flexible. Here are some bargaining strategies you can try.
1. Pay today. Go to the billing office and offer to pay with cash or by credit card on the spot. “I would try for a 20% discount,” says Larry Gelb, CEO of CareCounsel LLC, a health-care advocacy firm. “Often they will be obliging because they have a big incentive to get it settled rather than to go through a long, drawn-out collection. If you tie it to a little bit of a hardship story, you will increase your chances.”
2. Disclose your family income. You may be uncomfortable volunteering information about how much money you make, but if youre facing, for example, a $10,000 bill from a specialist, it might help to explain that your family of four lives on an income of $50,000. “Compared to the person with a net family income of $250,000, the health-care provider will look at those two people very differently,” says Marty Rosen, a former Aetna U.S. Healthcare executive and a cofounder of Health Advocate, a provider of health-care advocacy services to businesses and individuals. This is not a good strategy, Rosen notes, for families in an upper-income bracket.
3. Pile on the compliments. “A lot of doctors really respond to schmoozing,” says Laura Valentine, director of client services at CareCounsel. When she approaches billers on behalf of a patient, she appeals to doctors egos with a bit of flattery. She suggests saying something like, “I really wanted to have my cancer treatment here because my friends and colleagues all say youre the best and the brightest. But I have limitations on my pocketbook. Is there any type of discount or anything that you can do?”
4. Use Medicare rates to your advantage. Finding out what Medicare pays doctors and hospitals to perform a specific medical procedure will take a bit of research, but it is a gambit professional patient advocates frequently use. To do it, read carefully, because these steps are complicated: First ask your doctors office for the procedures CPT code, which stands for “Current Procedural Terminology” and is a code set developed and maintained by the American Medical Association (AMA) to ensure uniformity in describing medical, surgical, and diagnostic services. Next, go to the AMA websites CPT search engine to look up the Medicare payment for that procedure in your geographical area. (For example, the CPT code for one type of breast reconstruction surgery is 19361. Searching for the state of New York and the city of Manhattan, with the five-digit CPT code 19361, turns up a Medicare payment of $1808.76 for the procedure.) You can use that information in negotiating your non-Medicare rate, which you should do before the procedure. “Whatever you can do up-front is the best,” advises Valentine.
Not only will you have more bargaining leverage pre-procedure, but then, should anything change during or after the procedure, the hospital will also have a record that they cooperated with you before and will more likely be willing to cooperate again. For both hospital and doctors bills, a reasonable offer would be 25% above the Medicare rate, suggests Nora Johnson, the vice president and director of education and compliance for Medical Billing Advocates of America. If you are thinking about negotiating a hospital bill, however, consider hiring a professional advocate, since hospital bills are considerably more complex, Johnson adds.
5. Use your emotional state to your advantage. You may be feeling a lot of stress, but calling an administrator from the hospital an idiot is not going to get you very far. Instead, say something like, “I am just so frustrated right now. My spouse is ill, and Ive been trying to deal with my health plan, but I really want to make sure you get paid too.” Chances are, “because of human nature, they will try to help you, unless you get someone who is very hard,” says Valentine.
1. Pay today. Go to the billing office and offer to pay with cash or by credit card on the spot. “I would try for a 20% discount,” says Larry Gelb, CEO of CareCounsel LLC, a health-care advocacy firm. “Often they will be obliging because they have a big incentive to get it settled rather than to go through a long, drawn-out collection. If you tie it to a little bit of a hardship story, you will increase your chances.”
2. Disclose your family income. You may be uncomfortable volunteering information about how much money you make, but if youre facing, for example, a $10,000 bill from a specialist, it might help to explain that your family of four lives on an income of $50,000. “Compared to the person with a net family income of $250,000, the health-care provider will look at those two people very differently,” says Marty Rosen, a former Aetna U.S. Healthcare executive and a cofounder of Health Advocate, a provider of health-care advocacy services to businesses and individuals. This is not a good strategy, Rosen notes, for families in an upper-income bracket.
3. Pile on the compliments. “A lot of doctors really respond to schmoozing,” says Laura Valentine, director of client services at CareCounsel. When she approaches billers on behalf of a patient, she appeals to doctors egos with a bit of flattery. She suggests saying something like, “I really wanted to have my cancer treatment here because my friends and colleagues all say youre the best and the brightest. But I have limitations on my pocketbook. Is there any type of discount or anything that you can do?”
4. Use Medicare rates to your advantage. Finding out what Medicare pays doctors and hospitals to perform a specific medical procedure will take a bit of research, but it is a gambit professional patient advocates frequently use. To do it, read carefully, because these steps are complicated: First ask your doctors office for the procedures CPT code, which stands for “Current Procedural Terminology” and is a code set developed and maintained by the American Medical Association (AMA) to ensure uniformity in describing medical, surgical, and diagnostic services. Next, go to the AMA websites CPT search engine to look up the Medicare payment for that procedure in your geographical area. (For example, the CPT code for one type of breast reconstruction surgery is 19361. Searching for the state of New York and the city of Manhattan, with the five-digit CPT code 19361, turns up a Medicare payment of $1808.76 for the procedure.) You can use that information in negotiating your non-Medicare rate, which you should do before the procedure. “Whatever you can do up-front is the best,” advises Valentine.
Not only will you have more bargaining leverage pre-procedure, but then, should anything change during or after the procedure, the hospital will also have a record that they cooperated with you before and will more likely be willing to cooperate again. For both hospital and doctors bills, a reasonable offer would be 25% above the Medicare rate, suggests Nora Johnson, the vice president and director of education and compliance for Medical Billing Advocates of America. If you are thinking about negotiating a hospital bill, however, consider hiring a professional advocate, since hospital bills are considerably more complex, Johnson adds.
5. Use your emotional state to your advantage. You may be feeling a lot of stress, but calling an administrator from the hospital an idiot is not going to get you very far. Instead, say something like, “I am just so frustrated right now. My spouse is ill, and Ive been trying to deal with my health plan, but I really want to make sure you get paid too.” Chances are, “because of human nature, they will try to help you, unless you get someone who is very hard,” says Valentine.
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