Any Healthcare Consumer Can Benefit
It doesn’t matter whether you are insured or not, whether the procedure is covered or not covered, or whether the provider is in network or out-of-network. You can benefit from Medical Cost Advocate’s services:
- HMO, PPO and POS in-network procedures are typically covered by insurance contracts but are still subject to co-insurance and deductibles. Bills that are applied against these limits are negotiable.
- A large and increasing portion of PPO and POS procedures are out-of-network. Out-of–network means that individuals have chosen a doctor, facility or other medical provider that does not have a discounted rate with their insurance company.
- Out-of-network services are not discounted by insurance company contracts and result in additional costs that are generally billed directly to the insured consumer.
- Medical providers typically give up at least 30% of their revenue when they negotiate to be in a network (The Advisory Board). Many medical providers subsidize in-network charges by raising prices on out-of-network bills. Medical providers typically bill these procedures at rates which are in excess of “usual and customary” charges. There is no regulated limit on these fees.
- Out-of-network procedures are also often subject to deductibles, co-insurance and physician direct bills. When medical providers charge more than “usual and customary” rates these bills can be several thousand dollars.
- Consumer Direct Health Plans (CDHP) which typically include High Deductible Health Plans (HDHP) together with Health Savings Accounts (HSA) or Health Reimbursement Arrangements (HRA), are significantly increasing the amount medical charges being billed directly to consumers.
- Uninsured consumers have much more difficulty as they have no access to a network or a consolidator. Except in cases of charity care, the uninsured are required to pay the entire amount of billed charges.
- Likewise, a great deal of vision, dental, dermatological, plastic surgery, veterinarian and other procedures are not covered by insurance policies. Consumers are forced to pay these non-covered procedures in full based on the provider’s charged amount whether they are insured or not.