Health insurance coverage requires contracts between insurance companies, employers, employees, private individuals, as well as state and federal governments. The Affordable Care Act, which covers 20 million people, limits the wiggle room companies have when crafting these contractual agreements.
The contractual limitations trigger protections for long-term care, coverage for preexisting conditions, dependent coverage until age 26, as well as restricting usage caps and preventative care cost sharing. Another facet of the ACA is an individual mandate. The mandate requires all Americans to have health coverage and is enforced with a tax if an individual does not maintain health care coverage and makes over a certain income. As Congress works to repeal the ACA the Executive Branch, through executive order, is working to dismantle the effect of “any provision… that would impose a fiscal burden on any State, or cost, fee, tax, penalty, or regulatory burden on an individual.” The order also further stipulates that the Administrative Procedure Act will be followed, leading to a long gradual deregulation of the ACA.
Navigating carrier contractual allowances and limitations of medical costs does not have to be sickening, especially after reading Solved! Curing Your Medical Insurance Problems (Outskirts Press) and taking action using the tips given to lower medical bills. According to Andrew Fitch, the Product Manager at Nerd Wallet “This is a must-read for anyone who’s felt lost, angry, or confused after receiving a medical bill.” There are steps that the insured can take before paying a medical bill to lower costs.
The following 6 steps can lower your medical bill before receiving services and paying it:
1. Before services are rendered, be sure that all the medical providers accept your health insurance.
2. If the medical provider does not accept health insurance, see if there is a way you can agree to a reasonable fee for the services before rendered and obtain the agreement in writing.
3. When receiving a bill from a hospital/healthcare facility, a physician or other healthcare provider, from a lab, or bills for medical tests, verify that:
a. All of the services were actually rendered and
b. The medical provider is not charging above the usual, reasonable, and customary fees.
4. Be sure that all of the services are listed clearly and distinctly on the bill with an explanation of the services, including the five-digit CPT (Current Procedural Terminology) codes.
5. If you disagree with any of the charges from the medical providers, ask for an explanation in writing from them.
6. Be sure there are no duplicate charges for the service fees on the medical bills.
As the government regulation of insurance coverage contract clauses and mandated health care changes the need for a medical insurance advocate to act as a liaison between patients and providers is needed now more than ever. A medical health advocate is the bridge between patients and health insurance companies, acting on clients’ behalf to get claims passed, to ensure the highest coverage allowed (depending on the health plan), and to enable patients and their families to rest easy knowing their insurance matters are in an expert’s hands. Adria Goldman Gross, FIPC wrote Solved! Curing Your Medical Insurance Problems (Outskirts Press), to teach patients how to lower medical bills and has used the tips in the book in her own practice to lower medical claims by almost $1,000,000.00 in 1 case in 2016!