We’ve all heard the horror tales of the individual who used an account outside of his or her HMO and ended up with a ten thousand dollar bill after going to the emergency room for a fractured thumb. Arguments on how to improve the United States’ healthcare system have been stoked by such anecdotes. Most individuals have a skewed understanding of how often such things really occur. Because of this, a reliable billing system is essential for accessing the best possible, predefined rates.
Consider two cases where one party must pay a hefty medical charge while the other is shielded. Let’s say two persons, one with good health insurance , the other with none, both present at the emergency department with the identical injuries. The emergency department staff will instantly realize that not all patients will be charged the same amount. A national network with fixed price for almost any medical issue is available to everyone with the appropriate network billing plan. The other will have to pay whatever fees are set by the emergency department. The disparity in payouts might be in the thousands or even millions of dollars, depending on the severity of the illness. The caveat is that you need to be a member of the collaborating billing network in order to obtain this predefined billing.
Examining the inner workings of these billing networks reveals potential weak points, particularly on less-populated networks. Those who are self-employed or who do not have access to group health plans at work may attest to this fact more than anybody else. HMO and other limited network choices are not accessible to Texans shopping for insurance for health on the federally facilitated marketplace (Healthcare.gov). The insurance company or the hospital develop these networks to split the costs of bad claims and to attract more patients. Large gaps in billing systems may exist in even the smallest HMO networks. Even if a person gets surgery that is covered by their HMO, they may be in for a rude awakening when they receive their final bill. Although the patient’s surgeon will most certainly be reimbursed, the patient may be responsible for thousands of dollars in out-of-pocket costs if the anesthesiologist and surgical equipment hired for the procedure are not in the billing HMO network. Not a peep of caution, just a bill that insurance won’t pay long after the operation is completed.
Taking use of much bigger billing networks is the only way to escape the hidden dangers of tiny HMO networks when it comes to cost. Several hundred thousand of physicians and hospitals may be part of these bigger networks or providers. When it comes to billing, many of these countrywide networks require their recommended discount to be the main, or front runner, form of billing, which serves to safeguard the patient’s financial well-being by preventing the possibility of overpricing. Actually, insurance companies model their coverage after the preferred billing, which reduces out-of-pocket costs by hundreds of dollars, proving the accuracy of these predefined price modules. Users of this service may relax knowing that they are covered by a countrywide, unrestricted billing network that has their best interests in mind.
These billing network behemoths are difficult to find in the current ACA health insurance landscape, but they are present in every state, including Texas. In reality, in the last several months alone, I have assisted dozens of customers in taking advantage of these open networks, at considerably more affordable prices than ACA coverage. For individuals without access to a subsidy (a federal income credit offered to people with low financial means), network billing plans are a key consideration when selecting a health insurance plan for their family. A health insurance agent with access to these unconstrained billing networks is your best bet for safeguarding your finances.