Financial Wellness Blog » Health costs http://www.guidespark.com/blog Discussion of Financial Wellness and benefits education topics Sat, 04 Feb 2012 19:58:57 +0000 en hourly 1 http://wordpress.org/?v=3.3.1 Poor Benefits Communication Damages Both Employee and Employer Health and Financial Wellness http://www.guidespark.com/blog/poor-benefits-communication-damages-employee-employer-wellness/ http://www.guidespark.com/blog/poor-benefits-communication-damages-employee-employer-wellness/#comments Tue, 11 Oct 2011 00:20:01 +0000 Barbara Navarro http://www.guidespark.com/blog/?p=516 As busy as it can be, open enrollment is a good time to reflect on the effectiveness of your company’s benefits communication. While everyone seems to agree that benefits communication on the whole needs improvement, many organizations are in denial about how critical that improvement is to their own organization.

Findings from the 2011 Aflac WorkForces Report highlighted the discrepancy between how companies and their workers view benefits communications:

  • 85% of employers believe their HR departments are effective at benefits communication
  • 27% of employees say their HR communications are not very/not at all effective
  • 39% say the efforts are somewhat effective

And yet everyone agrees there is much needed improvement:

  • 8% of employees say they are fully engaged in making benefits decisions
  • 63% of companies say their workers need to be more engaged

What’s at stake? Not surprisingly, workers who are unprepared and under-protected against an accident or illness are highly vulnerable to the financial implications of an unexpected health event.

As more and more organizations realize, the health and financial wellness of an employee has a direct effect on the company’s productivity and retention levels.

]]> http://www.guidespark.com/blog/poor-benefits-communication-damages-employee-employer-wellness/feed/ 0 BEWARE: Usual, Customary and Reasonable Charges http://www.guidespark.com/blog/beware-usual-customary-and-reasonable-charges/ http://www.guidespark.com/blog/beware-usual-customary-and-reasonable-charges/#comments Wed, 19 Aug 2009 21:23:22 +0000 Joe Larocque http://www.thriveon.com/blog/?p=109 I visited my childhood pediatrician until age 28.  Why?  Well, I trusted his judgment and there was just a huge amount of peace of mind that came with dealing with a physician who had first-hand experience with just about every entry in my medical history.  Dr. Blair was never once in the network of doctors offered by my medical plans and therefore I had to pay 20% more for care.  Fortunately for me, it was only 20%.

What you may not know is that each year Americans incur significant unexpected charges when they pursue out-of-network care.  The issue is that your insurer will pay only a percentage of what they deem to be “usual, customary and reasonable” for the services provided.  So, while the insurer will provide 70% coverage of the medical test you had done as promised, it may only be 70% of the “usual, customary and reasonable” or UCR amount of $300 vs. 70% of the $500 your physician has charged for the test.  And yes, that’s right, you are stuck with the difference.  You can imagine how, in the case of major procedures, you may be responsible for thousands of dollars in unexpected medical bills for utilizing that highly recommended surgeon who happens to be out-of-network.

So, if you’re utilizing out-of-network care, experts recommend you take the following steps for ensuring that you aren’t surprised by UCR charges and optimize your plan benefits:

  1. Talk to your doctor and get the charges and procedure codes for your insurer
  2. Provide the codes to the insurer and understand how much they will pay
  3. Negotiate with your doctor, particularly if his/her cost for the procedure is more than the UCR amount.  It is often effective to agree to pay your portion of the services up-front so that they can avoid lengthy waiting periods from your insurance company.
  4. Utilize flexible spending accounts.  Many times the types of procedures or tests that involve large out-of-pocket expenses can be foreseen and planned for.  If this is true in your case, be sure to take advantage of FSA programs that allow you to pay your portion with pre-tax dollars.
  5. If you’re a member of a high deductible health care plan, be sure to tap into your employer provided health savings account or health reimbursement arrangement to pay down the amount that may be due.

This is a great plan in theory but unfortunately you may be challenged to complete steps 1 and 2. While codes and costs are critical to understand up front, they are very hard to get.  The reason is, insurers consider their negotiated rates to be proprietary.  They negotiate with each doctor and facility individually to minimize their costs and therefore it is to their advantage to maintain confidentiality.  However, that does not mean that you should not ask for this information and continue to ask for it until you get it.

The good news is that there is pending legislation for more transparency when it comes to costs.  Earlier this year, UnitedHealth agreed to pay hundreds of millions of dollars to settle class-action lawsuits brought by the American Medical Association and other groups on behalf of patients and doctors who claimed to be shortchanged for services provided out of network.  Some health care insurers such as Aetna and CIGNA have taken the lead on transparency, publishing the negotiated rates of tens of thousands of physicians in their network.  And with high deductible health care plans becoming more popular, the need for transparency is becoming ever more critical.

For years, patients have avoided asking about the cost of services, physicians don’t volunteer it and members find out what their ultimately responsible for after the fact.  Don’t be surprised by health care costs, be proactive.

I visited my childhood pediatrician until age 28.  Why?  Well, I trusted his judgment and there was just a huge amount of peace of mind that came with dealing with a physician who had first-hand experience with just about every entry in my medical history.  Dr. Blair was never once in the network of doctors offered by my medical plans and therefore I had to pay 20% more for care.  Fortunately for me, it was only 20%.

What you may not know is that each year Americans incur significant unexpected charges when they pursue out-of-network care.  The issue is that your insurer will pay only a percentage of what they deem to be “usual, customary and reasonable” for the services provided.  So, while the insurer will provide 70% coverage of the medical test you had done as promised, it may only be 70% of the “usual, customary and reasonable” or UCR amount of $300 vs. 70% of the $500 your physician has charged for the test.  And yes, that’s right, you are stuck with the difference.  You can imagine how, in the case of major procedures, you may be responsible for thousands of dollars in unexpected medical bills for utilizing that highly recommended surgeon who happens to be out-of-network.

So, if you’re utilizing out-of-network care, experts recommend you take the following steps for ensuring that you aren’t surprised by UCR charges and optimize your plan benefits:

1. Talk to your doctor and get the charges and procedure codes for your insurer

2. Provide the codes to the insurer and understand how much they will pay

3. Negotiate with your doctor, particularly if his/her cost for the procedure is more than the UCR amount.  It is often effective to agree to pay your portion of the services up-front so that they can avoid lengthy waiting periods from your insurance company.

4. Utilize flexible spending accounts.  Many times the types of procedures or tests that involve large out-of-pocket expenses can be foreseen and planned for.  If this is true in your case, be sure to take advantage of FSA programs that allow you to pay your portion with pre-tax dollars.

5. If you’re a member of a high deductible health care plan, be sure to tap into your employer provided health savings account or health reimbursement arrangement to pay down the amount that may be due.

This is a great plan in theory but unfortunately you may be challenged to complete steps 1 and 2. While codes and costs are critical to understand up front, they are very hard to get.  The reason is, insurers consider their negotiated rates to be proprietary.  They negotiate with each doctor and facility individually to minimize their costs and therefore it is to their advantage to maintain confidentiality.  However, that does not mean that you should not ask for this information and continue to ask for it until you get it.

The good news is that there is pending legislation for more transparency when it comes to costs.  Earlier this year, UnitedHealth agreed to pay hundreds of millions of dollars to settle class-action lawsuits brought by the American Medical Association and other groups on behalf of patients and doctors who claimed to be shortchanged for services provided out of network.  Some health care insurers such as Aetna and CIGNA have taken the lead on transparency, publishing the negotiated rates of tens of thousands of physicians in their network.  And with high deductible health care plans becoming more popular, the need for transparency is becoming ever more critical.

For years, patients have avoided asking about the cost of services, physicians don’t volunteer it and members find out what their ultimately responsible for after the fact.  Don’t be surprised by health care costs, be proactive.

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