We all heard the stories of the emergency room claim at $ 10,000 for the broken thumb, or the person who had to file a bankruptcy suit with the huge bill while using a network outside of the sick fund. These stories were the fuel for arguments about what to do with our country’s healthcare system. The truth is that these stories happen more than most people realize, and many of them have misconceptions about how this happens. This is why it is so important to have a suitable billing network to take advantage of the best available and pre-determined rates.
Let’s take a look at two scenarios where one person is stuck with a high medical bill and the other is protected. Suppose two people walk in the emergency room with the same injury, one with adequate health insurance and the other who does not have any. The emergency room will immediately know that each patient will be billed in a different way. The person with the appropriate network billing plan will be able to benefit from a national network, allowing pre-defined pricing for most of any medical conditions that you can mention. The other will be at the mercy of the emergency room that decides to ship. Depending on the medical condition, the difference between what is paid may be higher than tens of thousands of dollars. The goal is, in order to receive this pre-defined invoice, you must have access to the participating billing network.
When you take a closer look at how these billing networks work, it becomes clear where you might be exposed, especially to smaller networks. No one knows this better than freelancers and those who do not get insurance offered through work. When an individual buys health insurance on the exchange (Healthcare.gov), the only network options available in Texas are HMO, or restricted networks. These networks are formed for the insurance company and the medical institution to share the losses, while hoping to bring in additional amounts of patients to offset the claims. Even this smaller type of HMO can have big holes in their billing networks. For example, if an individual undergoes surgery within his HMO network, he may still have an unpleasant surprise when the final bill comes. Although the surgeon is likely covered, the anesthetist and surgical instruments rented for the surgery may run out of the bill’s HMO network, causing the patient to pay thousands of dollars. I guessed, not just a word of caution, only an invoice not covered by health insurance after surgery.
The only way to avoid a small HMO pricing trap is to take advantage of much larger billing networks, letting you avoid undetected bumps. These large networks, or service providers, can get hundreds of thousands of doctors and participating medical institutions from coast to coast. Many of these networks nationwide make it imperative that their preferred deduction be the primary or primary means of invoicing, and protecting the patient’s financial interests from any threat of excessive pricing. In fact, these pre-defined pricing units are very accurate, as some insurance companies cover their coverage to reflect preferred bills, thus reducing pocket spending expenses in thousands of dollars. Those who use this service can easily realize that their interests will be protected from moving forward from the correct billing network with unrestricted networks nationwide.
Although the giants of this billing network are out of reach in the current ACA health insurance environment, they are found throughout the country, including Texas. In fact, dozens and dozens of customers have been benefiting from these unrestricted networks over the past few months alone, in much more reasonable premiums than ACA policies. It is important to consider network billing plans when choosing a health insurance plan appropriate for your family, especially for those who do not qualify for a benefit (the federal income credit granted to those with limited financial resources). It is extremely important to speak to a health insurance professional who can access these unrestricted billing networks, in order to protect your financial interests.