Insurance

Reassessment of health insurance claims in 2022

We’ve all heard the stories of the emergency room claim costing $11،000 for a broken finger, or the person who had to go bankrupt from the huge bill while using a network outside of their HMO.

These stories have been fuel for arguments about what should be done with the nation’s health care system. The truth is، these stories happen more often than most people realize, and many have misconceptions about how this happens. That’s why it’s essential to have the right billing network in place to take advantage of the most favorable and preset pricing available.

Let’s take a look at some scenarios where one person is stuck with a high medical bill and the other is protected. Suppose two people enter an emergency room for the same injury، one has adequate health insurance and the other has none.

The emergency room will know immediately that each patient will be billed differently. The person with the right network billing plan will be able to take advantage of a nationwide network، allowing for pre-set pricing for most any medical condition you can name.

The other will be at the mercy of what the emergency room decides to charge. Depending on the medical condition, the difference in what is paid can be over tens of thousands of dollars. The catch is that to receive this default billing 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 can be exposed، especially on the smaller networks. No one knows this better than the self employed and those who do not receive insurance provided through work. When an individual purchases health insurance on the exchange “Healthcare.gov”، the only network options available in Texas are HMOs، or limited networks.

These networks are designed so that the insurance company and the medical establishment share the losses, hoping to bring in excess patient volume to offset the losses. Even these smaller types of HMO networks can have large holes in their billing networks.

For example، if an individual has surgery within their HMO network، they may still be in for an unpleasant surprise when the final bill arrives. Although their surgeon is likely covered, both the anesthesiologist and the surgical equipment rented for the surgery may fall outside the HMO’s billing network, causing the patient to pay thousands of dollars. You guessed it, no word of warning, just a bill that health insurance won’t cover well after surgery.

The only way to avoid a small HMO network pricing trap is to take advantage of much larger billing networks, allowing you to avoid the pitfalls uncovered. These networks، or larger providers, may have hundreds of thousands of participating doctors and medical facilities from coast to coast. Many of these nationwide networks mandate that their preferred discount be the primary or first billing method, protecting the patient’s financial interests from any threat of overcharging.

In fact، these preset pricing modules are so accurate, some insurance companies tailor their coverage to reflect preferred billing, thus limiting out-of-pocket costs by thousands of dollars. Those using this service can rest easy knowing that their interests will be protected moving forward by the right billing network with unlimited nationwide networks.

Although these billing network giants are elusive in today’s ACA health insurance environment, they exist across the country, including Texas. In fact، I’ve helped dozens upon dozens of customers take advantage of these unlimited networks over the past few months alone، at prices far more reasonable than ACA policies.

It’s important to consider network billing plans when choosing the right health insurance plan for your family، especially for those who don’t qualify for a subsidy “the federal income credit is given to those with limited financial means”. It is extremely important to speak with a health insurance professional who has access to these unlimited billing networks in order to protect your financial interests.

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