In a settlement reached in 2009 that was expected to increase coverage for out-of-network health care has proven to be ineffective as insurance companies are not obligated to use the new method. More frequently, insurance companies determine medical rates based on Medicare rates, which usually reduce reimbursements substantially. “Insurance companies defend the shift toward Medicare-based rates under the settlement, which allowed any clear, objective method of calculating reimbursement. They say that premiums would be even costlier if reimbursements were more generous, and that exorbitant doctors’ fees are largely to blame.”
As the nation continues to try and restore healthcare in an effort to insure everyone, the political philosophy of reimbursement, “is leaving millions of insured families more vulnerable to catastrophic medical bills, even though they are paying higher premiums, co-payments and deductibles.”
The differences in the cost of medical care when using Medicare rates to determine medical and hospital bills are astonishing. For example, Ms. Jaff, a New York resident maintained out-of-network coverage with $14,000 in annual premiums because she has Crohn’s disease. After a bad experience with an in-network physician in 2010, she then sought treatment from a top specialist who performed a colonoscopy and upper endoscopy for her in 2008. “Even with 250 percent of Medicare rates as the benchmark, Ms. Jaff owed four times more than she had paid (in 2008), or $3,137 of a $4,200 doctor’s bill that had increased by 13 percent.”
There are infinite reasons for a medical bill or hospital bill to be simply incorrect or highly inflated. With nearly 80% of all medical bills containing significant errors and highly inflated charges, it is essential to make sure your medical bill is fair and accurate. Contact Relamatrix Medical Bill Review, LLC for more information or for a free consultation regarding your high medical or hospital bill at (800)-653-7526.
Bernstein, Nina. The New York Times. “Insurers Alter Cost Formula, and Patients Pay More. April 24th, 2012.