The Way To Deal With Obamacare

by Gerri Willis

Tune in to The Willis Report tonight 6pm & 9pmET for your personal guide to coping with Obamacare. The new health care law has everyone on the run, it seems. Even the president this week apologized for the website problems, but he didn’t agree to delay the law. And, for that reason, you are going to have to deal with the law’s impacts, some of them harsh. Here is your personal guide to coping with Obamacare:

 First off, millions of people are desperate to know whether they are eligible for health care coverage under Obamacare and what they might pay. They want to know whether they could get a subsidy to help them pay for coverage and how much that might be. Unfortunately, the government website, healthcare.gov, is often down, inaccessible. Lucky for you, there’s an option. The Kaiser Family Foundation has a subsidy calculator tool on its website, www.kff.org, that gives you real details. You enter your zip code, age, income and sex and you get detailed information about the price of coverage and how much you might get in subsidies to help you cover the costs. For example, a 62-year-old woman in western North Carolina earning $32,000 and living on her own would be charged Obamacare premiums of $7,284 a year but receive a subsidy in the form of a tax credit of $4,443 a year, leaving her to pay $2,841 a year in premiums. Out of pocket costs, such as deductibles and copays however, could total as much as $6,350 over the course of the year. Ironically, the Government used the KFF information is setting up the website, and though you can’t necessarily get on healthcare.gov, you can access kff.org. Better yet, you don’t have to give up personal information that can be tracked to you.

This week, we’ve heard a lot about the people losing coverage. By the latest count, some 4.3 million people are having their policies cancelled because they don’t meet Obamacare standards.

Those folks are in the individual market where they buy on their own because they don’t have employer coverage or Medicare. However, I also reported this week that insurance plans in the small business market will likely get cancelled late next fall. Small business owners were able to extend existing coverage because of a loophole in the law but that loophole only prolongs the inevitable for a year. Which leads me to my next suggestion; don’t wait to get medical procedures or tests. My doctor sources tell me that people across the country are getting in front of changes demanded by the law by proactively taking care of potential problems.

I know a lot of people, particularly those of you on Medicare, are worried that the millions of Americans that will be added into the healthcare system under Obamacare, could negatively affect your care. Many people talk to me about their worries that their doctors will stop taking Medicare patients and get out of the business or offer their services only to cash-paying high-end clients. You need to talk to your doctor directly about his or her plans, so that if your doctor is planning to change his practice you’ll know in advance and can find a new doctor.

And, finally, what’s clear about the way that health care is changing in this country is this: Getting affordable care that you have confidence in will become more and more difficult. The burden of responsibility for your health care is shifting to your shoulders. It’s more and more up to you. And, frankly, hearing that you have to eat better and exercise regularly isn’t all that satisfying anymore. One healthcare shortcut that I took recently was a test of my DNA on the website www.23andme.com. I got information, that frankly, my primary care physician has never discovered, namely that I have a good chance of having Celiac disease, an allergy to wheat, and that I am sensitive to specific blood thinners. After getting this information, I cut out the wheat, went gluten free and feel so much better. I’ve added the information about blood thinners to my medical records so that if any doctor ever prescribes one for me, he or she will know to reduce the dosage. To be sure, not all health care problems are caused by your genes. If you eat fast food every night and never exercise, you’ll probably have some health problems, no doubt. But, by using 23andme.com.  I was lucky to find information that can help me be healthier without going to the doctor’s office. The cost for the service is $99 and I’d say you should probably talk to your doctor before you sign up, but for me it was a Godsend.

 

Your Obamacare Questions Answered

by Gerri Willis

The new health care law is starting to have a huge impact on people's lives, and it continues to be one of the most important topics we've covered on The Willis Report. In our series "User's Guide to Obamacare", a panel of experts answered your e-mails, tweets, Facebook questions and concerns regarding the Affordable Care Act. Here are some of your most important questions answered: 

Q: I’d still like to know what the IRS can do if I refuse to buy insurance and refuse to pay the fine.

A: Similar to the IRS pursuing people for back taxes, it could eventually start putting people in prison for not paying the fine for being uninsured. This year, the penalty for being uninsured is 1 percent of the individual’s income and by 2016, it will be 2.5 percent of the individual’s income.

Q: If this coverage must accept pre-existing conditions, what will prevent anyone, 25 to 100 years of age, to not purchase the insurance until they need it?

A: The penalty is very low and that’s the incentive to not purchase the insurance. The only real catch is, if you don’t have insurance, you have wait until the next enrollment period and that is going to be the incentive to get in, but that may not be a strong enough incentive.

Q: Can you explain how the deductibles, copays, coinsurance work and can you explain what extra taxes we pay due to Obamacare and will it affect my HSA account?

A: If you are below the poverty level, you get your insurance for free. If you’re above 400% of the poverty level, in terms of income, you’re going to pay a lot more because you aren’t eligible for free insurance.

Q: What will happen to those that don’t sign for Obamacare? They pay a fine, then what? Do they just go the emergency room for treatment?

A: There is a difference between providing emergency care and covering emergency care. Doctors are obligated to take care of those who are uninsured and will continue to do so, but these individuals will not be covered by insurance for their care. Taxpayers will continue to pick up the tab, as in the past.

Q: How can anyone sign up for it when no one understands it?

A: You’re not alone! In a recent Pew survey, 53 percent of the public disapproves of the law and only 25% say they have a very good understanding of how law will impact them. If you want to sign up, you can visit http://www.healthcare.gov

Q: If you sign up for Obamacare, can you ever get out of it for a different plan?

A: If you provide all of your information and sign up for Obamacare and then cancel, you could be charged the penalty for not being insured.

Q: What sort of Obamacare privacy controls are in place?

Every day, personal information is the subject of hundreds of thousands of hacking attempts from all over the world. However, HHS will have to store user information in their servers as Americans sign up at healthcare.gov. Information technology is driving the future of health care and it must be part of any reforms moving forward. But the hub puts millions of Americans at risk by creating an open invitation to steal treasure troves of personal data.

Q: Will the elderly on Medicare and living in nursing homes still be covered through Medicare?

A: People on Medicare will essentially not be affected by Obamacare, but those on Medicare advantage could potentially expect to pay more. Their premiums could increase. Medicare patients should be concerned about the restriction of physician networks and the cost of prescription drugs could increase under Obamacare.

Q: What if I sign up on the exchange and miss one or more payments? Am I kicked out and do I have to pay the penalty?

A: There is a 90-day grace period during which you can miss payments and not be penalized. After 90 days, you will have to pay the penalty because you will no longer be insured.

Q: What will happen to concierge medicine/doctors?

A: Concierge medicine and paying cash for medical services might expand because those on the exchange with limited coverage will seek care elsewhere because of limited choices and quality of care.

Q: What happens to me if I cannot afford Obamacare come January 1st?

A: Your adjusted gross income, tax-free interest, foreign earnings, and social security benefits all count towards your income. You may sign up for a plan but may be unable to afford the out-of-pocket expenses or the deductible. If you have low income, you may get a subsidy, but the subsidies decrease steeply if you’re above 400% of the poverty level.

 

 

Obamacare: A Good Deal for Young People?

by Gerri Willis

Tune in all this week for our User's Guide to Obamacare special coverage starting 6pmET. The success of Obamacare and the health exchanges that opened this week hinges on one thing: Whether or not the 57 million young people under the age of 65 participate. That's because higher costs assessed to younger consumers for coverage were imposed as a way of footing the bill for older and sick Americans.  It's an open question whether this demographic will choose to buy coverage on the exchanges. With 51 percent of Americans saying they don’t have enough information about the law to understand how it will impact them and their family, we decided to fill in the gap and give the facts and figures on what younger consumers need to know about the Obamacare exchanges:

          -- There is no need to rush.  Sure, the starting gun for Obamacare fired Tuesday with the opening of the exchanges, but individuals have at least three months and as much as six months to get coverage. The government doesn't requires individuals to be able to prove they have coverage until Jan. 1, 2014, but the fact is that people are allowed a "short coverage gap" of up to three months which means you can wait even longer. What's more, experts say the exchanges may not be ready for primetime. Major software glitches made it impossible in the days before the exchanges opened to reliably determine prices or subsidies, and staff was working around the clock to fix the problems. For that reason, the best strategy, if you want to see what Obamacare exchanges have in store for you, is to wait, until November or even December when, presumably, the problems will be worked out.

          -- Don't bank on lower costs. Last week, the Obama administration said the average monthly premium enrollees in the exchanges will be charged is just $328. But that doesn't tell the whole story. Premiums may be lower, but your out-of-pocket costs will be higher according to analysis of the plans by health care consultant Avalere.  That company estimates that deductibles (the amount you pay out of pocket each year before your coverage kicks in) will be $2,550 up to a high of $5,000.  That average deductible is double the level of the average employer-sponsored deductible of $1,135. What's more, you may pay more for drugs, as much as 40 percent. Some experts say they expect people in their 20s and 30s to see their insurance rates rise as much as 30 percent under the Obamacare exchanges.

          -- Compare apples to apples. You've no doubt heard about the thousands of "navigators" hired to advise people on choosing coverage on the exchanges.  Truth is, some states have advised navigators to stay away from directly advising people about their choices. Some of the navigators have said they hadn’t even seen the exchange offerings as late as Sunday. You could hire a broker to help, but chances are they are they may direct you to insurers paying their fees. So, it’s really on you to find the best deal. The key to doing it successfully is comparing all of the costs. Don't just focus on monthly premiums, but also consider deductible and drug costs. If you are employed and have been on a so-called “high-deductible plan” offered by 70 percent of employers, compare the details. The average deductible in an employer-sponsored plan is $3,000, higher than the average for Obamacare at $2,550, but some of the government policies will have deductibles as high as $5,000.

          -- Avoid the scammers. Like all government programs promising free money, the health exchanges are drawing lots of scammers. Fake websites are bilking seniors offering to allow them access to Obamacare. Understand that access to the legitimate exchanges is free (coverage isn’t, obviously). To find your state's legitimate website, go to www.healthcare.gov. You can find out whether you are eligible for subsidies to pay for your government-sponsored coverage, go to the Kaiser Foundation's website, www.kff.org, which has a subsidy calculator. Experts say that single, young people earning less than $46,000 will be eligible for subsidies, but you may be underwhelmed by the amount you get. According to a study from the National Center for Public Policy Research, subsidies for younger consumers start phasing out at 300 percent of the federal policy level. In 11 of the 15 exchanges, taxpayer subsidies disappeared by people aged 18 to 34 before annual incomes of $34,470.

 

Understanding Obamacare

by Gerri Willis

Tune in all this week for our User's Guide to Obamacare special coverage starting 6pmET. What can you expect when the Obamacare insurance exchanges open this week? No doubt, a lot of confusion. Understand that the entire system is a work-in-progress that may or may not be ready for primetime when the starting gates open Tuesday.

Here's what you need to know:

            -- Exchanges will be different state to state. If you have an elderly relative living in a different part of the country, you'll have to get your arms around the offerings in their state, and it could be far different from the one where you live. Different insurers are participating in each market. While Washington's Health and Human Services Department says the average number of plans per state is 53, averages mislead. The number of plans available ranges from just six to 169. What's more, don't expect to see the big brand name insurers you've come to know in these new marketplaces. They are more likely to be dominated by smaller, lesser known rivals.

            --Costs will vary, too. While the White House says the average premium consumers will pay is $328 a month or $3936 a year, that is unlikely what you’ll pay. Variation in prices is big and depends on where you live, how old you are and whether you receive subsidies from the government. In Albuquerque, NM, for example, a 27-year-old non-smoking man would pay $126 a month for a bronze plan, but in Little Rock, Ark., the cost for the same type policy would be $190 a month. If you are already in the individual market, you may be better off staying put. According to Tom Miller of the American Enterprise Institute, average annual premiums in the individual market at $2,580 a year, are currently far less expensive than the $3,936 average cited by the administration on the exchanges.

            --The law requires some similarities. Exchange health plans are required to offer what the government calls "essential health benefits." That includes an extensive list of services from emergency room services to care for pregnant women, new mothers and infants. Outpatient and rehab services, counseling, and therapy are also on the list, as are preventative care and prescription drugs. Insurers will package these offerings at five different prices, depending on how much you’re willing to pay in premiums. The most expensive will be called platinum coverage which will pay 90 percent of costs and carry the highest monthly premium. Gold coverage will pay 80 percent of your costs and will cost more than silver coverage which pays 70 percent of costs. Bronze has the lowest monthly premiums but only pays 60 percent of costs. You'll also see policies for a bare-bones "catastrophic" coverage. These policies are designed for young people and those who can't afford the policies I just described. Coverage will be cheaper and include three annual primary care visits and preventative services, but deductibles will be high. To qualify, you have to be under 30 years of age or get a "hardship exemption."

           --Watch out for glitches and errors. Up to the last minute, exchange operators were struggling with software which sometimes failed to price the insurance correctly. Some exchanges were pricing policies incorrectly, others were calculating subsidies wrong. In other words, it is likely to be tough going in the initial weeks and possibly months as the government attempts a near impossible technological feat of linking the major bureaucracies of Medicare, Medicaid and CHIPS with state exchanges.

 If you want to find the exchange in your state, check out www.healthcare.gov.

User’s Guide to Obamacare

by Gerri Willis

Tune in all this week for our User's Guide to Obamacare special coverage starting 6pmET. The new Obamacare health insurance exchanges open Tuesday, Oct. 1. This is the first time that individuals will be able to sign up for health insurance offered under the controversial Affordable Care Act. Opening of the exchanges marks the starting gun for the law's implementation, which is the biggest overhaul of the nation's health care system since Medicare in 1966. The devil will definitely be in the details -- and there are a lot of them -- and none has been more controversial than the individual mandate.

Tonight on The Willis Report on the Fox Business Network we'll be talking about the mandate and what it means to you. The government is requiring individuals to have health care coverage. And the requirement extends to you and everyone in your household, including spouses and dependents. The coverage can be issued by your employer, through federal programs like Medicare, Medicaid, CHIPS and the Veterans Administration, or it can be purchased through private networks. Failing those options, individuals are required to buy coverage through the Obamacare exchanges opening Oct. 1. Individuals must be able to prove coverage beginning Jan. 1, 2014.

The law’s authors are hopeful that premiums from young people who comprise the largest numbers of the uncovered will help pay for older Americans who don't have coverage. Despite all that attention to the mandate, 26 percent of Americans aren't aware of the requirement or didn't think the law included it, according to a March 2013 Kaiser Family Foundation poll.

There are penalties for failing to comply. If you do not have the minimum level of coverage and do not qualify for an exemption, you must pay a penalty to the IRS at the end of the tax year. The penalty for the first year is up to $95 per adult and $47.50 per child, or 1 percent of family income, whichever is greater. The fine, however, increases over time and in 2016 will be as much as $695 per adult and $347 per child (up to $2,085 for a family) or 2.5 percent of family income, whichever is greater.

We said everybody must prove coverage, but there are some exceptions to that rule. If you can't afford coverage because premiums cost more than 8 percent of your household income, you don't have to have coverage. Also, if you don't make enough money to file a tax return, you are also exempt. If you live in one of the many states which opted not to expand Medicaid under Obamacare, you also don't have to participate. Other exemptions exist, but they are fairly narrow, usually for people already receiving health benefits from the government, such as Native Americans.

Your first chance to prove coverage will be with the filing of your 2014 tax return on April 15, 2015. Job-based plans, including COBRA, or coverage from a retirement plan will likely satisfy the mandate. Coverage from Medicare, Medicare Advantage, Medicaid, CHIPs, some VA programs or TRICARE coverage for our military members and their dependents will satisfy the requirement. Likewise, you can buy coverage from a government exchange or a private exchange. Take care with the latter, though, because Obamacare has fairly high requirements for coverage that a private plan may not meet.  

What Your Genes Are Telling You

by Gerri Willis

Angelina Jolie’s announcement earlier this summer that she had a double mastectomy to prevent the possibility of contracting breast cancer came as a shock to many of her fans. The actress made the decision after learning that she, like other women in her family, had a genetic mutation her BRCA genes. Jolie, in her announcement, put her risk of getting breast cancer because of the defective gene and her personal history at 87 percent. The National Cancer Institute says that patients with BRCA mutations are five times more likely to be diagnosed with breast cancer and up to 28 times more likely to be diagnosed with ovarian cancer. Jolie’s mother died of ovarian cancer while her aunt recently died from breast cancer.

Jolie wrote these words about her decision to have a preventative double mastectomy, “My mother fought cancer for almost a decade and died at 56. She held out long enough to meet the first of her grandchildren and to hold them in her arms. But my other children will never have the chance to know her and experience how loving and gracious she was.”

Her decision prompted others to start asking questions: Should I have the test for the mutated gene? What other genetic tests are worth taking? You may be asking yourself the same questions. To be sure, early testing can lead to early cures. Here’s what the experts say about early genetic testing and screenings:

  • Age matters. Up until about 40, health tests generally aren’t recommended as a rule of thumb. As long as you’re healthy and don’t have any family history of certain diseases at early ages, you can get by with few tests. But once men and women reach 40, that’s when regular screenings are essential. One example is having colorectal cancer screenings at age 50. Colorectal cancer is third leading cause of death for both men and women in US. There’s a five-year survival rate when diagnosed at an early, localized stage. That rate of survival is 90 percent, but only about 40 percent of colorectral cancer is diagnosed at these early stages.  Your primary care physician can help you decide the right tests for you.
  • Know your family history. Another advocate of early testing is Pierce Brosnan, whose daughter and wife both died of ovarian cancer. In fact, his daughter’s passing marked the fourth generation of women in a row to succumb ovarian cancer. In this case, forwarned is forearmed. Keep track of parents’, grandparents’, and extended families’ medical histories and compare to your own. If you have warning signs at early ages, don’t wait until the recommended age to get tested. Early detection for diseases like Alzheimer’s leads to more treatment options. Taking cholinesterase medications for people in early stages of Alzheimer’s can delay worsening of symptoms for 6 to 12 months, on average, for about half the people who take them.
  • Map your personal genome. There are many projects in the works, like the Personal Genome Project, to allow all people the opportunity to sequence their DNA. While reading your genetic code can give you a clue as to what diseases you might be prone to, some mutations don’t mean you’re definitely going to get that disease. But DNA information is helpful to determine whether you should take preventive measures, like Jolie, especially if you have a strong family history. Not all these tests are readily available right now, or at affordable costs, but some companies like 23andMe do offer cheap DNA testing. For just $99 you can genotype your DNA, which means looking for markers of genetic mutations.

Most doctors and medical professionals will tell you that it’s better to get tested and have awareness earlier. But Don Powell with the American Institute for Preventive Medicine cautions patients not to become fatalistic if you do test positive for a disease. Even though you might have a predilection for a certain type of cancer or mental illness, it’s not an excuse to not take preventive measures and live a healthier life. Early detection is what saves lives, but Powell suggests only taking these often expensive tests only if there’s a family history. Being a rational, knowledgeable medical consumer can help you save money and your life.

How To Lower Your Medical Bill

How To Negotiate Your Medical Bill

by Gerri Willis

When Dr. Jeff Rice, a Nashville radiologist, was looking for a hospital for his son’s foot surgery, he was surprised to find a huge disparity in prices. The first institution he contacted said the price would be $15,000. Surprised, he started to shop around and contacted other surgeons he knew to be good at other facilities. And, just three blocks away at another hospital, he was quoted a price of just $1,500 – a tenth of the price.

Don’t be surprised – such disconnects are common. And, according to Rice, he has no regrets choosing the cheaper institution and doctor. His son’s recovery went as scheduled and it all worked out just as he planned. He says the differences in prices aren’t necessarily connected to quality of care and are instead the result of the prices that different insurers are able to negotiate with providers. Other factors can come into play, he says, such as whether the hospital you choose is a teaching hospital or takes on a lot of uninsured patients, but one of the biggest components is your insurers’ ability to drive down costs. It’s that experience that caused Rice to start www.healthcarebluebook.com, where people can find out for free the average cost of procedures, tests and surgeries all over the country. By simply filling in your zip code, you can access Rice’s impressive data base that can guide you in knowing whether you’re getting a fair price.

Getting that fair price, though, will require you to negotiate. And, that can be easier said than done. Here are tips to negotiating medical prices:

  • Get the facts. In the New York city area, prices for a colonoscopy can range from $2,000 to $25,000. And, the differences in those tests? Not a thing. Go to www. healthcarebluebook.com or www.newchoicehealth.com to compare prices on everything from drugs to surgeries. In this case, knowledge is power.
  • Negotiate prices before receiving treatment. Once you put your fees on paper, it’s all that much harder to negotiate prices because a bill is considered a legal document in the health care industry.  Dr. Pamela Gallin, a 30-year veteran of the business and a pediatric opthamologist at Columbia Presbyterian Hospital in New York City says when you negotiate is as important as how you negotiate. Offering speedy payment – say before the billing even occurs – can net you 50 percent in savings, she says. And, it’s all that more difficult to get employees working in the hospital’s billing center to lower prices that have already been entered into the system.  That goes doubly true for uninsured patients. One community hospital board member says that government billing practices encourage hospitals to boost the cost of services to patients with no insurance by as much as half. By simply calling and asking for a price reduction, the uninsured can net big savings, he said.
  • Document your doctor visit. Trips to the hospital are often stressful and time consuming. It’s likely that you’re not paying attention to all the medical lingo about what procedures you’re going to get. But that’s where many people can save money: By paying attention! While you’re at your doctor’s office, take notes or have a family member take notes about which doctors came to visit and when, what tests were ordered and what supplies were used.
  • Ask for an itemized statement when you leave. Billing errors are commonplace – either because staff fills in incorrect coding or charges are duplicated. Dr. Gallin, says that the complicated coding used by insurers is one of the things that can create billing errors because it’s challenging even for doctors and their staff to understand. And that makes it all the more important to review your itemized statement so that you can be sure you were charged for the items you documented in your doctor visit.
  • Review your bill. Here’s where the pedal hits the metal. Compare your notes from your visit with the itemized statement and the final bill that has been through the insurers’ offices. By now you may have already caught differences between the itemized statement and your own notes from the doctor’s visit. But now, you should look for any disconnect between the doctor’s office and that of the insurer’s. If you still feel there are miscellaneous charges or the bill is simply too expensive, contact the hospital’s billing department for an explanation as well as your insurer to see what you are covered for.
  • Contact a medical billing advocate. If all else fails, call in the experts. Negotiating medical bills is tricky business. Many consumers turn to professional advocates like www.medicalcostadvocate.com or www.billadvocates.com to get unaffordable bills lowered. Experts say medical billing advocates are familiar with hospital and insurer systems. They have a relationship with people inside the health care establishment and can usually get in touch with the right people, which can be difficult for us mere mortals. But there services are not free. Most billing advocates charge 35 percent of the reduced price if their negotiating is successful, or they may charge an hourly fee. If they are unable to get your bill lowered, they should charge you nothing at all. Ask about that upfront.

How to Read Your Medical Bill

How To Read Your Medical Bill

by Gerri Willis

There was a time not that long ago that a patient might never see a medical bill, much less have to read it. But few of us can afford to be blissfully ignorant anymore, as rising costs force insurers and employers to push higher deductibles and co-pays onto consumers.

What’s worse, once you get your bill, you may well decide it’s written in a language you don’t understand. Bills are chockablock full of complex coding and shorthand that insiders hope you never really understand. That strategy is working so far. Fully 77 percent of Americans say they don’t understand either the medical bills they receive or their health insurance. But it pays to be persistent. According to Medical Billing Advocates of America, 80 percent of medical bills contain some error. And, the most common ones are duplicate billing, typos in which the wrong coding or price is entered, charges for work that was cancelled and inflated operating room fees.

Of course, these errors could be in your favor or against you, but either way, you’ll want to know if your bill is simply wrong. Here’s how to read and understand your medical bill:

  • First off, understand that your charges can come from a variety of different sources, such as your doctor for the exam, the lab for testing and say, maybe radiology for services. The list can go on and on. Different sources means the possibilities for mistakes and errors escalates.
  • The second thing you’ll notice on an itemized bill from your doctor or hospital are five-figure codes. These are called CPT codes (for Current Procedural  Terminology). These codes are assigned to each and every service a primary care physician, specialist or technician provides a patient, including medical, surgical and diagnostic services. You can understand what these codes mean by going to the American Medical Association’s CodeManager on their website here (https://ocm.ama-assn.org/OCM/CPTRelativeValueSearch.do . You’ll have to fill out some details about yourself and promise not to use the information for anything but your personal information. But going to this extra trouble will allow you to see precisely what you are being billed for. Remember that some health care workers spend their entire careers mastering the CPT codes. So if you’re having trouble understanding them, ask your doctor’s office for details.
  • Suffice it to say that the story of what you pay doesn’t end with the doctor’s bill. You’ll also receive an EOB or  Explanation of Benefits, from your insurer or Medicare. It will show how much of each service was paid for on your behalf. Like the doctor's bill, each service coded. You’ll want to verify that the CPT codes on your doctor’s statement match the codes on the insurer’s statement to be sure that you’re being charged for the services you are receiving. If they don’t match, contact your doctor and the insurance company.
  • Let’s talk about the bottom line. So, at the bottom of your final bill, you’ll see a line item called the “charge.” Consider this the sticker price and not the final price. The discounted price or “adjustment” will follow, which will factor in anything you’ve already paid from your co-pay to deductible or insurance.  The “balance” (sometimes called the Patient Responsibility”) is your final bill with whatever late fees or credits may have been paid.

 

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