background

Financial Blog

How to address surprise medical bills

You have health insurance and think a service you receive will paid partly by your plan coverage. If your insurer paid less than you expected for the medical bill, you are surprised and wonder what to do. This article will explain some of your rights and where to complain.

During the past two years, 30 percent of privately insured Americans received surprise medical bills, according to a recent Consumers Union survey in May 2015. These bills were for more than what the consumer expected to pay.

The key question revolves around in-network verses out-of-network (OON) providers. Most insurance plans have a contract with certain hospitals, doctors and related medical services that are part of their network. To be really confusing, sometimes an out-of-network doctor practices at an in-network hospital.

Possible solutions depend on three common problems. Policy makers are still working on these issues. However, you may be able to identify those that match your situation to decide on the best action(s).

  • Inaccurate provider directories mislead patients into choosing a provider that is not in-network. Solution: Ask insurer to hold you harmless for OON bills based on inaccurate provider directories.
  • Non-disclosure of out-of-network providers. Solution: Providers must make pre-service disclosure of estimated patient costs at least 72 hours before service to allow patients to make other plans or arrange for in-network providers.
  • Excessive charges by specialists and other providers that provide care outside of insurance networks. Solution: Include consumer assistance and regulator contact information at the bottom of Explanation of Benefits (EOBs) to fully insured enrollees. This would enable more consumer awareness of where to inquire about their rights, register complaints and receive help. In Michigan, contact the Department of Insurance and Financial Services (DIFS) hotline at 517-284-8800 or 877-999-6442 (Toll-Free).

Michigan State University Extension provides education about health insurance basics, including the why, what and how for making a smart decision. Find out about Smart Choice: Health Insurance and find factual information online.

This article was published by Michigan State University Extension. For more information, visit http://www.msue.msu.edu. To have a digest of information delivered straight to your email inbox, visit http://bit.ly/MSUENews. To contact an expert in your area, visit http://expert.msue.msu.edu, or call 888-MSUE4MI (888-678-3464).

Related Articles

10/05: Business events

East Orlando, networking opportunities, Coffee Club East, 8:30-9:30 am, first and third Thursdays, Buffalo Wild Wings Waterford Lakes, 504 N. Alafaya Trail, #133, Orlando; Coffee Club Nona, 8:30-9:30 am, second Tuesday of the month, UF Academic and Research Center, 6550 Sanger Road, Orlando; Lake Nona Area Council, 8:30-9:30 am, last Friday of the month, Valencia Community College-Lake Nona, 12350 Narcoossee Road, Orlando; monthly luncheon, 11:30 am-1 pm, third Wednesday of the month, Stoneys Restaurant at Stoneybrook East, 2900 Northampton Ave., Orlando, registration required; Women on Wednesday, 11:30 am-1 pm, fourth Wednesday of the month, Florida Hospital East, Precedo Aamp;B Conference Rooms, 7727 Lake Underhill Road, Orlando, registration required. Details: eocc.org or 407-277-5951.

Education

Senior Education Foundation: Reverse Mortgage Seminar for homeowners 62 plus, 11 am, Fridays, Marks Street Senior Center, 99 E. Marks St., Orlando, free. Details: 407-694-8650.

Florida Small Business Development Center at UCF: Insurance Essentials: Managing Your Risk, 6-8 pm Oct. 6, $20; How To Start Your Business, 6-9 pm Oct. 6, free; Marketing for Business Success 6-9 pm Oct. 8, $30; Marketing in 2015: Making Video Work for You Now, 8:30-10 am Oct. 14, free; Business Success and the High Performance Team, 9 am-3:30 pm Oct. 20, $45/$95; Introduction to Government Contracting, 9-10:30 am Oct. 21, $15; Business Plan Writing Made Easy, 6-9 pm Oct. 22, $30; Subcontracting and Teaming, 9-11 am Oct. 28, $20; Effectively Managing Your Business with QuickBooks, 6-9:30 pm Oct. 28, $30; all classes at Orlando Fashion Square Mall, Suite A-20. Details: sbdcorlando.com or 407-420-4850.

SCORE Orlando-Small Business Mentors: Insurance Basics, 6-8 pm Oct. 6, $20; Starting Your New Business, 6-9 pm Oct. 7, $30; Paychex - Top 10 HR Issues, 9-11:30 am Oct. 8, $10; Leadership Breakfast Series, 8:30-10 am Oct. 9, free, includes light breakfast; Marketing Your Business, 9:30-11:30 am Oct. 10, $30; Building Your Business Plan, 6-9 pm Oct. 14, $30; Obtaining Customer Feedback-Constant Contact, 9:30-11:30 am Oct. 15, $10; You, Your Business Idea, How SCORE Can Help, 6-9 pm Oct. 15, 9:30 am-12:30 pm Oct. 31, free; Fox-Blogging, 10 am-noon Oct. 20, $30; Building Your Financial Plan, 6-9 pm Oct. 21, $30; Effectively Managing QuickBooks, 6-9:30 pm Oct. 28, $30; Funding Your Business, 6-9 pm Oct. 29, $30; all classes at Orlando Fashion Square Mall, 3201 E. Colonial Drive. Details: 407-420-4893.

Florida SBDC at Seminole State College of Florida, Business Startup Basics. Where do I Start?, 9:30 -11 am Oct. 6, Nov. 10, free; Understanding the Basics of Online Marketing, 9:30-11 am Oct. 20, free; all classes at Small Business Incubation Center, 1445 Dolgner Place, Sanford. Details and registration: 407-321-3495 or seminoleSBDC.org.

Small-business seminars: Business Startup 101 which covers the fundamentals of starting a small business in Seminole County, 6-7:30 pm Oct. 19, northwest branch of the Seminole County Public Library, 580 Greenway Blvd., Lake Mary; 10-11:30 am Dec. 8, central branch of the Seminole County Public Library, 215 N. Oxford Road, Casselberry. Business Plans 101 which covers the essentials for creating a blueprint for new business success, 6:7:30 pm Oct. 14, east branch of the Seminole County Public Library, 310 N. Division St., Oviedo; 6-7:30 pm Oct. 26, northwest branch of the Seminole County Public Library, 580 Greenway Blvd., Lake Mary; 10-11:30 am Dec. 15, central branch of the Seminole County Public Library, 215 N. Oxford Road, Casselberry. Presented by the Seminole County Public Library System, in a joint venture with the Florida Small Business Development Center at Seminole State College. Cost: free. Details and registration: 407-321-3495.

Engineering

Association for the Advancement of Cost Engineering International, Orlando-based North Florida section, The Construction and Cost Engineering Benefits of Insulated Concrete Forms: A Green Building Alternative Comparison with speaker Russell P. Ferry, president/CEO, RASTRA Inc. 6:30 pm Oct. 15, PMA Consultants, 4901 Vineland Road, Suite 330, Orlando. Meeting is free, optional dinners $10 with advance reservation by Oct. 14. Details and registration: nflaace.org or e-mail This email address is being protected from spambots. You need JavaScript enabled to view it..

Finance

American Association of Individual Investors, Central Florida Chapter, Ted LePlat, national speaker, Investors Business Daily, will discuss How to Find the Leaders With IBD, 6:30 pm Oct. 21, University Club of Winter Park, 841 N. Park Ave., Winter Park; $5 AAII members, $7 nonmembers in advance, $10 at the door for everyone. Details: aaii.com or call 407-644-1607.

Networking

American Business Womens Association, Four Townes Charter Chapter, 6 pm networking, 6:30 pm dinner meeting, Oct. 15, IHOP restaurant, 320 Dirksen Road, DeBary. Debbie Richards of The Lions Roar Boutique amp; Cafe in Orange City will be the guest speaker. Reservations: Heidi Plummer at 386-532-3055.

Orlando Economic Development Commission, BBQ on the Boulevard, 5-8 pm Nov. 4, outside on Central Boulevard overlooking Lake Eola with more than 700 of the regions top business leaders, elected officials, and representatives from the Orlando Magic, Orlando City Soccer, Orlando Solar Bears teams. 301 E. Pine St., Orlando. EDC Investor $45, Non-Investor $55. Orlandoedc.com or 407-422-7159.



America's most uninsured and underinsured risks: Swiss Re

  • Dave on 9/30/2015 12:20:36 PM

    There are generally three root causes of this kind of underinsurance, the presenters said: Insurability (where risks like cyber liability or terrorism are challenging to insure against), buying behavior (precipitated by faulty risk perception or lack of consumer awareness) and undervaluation (most property is undervalued by an average 26%, according to the Swiss Re report).

    There is a fourth. Widespread belief based on past experience that if something really bad happens, the government will bail me out. Another unintended consequence of the nanny state. Why should I buy insurance which is expensive if the Feds will just bail me out anyway?

  • Andre on 9/30/2015 3:10:50 PM

    Well, Underinsurance is the easiest to over come especially in California where the cost to insure is regulated of course to a degree. (up to 80% minimum. Requirements of 100% exist for homeowners with a Mortgage. As long as the property cost guides/calculators are properly used; as they are designed. what else are there.

    If no insurance exists and there is no one overseeing the property owner regarding the insurance protection he obviously needs, there is nothing that can be done. He/She is being marked for insurance all of the time. That is their choice to select or reject. Its not like they dont know about insurance.

    Overcoming the mindset of the general public is always going to be a slippery slope. Perception is never controllable. However Education is a step in the right direction. Hmm. Mindset, education, perception, personal experience. Sounds like something Ive said before. (No negative connotation intended or implied)

  • Dave on 9/30/2015 3:27:32 PM

    Andre, I entirely agree that education is a key. Where do you propose insurance basics be taught? I guess you could put it online for free and people could access it. But my assessment of people in general is that nobody wants to be bored with such stuff. Perhaps in our schools? Unfortunately I see an agenda there more involved with indoctrination than teaching important stuff. And also teaching useless subjects. I guess a decent education is a key to a whole boatload of our current problems. I dont see many out there trying to fix it though.

  • Andre on 9/30/2015 5:42:30 PM

    Dave. I feel the insurance companies and the Department of Insurance would pool their own respective resources and set this up. Informational content should come from the insurance company. The web site itself should be developed thru the DOI. This would eliminate special interests and bolster the importance of the role the DOI has regarding insurance matters. If it is set up properly, there are 2 categories. Insured and uninsured. The insured category would require insurance company info. Company name policy numbers. That way the insurance agent or company can be notified to call the insured to address and confirm the issues and potential resolutions. This would also eliminate some of the DOI complaints in this area.

    For the Uninsured, The DOI has listings of Insurance companies and agents based on categories of insurance. Based on the data submitted, The appropriate insurance companies and agents can be identified and contacted at the persons discretion. The list Companies and Agents should chosen at random. No discrimination or bias/hidden agendas.

    Now to get the word out. This website portal needs to be attached everywhere so the most used sites has the portal there. The depth the website would also have to be customers discretion. There should be a minimum amount of disclosure and there should not be a maximum. I believe this would be a very good start and the entire cost could be spread out to the all of the insurance companies involved.

    Lets face it. The DOI has its agenda. The industry has its agenda. This could be a win win for all concerned.

  • Dave on 10/1/2015 8:26:10 AM

    Andre, I know my friends and family. I also know that were such a comprehensive website developed, none of them would take the time to check it out no matter how useful it is. In the big scheme of things for those outside the industry insurance is a low priority item. A necessary evil that many would not buy if not forced to.

    I remember as a young adult being forced to watch videos of terrible auto accidents some the result of drunk driving and some showing the carnage of not wearing seat belt. Both meant to discourage drinking while driving and encourage seat belt use. Those were effective. Im not sure that a video showing the carnage of not being insured would be as effective. Unfortunately you have a general public clearly not engaged.

  • TLSK on 10/5/2015 4:17:19 PM

    If you ask homeowners if their home insurance includes Replacement Coverage the majority would say Yes or Im sure it does. In all reality, even if it does, the home is probably underinsured due to a failure of asking the correct questions or physically looking at the property we, as agents, are insuring.

    I am amazed at the number of people who come to my office and tell me they have Replacement Coverage on their property but with one look, I can see that they are underinsured. (Divide the dwelling coverage of your home by the square footage then ask a builder if he can build a home for that cost).

    Clients do not want to purchase Earthquake or Flood if its not mandatory. Most would rather have a new cell phone, new car, nice vacation, etc.

    Cost is also a major factor especially in zones where Earthquake and Floods happen. More and more the Government isnt bailing out those in need so its best to insure properly to avoid a large loss.

  • Paul on 10/5/2015 6:31:10 PM

    I work for a major property and casualty insurer in VA and we dont offer earthquake coverage for homeowners. I could find a stand-alone earthquake policy from an affiliated company, but the prices are ridiculous (even in this state which has a relatively low risk profile). Id like to see the major carriers encouraged by government to offer this coverage as an endorsement.

    Educating the public doesnt really help if coverage is not easily accessable.

  • Paul on 10/5/2015 6:38:51 PM

    I work for a major property and casualty insurer in VA, and we dont offer earthquake coverage for homeowners. I can find a stand-alone policy from one of our affiliated companies, but the pricing is ridiculous. It would be nice if the states "encouraged" (Im sure creative minds could think of some way to create a sense of urgency) the big carriers to offer earthquake coverage as a homeowners endorsement.

    Education doesnt help if the coverage isnt accessible.

  • Andre on 10/6/2015 3:52:53 PM

    Im in California. Earthquake coverage used to be an endorsement to the policy. A Consumer advocate decided to change that thru his own agenda. Thru fear and the general publics lack of understanding, this got on the ballot and the rest is History. (friends like that, who needs enemies. Earthquake coverage is not better of in California. The State of California runs Earthquake coverage. It is not an insurance policy. When it was an insurance product. There was a guarantee that if the insurance company couldnt pay their claims. There was a fund designed to cover the shortages. That Does not exist under the States EQ program.



Ways to afford health care costs: Part 6

Affording health care costs is challenging, even with health insurance. Many Michigan residents are going without medical care, despite having health insurance. Health insurance enrollment season for 2016 is approaching for employer based and private health insurance plans. This article will focus on some positive actions you can do to evaluate your current needs, finding the right plan for you, and affordability.

The Michigan Department of Insurance and Financial Services (DIFS) approved rate increases that average 6.5 percent for health care plans in the Health Insurance Marketplace for 2016. The Health Insurance Marketplace is the federally-facilitated marketplace put into motion by the Affordable Care Act of 2010, which Michigan participates with. Open enrollment starts Nov. 1, 2015 to Jan. 31, 2016. Read details of rate hikes for specific insurer plans.

Out-of-pocket health care costs have risen (6 percent in 2013), faster than wages (1.9 percent), according to the Center for Healthcare Research and Transformation report from the University of Michigan. The report covers health insurance costs in 2013. This is before major provisions of the Affordable Care Act were implemented. However, the report found some interesting data about out-of-pocket expenses.

Employers are now asking employees and individuals to pay more copay and deductible costs. In 2014, 41 percent of employees nationally had deductibles of $1,000 or more, compared to only 10 percent in 2006, according to the 2014 Employer Health Benefits Survey. These trends are only likely to grow based on health care costs projections.

The Underinsured are persons who are insured but living in households that spend a high share of annual income on medical care. The research found these individuals are more likely to skip medical tests and treatments. They also do not fill prescriptions. For chronic conditions like diabetes, that can lead to more serious, and more expensive, health expenses.

Doctor visits, medicine, braces and glasses are some expenses you have to pay for beyond an insurance premium. The good news is there are ways to manage your health care costs to save money. Also look for related articles on reasons to have health insurance (Part 1), estimating total health care out-of-pocket expenses (Part 2), special health savings accounts (Part 3 and Part 4) and correctly filing your federal income tax return (Part 5).

Many people enroll in the Marketplace in silver and bronze plans with the lowest premium. But for patients with regular health care needs, much of their annual health expenses are also determined by the cost-sharing structure of the plan they select. The National Health Council has created a free, online calculator which is easy to use, helps people have a better understanding of their health insurance marketplace options, and find coverage that meets their individual health care and budget needs. The free calculator shows how an individuals total annual health care spending can vary based on plan selection.

Michigan State University Extension provides education about health insurance basics, including the why, what and how for making a smart decision. Find out about Smart Choice: Health Insurance and factual information online.

This article was published by Michigan State University Extension. For more information, visit http://www.msue.msu.edu. To have a digest of information delivered straight to your email inbox, visit http://bit.ly/MSUENews. To contact an expert in your area, visit http://expert.msue.msu.edu, or call 888-MSUE4MI (888-678-3464).

Related Articles

2018  NC Peace Justice   globbers joomla templates