One of the major things we like to focus on in our blog is burgeoning changes in the quality/cost/usability/availability of healthcare. A recent Wall Street Journal article tells us about one such change, which many have already experienced. It seems that innovative insurance companies have streamlined the reimbursement process making it possible for doctor offices to immediately seek approval for coverage via the computer. What used to take weeks and multiple pieces of snail-mail can now be resolved instantly, allowing the doctor to print out a more comprehensive bill to provide the patient; one which must be settled prior to leaving the office. The article quotes a NaviNet questionaire that claims over half of their survey’s 650 respondents accept some form of pay beyond co-pays at the time of service.
Though we whole-heartedly appreciate the fact that patients can now have their bills resolved immediately without having to pore over much-delayed ‘explanations of reimbursement,’ the article points out that there is a potential hiccup in the new way of doing business.
Michael Gurion, an Atlanta attorney, says he didn’t object when an optometrist collected around $70 from him during a visit a few years ago for an exam and contact lenses. But months later, when he looked at his insurer’s explanation of benefits, he discovered he’d only owed about $25. He called the optometrist’s office and was told the difference was being kept by the practice as a credit toward future visits.
“I said, ‘Really? When were you going to tell me about this?’ ” says Mr. Gurion, 34, who says he wasn’t a regular patient and hadn’t planned to go to that optometrist again. In the end, Mr. Gurion says the office sent him a refund.
There appears to be a major cost and efficiency benefit to the way these offices are now settling payment, and at the very least, practice fees will become more transparent. On the other hand, you may now be paying significantly more upfront for your healthcare, and will be expected to agree to a bill on-the-spot. So, before your next office visit, make sure that you know the details of your insurance plan. Spend a moment reviewing whatever bills you are presented and make sure that you check any supplemmental material you receive later in the mail.
