Monday, February 26, 2007

Personal Health Insurance Claims Adjusters

Online claims adjusters, like the web-based My Medical Control, will soon be commonplace on the American Health Care landscape where individuals will need to control more of their out-of-pocket expenses.
(NYT) Mr. Fontana, a 42-year-old salesman, has a high-deductible health plan coupled to a health savings account. Since he was nowhere near meeting his deductible, he was on the hook for the entire bill.

So he did something that insurance companies routinely do: he forwarded the bill to a claims adjuster, in this case My Medical Control, a Web-based company that reviews doctor and hospital bills for consumers.

After concluding that Mr. Fontana was not getting the best possible price, the company’s representatives called the imaging facility and demanded a lower one, promptly saving him $200 — minus a 35 percent collection fee.
I think this will get filed under "Why didn't I think of that?"

But even more interesting is the company, that estimates nation-wide prices negotiated for by insurers and compares them to list price. Here's the information for a pacemaker and a defibrillator implant. (Where they got 5 days as an average length of stay for these procedures is anybody's guess: our length of stay is under 1 day, but I digress). These guys, too, will negotiate a lower fee on behalf of patients, not to mention permit ratings of hospitals and doctors along the way.

Transparency of sorts is here, it seems. The real question is, will people switch facilities for a lower price? I suspect if they're paying a bigger piece of the pie, they will. But "quality" of care rendered by a cheaper facility is still difficult to gauge, even for those of us in the business. Where the dust will settle with this price/quality war is anyone's guess.

No matter how we slice it, it seems the terrain for health care delivery has forever changed.


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