Healthcare Cost and Complexity Continue to Grow – Insurance Consultation and Claims Advocacy are Better Together in This Healthcare Climate

As we enter a new open enrollment period, companies and individuals are reviewing their health care plans. The litany of regulatory and economic changes in our health care system has created a daunting challenge of navigating less choice and availability, along with higher costs. Add to this the uncertain future health care landscape under a new Trump Administration and the complexity multiplies. Healthcare advocacy services are becoming even more necessary to help families manage the ongoing insurance, billing and navigation issues they will inevitably encounter.

Contributed by Derek Fitteron, CEO Medical Cost Advocate

November 1 marked the beginning of the open enrollment period for many individual insurance plans. Open enrollment is the time when individually insured families must enroll in, or make changes to, their health insurance coverage. The individual insurance market has been largely subsumed by the Affordable Care Act (ACA) and the State Exchanges in recent years. This year, choice, availability, features and cost have all deteriorated. Many of the largest insurers are withdrawing from the individual marketplace for economic reasons. The resulting plans have narrower networks, higher deductibles, and fewer features; all for a higher price.

The laws of supply and demand do not apply anymore. Wealthy consumers as well as those requiring subsidies must choose from the same underwhelming plans. Nowhere is this more evident than in New York. Aetna has left the market and Health Republic has become insolvent, leaving only Empire Blue Cross Blue Shield, United Healthcare and three much smaller companies offering plans. Perhaps most startling, none of the available plans are PPO plans that offer out-of-network benefits.

Consumers clearly need help selecting the best plans among available alternatives, but now more than ever they need assistance optimizing their plans going forward.

Consumers who wish to obtain the best care will go out-of-network in increasing numbers and will be largely “self-pay.” They will be on their own to manage filing, billing and administrative complexity. Medical Cost Advocate is recognizing these issues. To provide more value for clients, we have started bundling Insurance Consultation with Comprehensive Bill and Claims Advocacy. The benefits are clear. We can help clients select the best plan available and manage the ongoing issues they will inevitably face. We review bills, resolve problems, file claims, negotiate reductions and provide advice on how to better utilize these plans. For a nominal fee above an Insurance Consultation alone, consumers can obtain the same consultation plus 3 hours per month of billing advocacy over the entire year.

Our clients are looking for solutions to manage complexity in the changing healthcare system. Medical Cost Advocate is an even more advisable solution for those who want to focus on their health, not insurance and billing.

For more information on how Medical Cost Advocate can help your family/company realize value from healthcare, please click here or call us at (201) 891-8989.

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