Employers’ Medical Costs to Rise in 2011

July 7, 2010 J Roberts

Looks like medical costs are expected to trend well above inflation for 2011. In addition, consumer out-of-pocket costs have increased as employers continue to shift the cost onto employees.

Medical costs are expected to increase by 9 percent in 2011, according to a report from PricewaterhouseCoopers LLP. Although the increase is down 0.05 percent from the 2010 growth rate, it still is expected to outpace the rate of inflation. For the first time, the majority of the American workforce is expected to have a health insurance deductible of at least $400 as more employers return to indemnity-style cost sharing by raising out-of-pocket limits, replacing co-payments with co-insurance and adding high-deductible health plans.

Hospital and physician costs, which make up 81 percent of premium costs, are the biggest inflators of the 2011 medical cost trend. Hospitals shifting costs from Medicare to private payers and employers is seen as the top reason for higher medical cost trends. In 2011, Medicare will reduce payment rates to hospitals for the first time after seven years of increases that almost matched or exceeded inflation increases. Some hospitals that benefitted from higher payments in 2008 and 2009 may be able to manage this type of cut by tapping their reserves, but many hospitals are likely to shift more costs to commercial payers during their negotiations, according to the report.

In addition, increasing consolidation among physician practices is expected to increase their bargaining power. Payers expect to see more negotiating power and higher prices in the short term, but efficiencies created by consolidation will moderate future rate hikes.

The report findings are based on a survey of more than 700 employers from 30 industries and interviews with health plan actuaries.

Doctors tack on ‘a la carte’ fees for patients

June 14, 2010June 14, 2010 J Roberts

It appears that physicians are now charging ‘a la carte’ fees for services not traditionally covered by insurance or Medicare. The extra fees mean greater out-of-pocket costs for consumers. Read on to learn more.

By Alison Young • USA TODAY •

A growing number of doctors across the country are boosting revenue by asking patients to pay new fees for services they say insurance doesn’t cover, insurance and physicians’ groups say.

The extra payments include no-show fees of $30-$50 for missed appointments, widely varying charges for filling out health forms for school, work or athletic teams, and annual administrative fees of $35-$120 or more to simply be a patient in some practices, medical associations and doctors say.

“It’s not unlike the airlines,” said William Jessee, president of the Medical Group Management Association, which generally advises against extra fees that may anger patients or run afoul of insurance contracts. “They’ve gone from all-inclusive to a la carte. That’s what you’re seeing with physicians.”

Doctors who charge extra fees are in the minority, he said. Some have done it for years, but more are joining them because they say they need the fees to offset the rising costs of practicing medicine.

Allen Greenlee, an internist in Washington, sent a letter in March to 7,000 patients in his group practice asking for a voluntary $35 annual administrative fee for costs insurance didn’t cover. He said he got only two angry letters and dozens paid extra to help others. “I’m trying to stay solvent,” he said.

WellPoint, the nation’s largest insurer by membership, is receiving more inquiries from doctors seeking to charge annual administrative fees.

“We have seen some increase in that type of activity,” said John Syer, a vice president over provider contracting at WellPoint, which operates 14 Blue Cross and Blue Shield plans. “The vast majority do not engage in that,” Syer said, noting such fees may violate provider agreements if doctors charge for items insurers consider included in their payments.

Though no national data are available on how many practices charge extra fees, Jessee said primary care doctors face increased financial pressures as insurance reimbursement hasn’t kept pace with costs. The result has been a growing shortage of primary care physicians as medical students choose more lucrative specialty fields. Primary care is critical to the nation’s new health law, which will give 32 million uninsured Americans coverage.

Office visits are the main source of insurance payments to primary care doctors, yet physicians spend much of each day on activities they’re not directly compensated for, such as phone calls and prescription refills, a study in The New England Journal of Medicine in April found.

“A lot of doctors are trying all kinds of experimental things just to survive,” said Gary Seto, a doctor in South Pasadena, Calif., who charges an annual $120-per-family “non-covered benefits fee.”

Sue Braga of the Arizona chapter of the American Academy of Pediatrics said she’s hearing of more practices charging for no-shows and health forms.

Susan Wheeler, 33, said her kids’ pediatrician near Atlanta recently started a $10-per-child form fee. “I don’t like it,” she said. “It’s part of their job.”

Negotiate Your Medical Costs: Interview with Derek Fitteron, CEO of Medical Cost Advocate

January 25, 2010January 25, 2010 J Roberts

Medical Cost Advocate is in the news! Reporter Miranda Marquit from All Business News recently spoke with CEO Derek Fitteron about negotiating medical costs. Read on to learn about Medical Cost Advocate and what they are doing to help consumers who have large medical expenses. It’s great to know that there is a company working as an advocate on behalf of consumers to reduce healthcare costs.

Miranda Marquit

I recently saw an increase in my health insurance premium, and I will see it again quite soon, thanks to age-based premium increases. As a result, I am seriously thinking of a Health Savings Account and a high deductible plan. The ridiculousness of rising medical costs is really starting to be annoying — and increasingly moving toward unaffordable. Many people already experience the fact that health care in this country is unaffordable for them. So it was interesting to learn a little bit about a company that works to negotiate medical costs.

I recently spoke with Derek Fitteron, the CEO of Medical Cost Advocate, and he gave me some insight into what his company does to help consumers reduce their health care costs.

“Expectations were that health insurance premiums would go up six to eight percent,” Fitteron told me. “Instead, they are going up 10 to 12 percent. That means that employers are passing more costs on to employees, and consumers find that they have to pay more out of pocket. What we do is work to negotiate out of pocket expenses so that consumers pay less.”

The way it works, he explained, is that consumers can submit their out of pocket expenses, spent to meet a deductible or due to out of network treatment, and Medical Cost Advocate will attempt to negotiate a lower payment. Fitteron said that the company only charges if the fee is successfully renegotiated. “We take a percentage of what we accomplish. If the bill isn’t reduced, we get nothing.”

“We also help the uninsured,” Fitteron continued. “About 15 percent of the people we serve are not insured, and we can help them get a better rate, since they don’t have the advantage of a group rate through insurance.”

Fitteron also told me about a program that can help manage a family’s health care costs. “For 200 dollars a month, it is possible for us to track bills, review insurance and negotiate your costs. And this is for the whole family.”

Services offered by Medical Cost Advocate can be paid for using money from Flexible Spending Accounts or Health Savings Accounts. I haven’t used these services, but they seem intriguing. If I decided to go with a Health Savings Account, and have to pay out of pocket for more of my health care, it might be worth it to see if cost negotiation can save me a little more. I’m not sure that I would need the monthly service, but it might be worth it to check into the negotiation service offered.

A Guide Through a Medical Wilderness

August 10, 2009October 16, 2009 Doug

As the government churns through health care reform, the media has realized that consumers can negotiate their health care with doctors and hospitals. The article indicates that it is best to choose an advocate with a successful track record in health care cost reduction. Medical Cost Advocate is a leader in health care cost reduction through expert negotiation.

New York Times

By WALECIA KONRAD

THESE days, dealing with medical bills and insurance claims makes April 15 look easy. The medical jargon and inscrutable coding on invoices and explanations of benefits are indecipherable for most lay people. Worse, seriously ill patients may simply be too sick or too broke to deal with the mountains of red tape. That can lead to unpaid medical debts and even bankruptcy.

It’s no wonder that a cottage industry has sprung up to fill this void. Known as medical billing advocates, these middlemen and women help patients deal with the paperwork and haggling often associated with medical costs.

In general, medical billing advocates help you find errors in your bills, negotiate with your insurer to appeal coverage denials, or negotiate lower fees with your medical care providers. Some advocates do all three tasks equally well. But others, because of their training or background, may specialize in one area or another.

Still others give the client the ammunition he or she needs to negotiate. That’s what happened to Susan Redstone, a freelance fashion stylist and author. When she broke her back in a horseback riding accident last summer, she held only a bare-bones insurance policy. So Ms. Redstone, who has since recovered, knew that she would be responsible for the bulk of her medical expenses.

Five months after the accident, just when she thought she had paid everything off, she got a bill for $16,000 from the helicopter ambulance service that ferried her from the remote location in Colorado where the accident occurred to a large medical facility 75 miles away. “I was completely taken by surprise to get this bill so long after the accident happened,” Ms. Redstone said. She consulted with Victoria Caras, a medical advocate in Aspen, Colo., who coached her on how best to approach the medical transportation company to lower her bill. With Ms. Caras’s advice, Ms. Redstone was able to negotiate a 25 percent discount in exchange for paying the bill in full. (more…)