It can be a dizzying headache that makes you sick to your stomach: navigating the complex layers of health insurance billing.
Kristi King, financial services director at Ozark Health, explained some of the terminology and strategies on how to make the challenging process a little easier during the hospital’s Lunch and Learn educational luncheon at the Van Buren County Library last week.
“Navigating the different facets of an individual’s financial responsibility related to health care is complicated,” said Kristi King, financial services director, at Ozark Health.
There are no one-size-fits-all, easy answers, which is why the patient, as the consumer, has to remain vigilant.
“What might be best for your neighbor, may not be best for you,” King said.
Unlike retail where the consumer has a pretty good idea of what they need and about how much something costs, health costs can be unexpected and life changing, and there are numerous federal, state, and local regulations, that can add extra layers of complexity to the situation.
Everyone’s individual health needs are unique, as are they ways they pay for their health care.
Some people have health insurance through work, through their spouse’s work, veterans’ benefits, Medicare, Medicaid, health exchanges, or no insurance at all.
Those with insurance need to stay up-to-date on insurance requirements such as pre-authorization before receiving certain services, referrals, in-network versus out-of network providers, co-pays, and deductibles.
This is homework of sorts, that can be done ahead of time. For those blessed with good health, they might even need to research the insurance terminology a little beforehand. Many providers provide a telephone number or a website to help individuals access this type of information and the financial services office at Ozark Health is always willing to help patients, for example, call the insurer to find out if a specific service requires pre-authorization.
Each year Medicare sends out a large book that contains hundreds of pages of annual changes to the program; including the pharmaceutical formulary, which tells a recipient which medications are covered and which are not covered.
From the writer’s own personal experience: one year Medicare decided to stop paying for a certain medication my mother, 84, takes daily. We found this out at the pharmacy when the bill rang up close to $80. But we were fortunate enough to pay for it at the time, and schedule a trip to the doctor to get a new prescription for the less-expensive generic version. Many on Medicare are on their own when such baffling and expensive changes occur. This experience taught us to research our specific medications in the formulary each year, to make sure there are no out-of-pocket surprises.
A little homework on procedures such as CT scans and some lab work, can also help people get an estimate of how much a certain service costs, which can help some patients budget ahead and avoid sticker-shock when the bills start arriving. Also, the Ozark Health financial services are always ready to help patients with questions about payment options or help decipher the many billing codes that show up on bills. These unique codes are assigned to all facets of health care, from diagnostic codes for particular services, to codes for pharmaceuticals, and supplies.
Homework is good, but again, everyone’s health care costs are unique. Surgery costs can vary based on how long the procedure takes, how many medical personnel are involved, and any unexpected discoveries.
There may be additional bills from other providers such as radiologists, anesthesiologists, and other medical personnel involved in treating a patient.
Gone are the simpler days when you could pay your local doctor for a housecall with a fat sow pig.
There will be a “Breast Cancer Awareness Lunch and Learn” beginning at 11 a.m. Monday, Oct. 16, at the Van Buren County Library. Dr. Hill from the University of Arkansas for Medical Science (UAMS) will be the speaker. Seating is limited, so call 501-745-9306 to reserve a seat or for more information. Ozark Health will be giving away ten free mammograms.