Inflation naturally occurs each year and raises the cost of living. Healthcare isn’t immune to inflation, and costs for care are bound to increase over time. However, what if you’re experiencing dramatic increases in your health insurance costs–and seemingly not getting anything else in return? A lack of transparency in the healthcare and health insurance industry has led to significant–and detrimental–costs for hardworking employees like you.
While the federal government’s recent efforts to promote transparency in hospital billing and regulate the information employers provide employees about their benefits should, in theory, help you budget and save when it comes to health insurance, hidden costs associated with traditional brokers and Preferred Provider Organizations (PPOs) hinder this progress.
Here are five areas to watch where you may be paying too much in your current health insurance plan with a traditional PPO network.
Deductibles That are Too High
The deductible is the amount a member has to pay before their health insurance takes over medical costs. This is often one of the biggest areas where people try to save when looking for insurance of any kind. But for members in a PPO plan from a traditional broker, this can be difficult because of costs associated behind the scenes to maintain a PPO network. In order to create a strong network of medical providers, traditional brokers must constantly be negotiating new contracts with providers to keep them satisfied. These costs are then passed along to the end-user–in this case, members.
Employee Contributions to Your Health Insurance
Along with high deductibles, employee contributions to health insurance coverage are another area where you may be paying too much in your current plan. Traditional brokers often have confusing, hard-to-follow fee systems in place to support their provider networks behind the scenes. Conversely, with a transparent health insurance plan without a network, employees can see just how much their plan will cost them and where every dollar spent will go.
Out-of-Network Penalties for Seeing Different Medical Providers
One of the greatest shortcomings of a traditional PPO plan is it limits members to a strict network of providers with agreed-upon contracts behind the scenes. Going outside of the provider network causes an increase in cost with an out-of-network penalty.
Say you found a medical provider you’d love to see for treatment, but they aren’t covered under your plan. If you do ultimately choose to see this provider, you’ll be subjected to a hefty penalty. Even worse, if your employer switches from one PPO to another, the provider you’ve been seeing may no longer be covered. You’ll have to find a new provider within your new PPO, or pay the out-of-network penalty.
Unclaimed Prescription Rebates–Even If You’re Eligible
Do you have any name-brand, high-cost prescriptions you currently take? This may be somewhere you’re overpaying in your health insurance due to unclaimed prescription rebates. Oftentimes, a member in a traditional insurance plan won’t even know their prescription is eligible for a rebate when they refill it. The broker will intentionally keep members in the dark about the available rebate, and instead allow a rebate aggregator to claim a portion of the dollars for themselves. Sometimes, the entire rebate will be kept by the broker and aggregator.
Prescriptions are often one of the least regulated areas of health insurance–and as such, some of the most common areas for fraud.
Unbundled CPT Codes From Hospital Billing Departments
Everyone deserves to be fairly compensated for the work they do–our team at ClearChain Health abides by a strict Fair Payment Model for all providers we work with in our transparent model. The problem with hospital billing isn’t from doctors charging too much for service, but from hospital billing departments manipulating processes to get more money from procedures. This happens when a billing department unbundles preset CPT (Current Procedural Terminology) codes so they can charge someone for multiple different services, as opposed to one all-encompassing procedure included in the code.
Closely evaluate your next hospital bill to see if you’re being charged for a procedure included all in one code, or if the billing department has charged you for multiple different codes. If you work with a transparent health insurance provider, your insurance will often do this audit for you before you even receive the bill.
Tired of Paying Too Much with a Traditional Broker?
At ClearChain Health, we specialize in building a transparent, direct relationship between you, your medical providers and your health insurance. By removing the provider network and allowing our members to nominate who they’d like to see, we allow the freedom to receive care from who you’d like. Our team also closely audits all claims to prevent overcharging from billing departments. Contact us today to learn more about our innovative and cost-saving model!