Tag Archive for: health care pricing

Uninsured COVID-19 Patients, Hospital Bills are Covered

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Covid-19 hospital bills

 

Most major health systems around the country are part of a program through the Center for Medicare and Medicaid Services that provide payments for uninsured patients who have COVID-19.

Medical bills are covered through the pandemic legislation relief, the CARES Act.

 

Patients may not be informed of this upfront; ask the question if it is a concern.

Tip # 3 From the Single Mom’s Guide to Health Insurance- Look at your income and cash flow situation.

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There are two basic types of plans.

Traditional plans, which often have low copayments for regular visits, and High Deductible health plans.

Traditional plans are what many people used before healthcare reform. They had copayments
(a small amount due at the time of service) for regular Dr. visits and medications. They have
a deductible and coinsurance for unusual things like MRI’s, CT Scans, and hospital visits.

These plans tend to be more expensive every month, but generally require a smaller portion
to be paid by you when a claim happens.

High Deductible health plans are paired with a tax-protected savings account called a Health
Savings Account or HSA. These plans require that your deductible come first unless it is a
preventive service.

 

To download the complete guide, click here.

You may qualify for health insurance assistance

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Below is the table that the federal government uses to determine health insurance assistance.

If your income falls between 135% and 400% of the federal poverty level for your family size you may qualify for assistance with your premiums.

Recent Study Looks At Health Care Pricing

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According to a recently published healthcare economics paper, different insurers pay varied prices for the same services and procedures at the same hospital, indicating that bargaining leverage really does impact healthcare prices.

 

Authors took actual data from claims for three national insurers. Studies showed that dominate hospitals can dictate how much they are going to get paid for specific services and procedures. For hospitals that hold an monopoly in their area, that number was 12.5% higher than those who had nearby competitors. For more concentrated markets, providers can shift more risk to insurers, which affects the ability to keep prices at a set standard.

 

“The two main types of contracts use prospectively set prices that pay a fixed dollar amount based on the DRG classification code, or a model that sets payments as a percentage of hospital charges.
Hospitals are likely to prefer the latter because they get paid for every service they provide, and thus bear less risk. This drives prices up and also places less pressure on the hospital to reduce costs.”

 

In simply terms, it’s about negotiation. The hospital may charge $50,000 for a hip replacement, but the negotiated price may be more like $22,000, Medicare reimbursements would be even less.

 

“Researchers also found that prices increased by more than 6% when merging hospitals were less than 5 miles apart. They didn’t find significant price impact when the hospitals were separated by at least 25 miles.”

 

 

 

 

Sources: The Price Ain’t Right? Hospital Prices and Health Spending on the Privately Insured Zack Cooper (Yale University) Stuart V. Craig (University of Pennsylvania) Martin Gaynor (Carnegie Mellon University and NBER) John Van Reenen (Massachusetts Institute of Technology, CEP, and NBER)

Modernhealthcare.com

Health Care Cost Institute