Saturday, February 24, 2018

Cash Flow Considerations – Time Lag Between Payment and Reimbursement

Let me be clear – this post may not be relevant to you. If your healthcare provider sends itemized invoices directly to Liberty after appointments/procedures, and then you are reimbursed, you will not experience this issue. However, if your healthcare provider views you as a self-pay customer, and you need to pay before appointments, this is a relevant consideration for you.

As we documented in our prior post, our healthcare provider requires us to arrange for payment prior to scheduling an appointment. What that means in practice is that we’ve fully paid for an appointment in late February that we won’t have until early April. If we use this example, here’s what a likely pay cycle will look like:

February 23 – Payment is made (money out of our pocket)

April 3 – Date of appointment (roughly 40 days later)

April 10 – Let’s assume it takes at least a week to receive the itemized bill because my gut feeling is it’s not something they’ll provide at the appointment 

April 11 – Submission of itemized bill to Liberty

May 25 – Let’s assume it takes approximately 45 days to receive payment once submitted to Liberty

In this particular example, it would be approximately 3 months from the time we paid until the time we were reimbursed. This is an important consideration for individuals or families that may not have the free cash flow to front these types of payments before receiving reimbursement. With traditional insurance, if it’s being reimbursed, the health care provider will work with the insurer directly before you see an invoice. 

We are in the fortunate position that we are able to cover this lag from payment to reimbursement. However, if we needed to arrange for a significant procedure up front, before being reimbursed, that would be much more challenging. In that case, I think we would connect Liberty with the Clinic to work something out beforehand.

There’s some silver lining here: At least Liberty’s structure provides for full reimbursement on wellness visits as well as on any expenses over the $1,500 annual unshared amount. Even if we have to wait a while, we’ll at least get reimbursed. Nonetheless, we just wanted to share this as something to think about as you prepare financially for the making the switch.

The Realities of Non-Traditional Health Insurance – Scheduling our First Appointments

When we made the move to a healthshare from traditional insurance we thought we would get better visibility into how healthcare providers operate and price their services. As our primary healthcare providers now viewed us as self-pay customers, we were curious how easily they could provide us a quote for an appointment or procedure and how efficiently the process would operate. This post details our first experience scheduling appointments as self-pay customers with our healthcare provider. 

Scheduling the Appointments

There are two appointments we were looking to schedule in the March timeframe:
  •         My wife’s annual wellness check with her OBGYN
  •         My 9-year old son’s annual wellness check
I’ll start with my wife’s appointment because that’s where we experienced the most inefficiency. My wife was contacted by her doctor’s office to let her know that the appointment she had scheduled at the end of March would need to be re-scheduled due to the doctor’s schedule. When asked whether her insurance was up to date she mentioned that we are now with Liberty Healthshare. The office informed her she would be viewed as self-pay now (which is consistent with what we were told coming into this) and would need to speak to a Financial Counselor before being able to re-schedule the appointment. After some inefficiency trying to get connected to the right Financial Counselor, which took a few days, we were connected to the Financial Counselor that serves her doctor's department.

My wife explained that we are now with Liberty Healthshare and we are considered self-pay customers so the office told us we needed to speak with a Financial Counselor before we schedule an appointment. The counselor informed us that we’d need to arrange for payment before scheduling the appointment. We would need a quote for my wife's appointment and after a few minutes of holds we had our answer:

$418 but if we pay now we’ll receive the 35% discount which will take the cost to $271.70

So we got our credit card out and paid for our wellness check, that will occur at some point in the future. This brings up a reality regarding cash flow that some will need to consider if your health care provider considers you a self-pay customer. We’ll follow-up this post with a more detailed analysis of that consideration. After paying for the appointment my wife was transferred back to the doctor’s office and was able to re-schedule her appointment for April 3. 

Now that we had this experience under our belt, setting up my son’s appointment was much easier. The Financial Counselor we spoke with in pediatrics was very knowledgeable and friendly. My son’s appointment cost $369 and $239.85 after the 35% discount. So once again, we paid in full on February 23 for an appointment that will occur on March 22. 

What Does this all Mean?

In reality, the process worked as our provider suggested it would. You should understand the process may be a bit more complicated than what Liberty describes on their website if your provider considers you to be self-pay. It would be nice if our providers could reach an agreement with Liberty on a discount rate and process but for now, this is what we’ll experience.

As we documented in some of our first posts, we did contact our healthcare providers before making the change so this was not that surprising. I do think it will become more efficient as we move forward – we’ll know the drill. And ultimately, we like our health care provider enough that we don't want to move to another (they have great doctors) - so it's ultimately our choice to deal as self-pay customers.

Questions We Have that Will Get Answers to as we Move Forward

One of the great things about documenting our experience here is the ability to inventory the questions we want to make sure we get answers to moving forward. Here are a couple that came out of this experience:

·        Will our upcoming visits be covered by Liberty since they are “wellness visits”? According to Liberty, up to $400 of wellness/preventative procedures are covered, per person, per year. Thus, each person in the family should be able to have one wellness visit per year. I called Liberty to understand how they would know an invoice is related to a “wellness visit” and they explained it’s all a matter of how the healthcare provider codes the procedure. You qualify for this once you are a member for 60 days and both of our appointments will occur after this threshold for us.

·       What would happen if we had an emergency and didn’t have time to go through the process of speaking with a Financial Counselor first? We actually asked a Financial Counselor this question and they said we wouldn’t be refused service, they’d allow it. As we know, sometimes things work differently in practice but hopefully we don’t need to test this anytime soon.

Our effort here is to document the practical experience that we’ve had. Your healthcare provider may be different and have a different relationship with Liberty. The punchline: Do the work to understand how things will work beforehand and understand the reality, particularly as you go through this the first time, may be different.

Tuesday, February 20, 2018

About Those ID Cards (for all of your anxiously waiting)

Again, not that failing to receive our Liberty ID cards will prevent us from receiving medical care I did want to provide a little update on this. As of our last update we still had not received our ID cards so after giving it a few more weeks I did place a call to Liberty today. The good news is I reached a human within under a minute and they were very engaged. The gentleman I spoke to was friendly, looked up our account information and noted that while we should have received them he’ll gladly have new cards sent immediately. Perhaps we missed them in the mail (oops, we could have!). I’ll take a picture using my high-end photography skills as soon as we get our new cards. So for those of you becoming new members in the future – if you don’t get your cards within the first 3-4 weeks just give them a call (hope you enjoyed that bit of rocket science)!

In other news, we have our first doctor appointments under Liberty upcoming. They are both fairly routine – one for my son and one for my wife. Stay tuned for an update on how the process goes down and how we rate the experience!