Wednesday, October 24, 2018

The Complications of a Major Health Provider: Obtaining an Itemized Bill

In our post highlighting cash flow considerations, we talked about the time lag between when we had to pay for an appointment vs. when we would be reimbursed by Liberty. We anticipated a lag but the reality was that the lag was much longer than we even anticipated. Let’s start with the date we thought we would have an itemized bill available from our healthcare provider.

As we have mentioned in previous posts we need to pre-pay for any services at our healthcare provider since we are designated as self-pay customers. Our primary healthcare providers in the area do not work directly with Liberty. Thus, we receive a 35% self-pay discount which is applied at the time we pre-pay for services. When we pre-pay we worked with a financial counselor who would estimate the cost of the services. We would then go to the actual appointment. In nearly all cases, as you might imagine, what actually occurred in the appointment was different than what we pre-paid for. Sometimes we paid too little, sometimes we paid too much but things were always off.

The financial counselor coming up with the pre-payment don’t really know what exactly will happen at the appointment…and these were the most routine wellness visit type visits that you could have. For example, at my 9-year-old son’s wellness visit they did some additional testing that the financial counselor was not aware of so our charge was higher. At the end of the day I think the financial counselor is doing the best job they can but inevitably there will be differences.

Ultimately, there were two outcomes based on this experience:

THE BAD: It took a really long time for the individual office within the healthcare provider to reconcile billing with the financial counselor. We could never just submit a bill to Liberty at the time of our pre-payment because we knew it would probably be different than what the ultimate cost is. This led to delays in submitting then obviously getting reimbursed.

THE GOOD: We’ve gotten a lot better at asking what procedures will be performed, what it costs, whether it’s truly needed, etc. If you are on traditional insurance it is a lot easier to not worry about what something costs, we are much more mindful now. Whether we stay with Liberty or not I feel this is a helpful skill to have developed.

My wife has gotten better at navigating this extremely complicated system but it’s come at the cost of hours on the phone. It’s comical seeing one person send you to the next, then send you back to the original (then repeat). Overall, inefficient, complicated and easy to see why healthcare costs so much. As a consultant, it’s a problem ripe for solving and I know there are many good ones trying to do just that.

Our Advice: If you will be moving to Liberty contact your healthcare providers to see how they interact with Liberty. If they submit bills directly to them it will make your life far easier (or would at least solve this problem).