| Are you aware that the standard guide for | | | | In my example you live in Los Angeles and after |
| medical rates begins with Medicare? Simply, | | | | your insurance paid the provider you get a bill for |
| Medicare adjusts prices for procedures on a | | | | the balance of $1,938. What will you do when you |
| regional basis taking into account various factors | | | | see the bill? Write a check for the full amount, |
| to determine a fair billing rate for that procedure. | | | | pay by credit card in full, call and ask for a |
| You can access CMS website to connect to the | | | | payment plan or call for a discount? |
| official Medicare site. The rates propagated here | | | | There are a number of other issues including the |
| are referred to as the Official Medical Fee | | | | reasonable rate you insurance thinks the bill should |
| Schedule (OMFS). An easy example of how rates | | | | be. You could get an EOB (explanation of benefits) |
| vary is to consider an MRI (Magnetic Resonance | | | | from your insurance. The EOB will contain the |
| Image) of the knee. The fee includes the | | | | amount billed $2,608, the amount they paid $670 |
| physician's interpretation and technical imaging | | | | and the reasonable retail price for the procedure |
| combined. | | | | $2,288. So you figure to deduct the $670 paid by |
| Location / OMFS / Standard Bill | | | | insurance from $2,288 and you should pay $1,618. |
| New York $728 $2,912 | | | | Wow, a 16% savings and I guarantee they will |
| Dallas $623 $2,377 | | | | accept it as full payment. |
| Los Angeles $652 $2,608 | | | | The more reasonable amount you should pay is |
| Remember how this rate began from Medicare? | | | | between an additional $130 to $280. Why, |
| When the 68 year old patient needs and MRI of | | | | because an MRI should not cost more then |
| the knee, Medicare may be billed the standard full | | | | $960.00. |
| price but they only pay based on OMFS. What do | | | | Various sites and services exist that can help you |
| you pay through insurance or out of pocket if | | | | work through maze of medical billing. Overall they |
| you are uninsured or if your plan refused to | | | | will provide similar results saving you money. |
| authorize the procedure? | | | | However, many work on a contingency fee |
| Healthcare insurance plan have contracts with | | | | based on what they save you, usually 30%. In |
| medical groups, hospitals and medical professionals | | | | our example, if your bill should be $960 from the |
| to pay a specific negotiated price. Depending on if | | | | original $1,938 saving you would pay them at least |
| your plan is an HMO, PPO, 80/20 conventional | | | | $293.00 and possibly and retainer of $250.00 and |
| policy, high deductible policy or uninsured; you may | | | | you still have to pay the MRI provider around |
| be required to pay in addition to what you carrier | | | | $150 for a total cost of $693. |
| paid. How much? That is where the battles lie. | | | | |