Paying too much for pizza and paying too much for healthcare

Over the weekend I picked up 2 pizzas my family ordered from a local pizza shop. We ordered a pepperoni pizza and a cheese pizza. I paid for the pizza’s and brought them home. When I looked at the receipt I noticed that each pizza had a base charge of $9.75 and then there was a 1 item charge of $1.75 for each pizza. I understand the additional 1 item charge for the pepperoni pizza, but I do not understand the charge for the cheese pizza. After all, the pepperoni pizza had cheese as well.  To me, this is unbundling of charges, similar to what can happen with medical bills.

Unbundling is defined as the practice of expanding into individual units a group of diagnostic or procedural test codes. For example, the CPT code for an upper gastrointestinal endoscopy with biopsy of stomach is 43239. Separating the service into two component parts, using CPT code 43235 for upper gastrointestinal endoscopy and CPT code 43600 for biopsy of stomach, is inappropriate. CPT codes (Current Procedural Terminology) are how a medical facility bills a health insurance company. It is a complex system and is difficult to understand, and easy to make an error.

Today more people who have insurance have a high deductible plan, which means you pay more before your insurance ‘kicks in’. It is relatively easy for an insurance company to miss an unbundling issue, especially since they are not paying anything on the claim, what incentive do they have to really investigate? Those without health insurance have nobody to look at a bill for them. It is possible, just like I did for my cheese pizza, to pay more than you really should for your healthcare.

Medical bills and the uninsured

A new report has come out and states that a record number of people have gone without health insurance for at least part of the past year. The report indicates almost 50 million were without insurance, up from 46 million in 2008.

I think there is plenty of room for debate about this actual number, but I don’t think there is much argument that the number has increased in recent years. Over 62% of people with health insurance receive benefits through their employer. If people are losing their job due to the economic times we live in, it just stands to reason there are fewer with health insurance.

Not having health insurance guarantees you of one thing, that you will pay the most when you need health care. Only the uninsured pay ‘sticker price’ on a medical bill. That is because most medical providers have agreements in place with insurance, both private and government sponsored, to make adjustments to the amount they actually collect.  Without the benefit of an agreement, the uninsured is out of luck.

What can the uninsured do when they receive a bill? First, don’t ignore the bill. Talk to the hospital or doctor billing office and ask to set up a payment plan. You should also inquire if they offer a prompt pay discount.

Since most medical bills are generated for the insurance company to pay, they have confusing alpha numeric codes. Without a ‘key’ to unlock what these codes mean, it is difficult to understand what you are being billed for when you receive a bill. Those without insurance have no means to the ‘key’. Patient advocates like INSNET can help. We provide risk free medical bill review and negotiation. A fee is charged based on a percentage of the amount saved on the negotiation. If there is no savings on the negotiation, there is no fee for the review.