Lab & X-Rays (Best Insurer)

Nov 2, 2007

  1. Consultant
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    Consultant Super Genius

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    I think this is a very important question that needs to be answered in our community. The number #1 problem I get with most individual cases, in regards to their billing, is bloodwork in particular.

    Doctors jump to the idea of always doing labwork whenever they see a jump in their blood pressure. Eventhough, its usually because they're nervous about doctors or drank coffee etc. hence skewing the readings.

    What carrier have you seen cover the labwork best? I know for group its UHC hands down. No Charge for lab & x-ray. But what about IFP? This week alone I have had Blue Cross, Nationwide & Aetna clients call me complaining about the cost.

    The current bill that is on my desk (Aenta) is 9 lab services and 2 x-rays for over 1,500. Negotiated down to about 1,200 since he has a high deduct. All because of a high blood pressure reading.

    Any other companies specifically IFP that have better UCR's to keep these bills lower would be greatly appreciated. Thanks for reading!
     
  2. Dave020
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    Dave020 Super Moderator Moderator

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    I think you have answered your own question here. If doctors will order up thousands of dollars worth of labs because of these things, why would anyone expect the health insurer in a non-pooled market to pay first dollar on it? If they did, everyone would be getting all sorts of labs and x-rays routinely. Premiums would go way up.

    Group is different, risk is pooled in the group and self-offsetting (I made that word up but you get the idea). Statistically, something like 70% of any given group will use less than $100 of benefit per year.

    As to costs, the subscriber can shop different labs to get prices for those services. Just because the doctor fills out a lab slip for XYZ lab does not mean the patient has to use that lab. Search in-network labs and call for pricing. I mean, they do it to buy a muffler, why not for something like this?????
     
    Dave020, Nov 2, 2007
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  3. Consultant
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    Extremely awesome point. I'm happy you replied. That makes total sense. I will shop around the 6 counties I do the most business with. I can add it to my value added service bag once the client gets approved for coverage or if they live out of my area I will just let them know they should be diligent in shopping around.

    If I find a site, I'll let others know. I'm here to have clients for life and I'm sure everyone on board would like that too :yes:

    Thanks again Dave - Have a great weekend!
     
  4. CHUMPS FROM OXFORD
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    CHUMPS FROM OXFORD Guru

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    Aetna HMO does well.

    UHC 80% but capped at about $300.
     
  5. salpro22
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    salpro22 Guru

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    Here's something I came across when I was 1st researching HSA's.

    Maximize Your HSA Newsletter - How to Save Money on Lab Work - HSA for America

    I haven't had any direct experience with USBA, but I'd love to know if anybody else has used or recommended their services.
     
  6. TXINSURANCE
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    TXINSURANCE Guru

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    Plans have a deductible - which by definition is the amount you pay FIRST before your insurance kicks in. Prior on an in network PPO you will get negotiated rates on covered services.

    Sure a customer wants an MRI for $30 co pay, they also want a family of 5 for $50/mo - the reality is this is just numbers and in order to make IFP affordable lab and xray is almost always towards the deductible.

    Some companies allow same day or doctors lab / xray (little stuff) part of the co pay. By the way Aetna IFP will pay same day , doctor billed lab xray as well. Of course most lab xray is NOT done in docs office as it is not profitable for the doc to do a lab test that a huge lab farm can do for pennies on the dollar.

    I guess my take is customers need to realize WHAT A DEDUCTIBLE TRULY IS. These other "perks" are really just that some add ons to make you feel warm and fuzzy or similar to group coverage.

    Times are changing with H S A and higher deductibles - benefit rich plans are the #1 reason health costs in America are out of hand - people want the nickel and dime stuff covered which financially is absurd.

    I had a customer call about 3 months ago - their COBRA was $1200/mo - their IFP was under $500 - i.e. $700/mo savings and they called to make stinker about a $150 lab bill - ummm you are saving $700/mo how about coming back to earth please?

    I did tell him he can get back on his COBRA, pay all back premiums of $3000+ to get the $150 lab bill covered , but what a shock he didn't take up my suggestion!!!

    I guess it is 2007, not 1957 and people need to put a few grand in the bank and you would be surprised how many of life's problems start to go away.

    If I cut coupons on Sundays, and have an old computer and outdated cell phone so can they...

    p.s. I have found virtually ALL BLUE'S beat everyones negotiating power by a large margin in most markets if that interests you - however on the front end the customer could care less this is not sellable in the least bit, and most states Blues pay lower than industry average commissions as most of us are aware.
     
  7. MHart
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    MHart Super Genius

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    I used usba for myself and suggested to my clients and I was extremely please at how easy it was sign up for the test online go to the place and get your lab work done. Its amazing that most of the places are where you go for your major medical insurance plans anyway. Great service.
     
    MHart, Nov 3, 2007
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  8. somarco
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    somarco GA Medicare Expert

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    JR -

    It appears USBA has a referral program for agents. Do you have any information on that?
     
    Last edited: Nov 3, 2007
    somarco, Nov 3, 2007
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  9. CHUMPS FROM OXFORD
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    CHUMPS FROM OXFORD Guru

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    I know this sounds absurd...but it is true. We have an Anthem BC HSA. On a typical lab test of about $150, after the Network negotiated price is applied, our portion is about $40. Crazy, but true.
     
  10. salpro22
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    I haven't had a chance to contact the folks over at USBA yet, but I will next week. I'm curious to find out what the codes in the search directory mean as there are no names or address for facilities in their network. It also seems odd that their is not a contact us option on their website.