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MediBid Controls Costs for Procedures Not Covered by an Insurance Plan

According to a 2015 Consumer Reports survey, about one third of privately insured Americans had received an unanticipated balance bill within the past two years. The Texas Department of Insurance backs this data up, as the number of balance billing complaints increased roughly 1,000 percent from 2012 to 2015.

Balance billing usually occurs when group members receive care that’s not covered by the insurance plan. This can come as a surprise, and one that can raise serious doubts about the company’s benefit offerings.

MediBid, though, has done away with balance billing with a competitive market that offers price and quality transparency. With MediBid, group members and their employers no longer need to brace for a surprise bill, and they no longer need to worry about coverage gaps.

Why Balance Billing Occurs

Balance billing occurs when the patient’s insurance does not cover the entire cost of treatment. In the days or weeks following treatment, the patient receives a bill for the remainder, and this amount may be in the thousands. It’s an unexpected shock and is likely to inspire anxiety. Group members are reassured that if they are balance billed, it will be negotiated down or away, but this is never a certainty, and it causes undue stress in the meantime.

Employers with fully-insured PPO plans may be convinced that they are immune from balance billing, but this is not the case. Even if group members see an in-network physician at an in-network facility, their treatment may be handled by a team of medical professionals, and some of them may be out of network. It’s usually impossible for people to know this upfront, and while treatment is being rendered, few patients think to ask who is in network and who isn’t.

When out-of-network charges are accrued, it’s usually because the anesthesiologist is not in the patient’s network. Not always, though, as other medical professionals that may balance bill include:

  • Radiologists
  • Neonatologists (doctors that specialize in newborns)
  • ER doctors
  • Pathologists (doctors working out of a laboratory)
  • Intensivists (doctors that specialize in ICU patients)
  • Ambulance services
  • Some medical equipment suppliers

With so many medical professionals involved in a single episode of treatment, gaps will eventually show in a PPO plan’s coverage. Many employers and most patients just accept this as the reality, but it doesn’t have to be.

Insurers Almost Always Underpay Out-of-Network Charges

Some fully-insured plans provide a modest amount of coverage for out-of-network providers, but it’s usually more modest than it first seems. That’s because insurance companies don’t base their out-of-network payments on what is actually billed. Instead, some insurance companies use a portion of what is known as a “reasonable and customary rate,” which is what the insurer believes the provider should charge for a particular healthcare service. Unsurprisingly, the reasonable and customary rate is almost always lower than what the patient is billed, so even if an insurer does cover a portion of out-of-network costs, it will typically do so at a rate that’s much lower than advertised.

MediBid Has Eliminated Balance Billing

With so much confusion regarding balance billing, out-of-network charges and coverage, it’s clear that transparency and competition is needed. MediBid’s competitive marketplace provides both.

Thousands of providers are already using MediBid to compete for patient traffic by submitting bids as patients request healthcare services. Every one of these providers is prohibited from balance billing patients. It’s in our terms, as MediBid knows that balance billing remains one of the last major obstacles to insurance alternatives, like reference-based pricing plans.

There remains a concern, though, that while the provider submitting the bid won’t balance bill, what’s to stop someone working with that provider from balance billing?

Providers on MediBid are not only prohibited from balance billing, they must also provide a single, bundled price for all provided services. This includes the cost of the physician, the facility and the anesthesiologist, which covers the major bill items. What is included in the cost is always disclosed in the bid. When MediBid’s users receive bids from providers, the price is included, so it’s made available before the user chooses a provider. Users are also given important quality information, which includes the provider’s background, their quality outcomes, education, training and any reviews left by former patients.

With price and quality clearly presented, there’s no chance of a balance billing situation unfolding. Before selecting a provider, group members know who will fit into their plan’s allowable payment, taking into account things like travel and accommodations. Finally, healthcare consumers are allowed to behave like consumers and avoid a balance billing situation.

MediBid can work with any employer’s health insurance situation, whether they are fully-insured, self-funded or looking for an alternative to expensive, bloated plans. MediBid can also provide a cost-effective option for employer groups that are having issues with coverage. No matter how sophisticated and expensive your organization’s health plan is, if it’s a traditional provider network, it’s only a matter of time before someone receives a balance bill. With MediBid, though, balance billing is no longer a fear, which means your employees don’t have to concern themselves with coverage gaps, either.