Thursday, February 14, 2008

Looking Behind the Curtain

[Welcome Industry Radar readers! Please take a look around the site]

One of the memorable scenes from the Wizard of Oz occurs towards the end of the movie. Dorothy & friends are addressing the Great Wizard after completing the task of bringing the Wizard the broom belonging to the Wicked Witch of the West.

In the midst of all the smoke and flashing lights Toto grabs the hem of a curtain and reveals a man pulling levers and speaking into a microphone.

"Pay no attention to the man behind the curtain."

To many, making heads or tails out of the true cost of medical care is every bit as much of a mystery as the Great Oz.

The consumer has been confused by copays, coinsurance, deductibles and more. What should be fairly simple is in fact made complicated.

Health insurance is the only form of insurance that contains copays. Your auto coverage doesn't have a copay for tires, brakes, oil changes or wiper blades. So why does health insurance come with confusing copays?

The truth is, copays are expensive and totally unnecessary. Once you look behind the curtain you can find out, usually within a few dollars, how much a procedure is going to cost you and your carrier.

If you want to know how much a procedure will cost, you can get an idea by using a few tricks readily available to the public.

Step 1 - Get a procedure code from your doc or an online reference.

Say you are going to have a vasectomy. The procedure (treatment) code is 52601.

Step 2 - Call your carrier, or use an online source to get the Medicare allowance for the procedure.

If you are using Medicare guidelines, you will see that the allowance is $812.

If you are not on Medicare you will want to multiply this figure by 1.5 to get a rough estimate of what the allowable charge will be by your carrier for the procedure when performed by a network provider. That means your cost will be somewhere around $1206 if you have a high deductible plan.

These are rough estimates but will get you in the ballpark.

Navigating the world of health care does not have to be a mystery when you know where to look.

You are not in Kansas any more.
blog comments powered by Disqus