Healthcare Deciphered

Healthcare is frustrating, complicated, and overall boring. This is the reason most are completely un-engaged in their health insurance or any other administrative components of their care. However, much like the buying any item on the market today, if you do not do your research, you could be left paying thousands more than necessary. This is the reason for the book. The goal is to enhance the healthcare experience by providing usable, relevant industry knowledge in a way that is easily understood. The only people engaged in healthcare, in most instances, are other healthcare professionals. We need to change this trend. You have to take an active role to prevent overspending! The only way to own your experience is to have a degree in healthcare currently. This book prevents the need for higher education, breaking down the industry into a handbook for success. By applying a few steps, everyone can decrease the amount paid on everything from doctor visits to large hospital bills. In addition, we help provide undisclosed secrets about your health insurance company. Why does this matter? Despite the significant financial impacts, $1.5 billion of health care costs is due to claim errors each year. The astonishing part is that you pay over 25% of the costs of these errors each year. The remainder of the cost is paid by Medicaid, Medicare, employers, etc. Basically, we are sharing the cost. The more significant issue is it is difficult to truly track this problem. Health plans self-reported to Consumer Reports that in the last few years, claims are processed with over 90% accuracy. However, this is really impossible to independently measure. Health plans process claims based on their system guidelines, which change almost daily. In addition, if a physician, hospital, or other healthcare providers bill in error the claim is rejected or denied. From the health plan's perspective the rejection or denial was processed correctly. However, the claims in these situations contained errors. It is up to the physician to fix and re-submit. More often, the physician bills the patient directly. At this point, it is up to you to identify the source of the error. The clincher is the health plan sent you a letter denoting the error, but did you catch it? Likely, you did not. On top of not catching the error, you just paid the bill from the physician too. Therefore, there is no incentive for the physician to send a corrected claim as the physician just got paid by you. It is estimated that 80% of claims contain errors, as reported by the Wall Street Journal. Despite the commonality of billing errors, many people do not know how to spot a billing error on their claim. The Washington Post surveyed 11,000 people and only 5% (550) could identify an error. In comparison to the total U.S. population of 321,442,019, this means only 16,072,101 people really have any idea what medical billing errors resemble. To put this in perspective, there are 12,219,330 people in the healthcare industry (KFF.org, 2016). Therefore, 80% of the people who can identify errors are within the healthcare field. This means that most Americans, in other industries, cannot recognize claim/bill issues. Despite the fact that the information is listed on your eligibility of benefit statements from the health plans. Health care is a confusing industry, which principles are opposite traditional business rules. Traditional business rules state higher demand lead to more product purchases and a greater bottom line. However, in healthcare higher demand is a result of a mismanaged population with increasing medical needs. An effective treatment plan reduces increases in services and limits demands. The concentration in healthcare focuses on the health of the patient; therefore, operationally there is room for improvement. Healthcare costs are increasing at more than 3 times the rate of inflation. In addition, medical debt is the leading cause of bankruptcy in the U.S. Furthermore, almost 40% of U.S. citizens have medical bills that are with collection agencies due to non-payment (The common wealth fund, 2011). The average medical debt is almost $2,000 per family (Consumer Financial Protection Bureau (CFPB), 2014). The best way to eliminate medical debt is to verify accuracies. It is estimated that 80% of claims/bills have errors, which in turn leads to billions being unnecessarily overpaid. Whether you have medical debt or not, stop overpaying. Overpayment is costing us thousands per family each year. It is time to get to a better healthcare state. It is time to get to a better healthcare state. Give yourself a little reassurance and be the expert.