Potential Insurance Problems and Our Solutions
Approximate Read Time for Entire Page: 10 minutes
At Trinity Heart and Vascular Group, one of the things that sets us apart is that we don’t accept health insurance payments. While we believe that health insurance plans can be of great benefit for certain types of needs, they also have many drawbacks to consider, specifically when it comes to outpatient medical services.
For those who have encountered issues with their insurance plans (in relation to their cardiovascular health), we want to provide them an opportunity to defer using their insurance plan at our practice, especially if it will help them medically and/or financially. This may be a good option for you if you’ve encountered any of the following issues.
Here are five ways that insurance companies can limit your healthcare freedom when it comes to outpatient testing and treatment, and the solutions that we provide to help you get that freedom back.
[To see all of the content on this page, you can simply keep scrolling. If you’d like to go directly to a specific ‘problem and solution,’ click on the ones you’re interested in the Table of Contents below.]
Table of Contents
Problem #1: Health insurance companies indirectly limit the time you get to spend with your provider.
Have you ever waited several months for a new appointment with a specialist, only to arrive at your appointment, and have them spend 10 minutes with you?
Patients understandably often think that the physician doesn’t want to take the time to understand their health concerns. While that may sometimes be the case, most of the time, providers want to spend more time with each patient, but are restricted as an indirect result of their contracts with health insurance companies.
Most present-day medical providers now spend a significant amount of a patient’s appointment time filling out unnecessary paperwork, entering duplicate data, and trying to understand complicated procedural rules (what they can and cannot do) in order to meet the demands placed upon them by insurance companies and government regulations.
This means that if they planned on spending 45 minutes with you in a new patient appointment, at least two-thirds of that time slot could be taken up by complex forms and procedures that third parties often require them to do.
Physician and Advanced Practice Provider burnout is increasing at a rapid pace, and it’s largely due to the red tape that’s put in place by a multitude of third parties. As a result, patients don’t get the proper care that they deserve, and suffer in multiple ways.
Our Solution: As a third-party-free practice, we don’t have to spend two-thirds of your appointment stressing over complicated paperwork and documentation requirements. As a result, we have time to listen to your concerns, thoroughly assess your medical issues, patiently answer your questions, and offer a clear diagnosis and treatment plan.
Problem #2: Health insurance companies often make the final decisions regarding your health needs.
Another way medical freedom is hindered when using health insurance, is that you and your doctor technically don’t have the ultimate freedom to make decisions regarding your healthcare needs – your insurance company ultimately often calls the shots.
If your provider recommends a specific type of test or procedure, your insurance company has the power to hinder your access.
They can refuse to authorize certain tests, even if your provider believes that you’re heading into a dire health situation. That can put you and your loved ones in a very distressing situation, and can ultimately harm your physical and emotional health.
Our Solution: At Trinity Heart and Vascular Group, you get to make decisions based on your physician’s recommendation, not based on whether your insurance company wants to give you permission or not. This allows you to do what you think is best for your health since you don’t have to receive prior authorization for any testing that we provide.
Furthermore, since we don’t have to ask any third party for permission to run tests or wait weeks for an approval (all we need is your permission and approval), we can get you scheduled for testing in a timely fashion, and give you the exceptional cardiovascular care that you deserve.
Problem #3: Health insurance companies often limit your options when it comes to choosing your providers.
An insurance company will give you a limited list of approved (‘in-network’) providers that you’re allowed to see. This is usually based on your geographical location, as well as certain types of contracts that they have with specific providers.
This means that if you choose to see a specific provider in your area (or even out of state) whom you’re most comfortable with, but he or she is not on the approved ‘in-network’ list, you are seeing an ‘out of network’ provider.
Regardless of whether you have out-of-network coverage, it can often be prudent to be a self-pay patient for that out-of-network provider. However, if the out-of-network provider is employed by a hospital, the hospital will most likely not be able to offer a definitive ‘cash-pay’ or ‘self-pay’ price.
Even if they give you an estimated price, it most likely won’t be a fair-market price. That means you have to negotiate with the hospital system to get a better price, which is a time-consuming and stressful endeavor.
That entire process discourages people from seeking care outside of their insurance network because it’s too much of a hassle, and it ends up being too expensive.
Our Solution: Since we don’t have any contracts with health insurance companies, and we’re not owned by a hospital, anyone can become a patient at our practice whether they have health insurance or not – and they all receive the same prices based on fair-market values.
If you happen to have insurance, we gladly welcome you – we just won’t submit a claim to your insurance plan. Instead, you’ll defer insurance payments for our services, and choose to become a ‘self-pay’ patient at our practice. While that may seem scary, we’re here to reassure you of the major advantages in doing so.
While we’re considered an ‘out-of-network’ provider (in relation to all insurance plans), our office won’t charge you arbitrary ‘out-of-network’ fees, and we won’t send you multiple surprise bills in the mail for months on end. You pay a flat fee for the services that you receive, and you only pay us one time when you come in for your appointment.
Furthermore, we gladly provide you with a receipt-charge sheet that documents your diagnosis, and any types of tests you had, which you can submit to your insurance company or health sharing plan.
Problem #4: With health insurance companies, your privacy is compromised.
You should be allowed to choose who has access to your PHI (Private Health Information), and who doesn’t.
When you go to a health facility that accepts your insurance, everything that you tell your medical provider is technically allowed to be accessed by your insurance company. They can read your test results and medical records, and can see other personal details, such as notes regarding sensitive issues.
What’s worse is that your insurance company can sell that information to labs, pharmaceutical companies, and hospitals. Those medical-related companies want your PHI so that they can market their products and services to you based on your specific medical conditions.
The unfortunate reality is that your private health information is hardly ever truly private when it’s submitted to an insurance company.
At Trinity Heart and Vascular Group, we take medical privacy very seriously. We will we not share your PHI with anyone outside of our facility unless we have your express permission to do so (such as allowing your spouse or primary care physician to view your records if you provide written consent).*
We believe in your right to privacy. Your health information isn’t something to be sold and shared – it should be kept in confidence. When you trust us to keep your health information confidential, we will honor that trust, and respect your rights.
[*For more information, please read our HIPPA Notice.]
Problem #5: The negotiated prices from your insurance company are often inflated, and it’s difficult to find out what those prices are before you receive medical services.
When insurance companies contract with ‘in-network’ medical providers, the prices that they negotiate for exams, testing, and treatments vary from provider to provider. While office visits may have a copay under certain plans, any tests that are ordered are usually put toward a deductible.
This presents a problem for people who have high deductibles, as the negotiated prices are often in an over-inflated price range.
That price range is dependent on numerous factors, including (but not limited to) the original prices that have been set by the health system that employs your provider, your particular insurance company’s negotiation policies, what type of insurance plan you have (HMO, PPO, etc.), and what state you live in.
Considering all of those factors, it’s very difficult to budget for your outpatient healthcare needs when you have a high-deductible insurance plan. Unfortunately, it’s cumbersome (and sometimes nearly impossible) to find out ahead of time what you’ll be charged.
For example, if you have a high-deductible insurance plan where your deductible is $5,000, and you need to have an MRI of your ankle, it can be very difficult to obtain an estimated price from your local hospital. Furthermore, that price may be much higher than what the MRI is actually worth.
[A new Federal requirement called the “Health Care Price Transparency Act” is now in place, which requires hospital systems to provide ‘good faith estimates’ for all services provided. This could make the price-discovery process a little easier, although according to recent reports from patient rights advocacy groups, only 14% of hospitals in the U.S. are currently fully complying with this new regulation.]
Overall, when using health insurance, the cost of basic outpatient testing is often much higher than it should be, and that includes cardiac testing. For example, an EKG (which is a quick, non-invasive, painless test that takes about 10 minutes) can be anywhere from $30 – $100 when seeing an in-network provider, and can be anywhere from $200 – $2,000 if you’re uninsured or go to an out-of-network provider.
At Trinity Heart and Vascular Group, an EKG is $25. This rate is given to every single patient, regardless of their insurance status.
An EKG should never cost hundreds of dollars, but for some people, this is what they’re obligated to pay when they submit an out-of-network claim under their insurance plan, or if they don’t have insurance at all.
Our solution: We remove the guesswork when it comes to budgeting for your medical needs, and that’s the way it should be. We do so by offering transparent, fair-market prices for all exams and/or tests that you receive, and you pay us directly at the time of service. That’s it – no hoops to jump through, no surprise bills in the mail, and no hidden fees.
The pricing for outpatient medical services shouldn’t be a mystery, yet insurance companies and hospitals have conditioned us to believe that this is “normal.” When we look at the bigger picture though, it isn’t normal at all. Anything else we buy in our day-to-day lives has transparent pricing, so why shouldn’t healthcare services be the same way?
For example, a grocery store that didn’t list their prices wouldn’t thrive as a business. Would you agree to buy groceries at that store, and then before you step inside, sign a contract that says they’ll send you a bill in the mail, and you have to agree to pay whatever they decide to charge you?
There would be no way of knowing if you’d be billed a market-based price or not. What if you bought one loaf of bread and one gallon of milk from that store, and then received a bill in the mail for $75? Not only is that unaffordable for many, but it’s also not representative of a true-market value.
At Trinity Heart and Vascular Group, we believe in providing fair-market pricing for cardiovascular services, and we also believe in being transparent upfront about what we charge. As a result, we publicly list all of our prices directly on our website, and we provide a Price Comparison chart to show you approximately how much money you can save.
We believe that this is essential in building trust with our patients. When you know exactly what to expect upfront, it gives you more peace of mind about your healthcare decisions, and that’s invaluable.