Today, change:healthcare had two great health care questions that I thought I should share with the rest of the change:healthcare community.  Remember, we are hear to help and answer your questions… so let us know if we can be of service!

First user question: I had surgery and received a bill for anesthesia. When I called the insurance co. they informed me the provider was out of network, therefore I was charged per the terms of the contract (40% of bill). I was never told by anyone that the provider was out of network prior to surgery. Am I responsible to pay bill?? I have already reached the maximum annual out of pocket expense BEFORE the anesthesia bill. Do I have any recourse and if so who do I address it with.

This is a great question because it happens frequently.  Oftentimes, the facility will be in-network, but the anesthesiologist is contracted through the facility and out-of-network for you as the patient. Here is the answer:  If the patient signed a contact with the facility that performed the procedure, prior to receiving services, agreeing to pay for services provided by out-of-network physicians, then there really is nothing that can be done.

However, if the patient did not sign any paper work the best place to start conversations is at the facility level. Begin by calling the billing department number included on the bill.  If the patient was not notified prior to surgery that the facility may use out of network physicians, then they should be willing to provide  in-network pricing for those providers.

At this point it can be helpful to contact your insurance company and see what a reasonable reimbursement would be for an in-network anesthesiologist.  This will provide you with a great baseline for negotiating with the hospital.  You may also want to check with them regarding refiling the claim. This will help with getting the insurance company to cover more of the costs.

Second user question: Can a company keep changing insurance carriers every year?  Are employees protected if their doctor then becomes out-of-network?

This is another great question. I imagine that employees are seeing this occur more frequently as health care cost and insurance rates continue to increase.  Here is the answer: Unfortunately, a company can change insurance carriers every year.  This is probably occurring due to increasing rates, which are sometimes upward of 30%.  They are probably having multiple carriers bid on the company’s health insurance coverage and then going with the option that proposes the lowest cost increase. This is a method some companies use in an attempt to maintain health care cost increases.

Unfortunately, employees are entitled to have their physicians included in the company’s new insurance network, or offered protection if a shift in network coverage occurs. The best thing to do in this case is to speak directly with your physician and/or the physician’s billing department.  If you speak with the billing department, inform them of how long you have been a patient, and that your company recently switched insurance companies, making your doctor out-of-network. The physician may be willing to offer you an in-network rate for their services.

If not, make sure you understand how much of the bill you will be responsible for when the doctor’s charges and services are processed out of network.

For more information on understanding In vs. Out-of-Network Healthcare Cost click here (8).

change:healthcare’s COO Robert Hendrick has been featured  in several stories (practically across the country) for tweeting his outpatient surgery last October. Recently the Kansas City Star plublished a story about ‘Twitter’ titled “More people flock to Twitter as a conduit for information.”

Highlight: “Hendrick is a co-founder of Change:Healthcare, a business that helps clients save money on health care. Hendrick said that twittering his surgery was a way to show people the process and educate them. ‘2 veins down. 2 to go. 1 lower left leg. 1 lower right leg. Top left leg done,’ he tweeted from what he described to his followers as a cold operating room. Twittering, Hendrick said, “gave me a sense of connection to people during the surgery.”

Check out the full story online at the Kansas City Star website or download the PDF here.

In a recent survey conducted by Hewitt Associates, about 20% of employers said they are planning to stop offering health benefits over the next three to five years.

Sad… as if we need another player in the health care game to quit! See Workforce Management for more details on the study.

Equally as interesting as those planning on leaving the game are the priorities of the employers who plan to continue to offer benefits. “Promoting employee accountability” was ranked as the number one component of employers 2009 health care strategies. “Offering competitive benefits” and “managing health risk” came in at second and third.

What I have to say is directed at those who plan on dropping benefits and those who plan on keeping benefits and promoting employee accountability:

LET change:healthcare HELP!!! Our site and online tools help employees save money (which saves the employer money) and make smarter healthcare decisions.

The problem is apparent… we are asking employees to be responsible for their health and healthcare when they still do not know what health care really costs, they do not have enough skin in the game ($20 co-pays are not going to increase responsibility) to care, and those who are on CDHPs are lacking the tools to understand how to save money and make better decisions.

The message to employees is simple … we want you to get engaged.  There are tools out there (if we are working with your employer) that will show you simple and tangible ways to save money on your healthcare… tools that will show you what your peers paid (the network price) for services and prescriptions you need, allowing you to proactively research costs and quality, allowing you to become an active participant in your healthcare.

The action for employers… call change:healthcare.  We want to help you preserve your benefits and engage (keep) your employees. We want to help you save 30% on your healthcare.

Healthcare does not have to be daunting and saving money does not have to be hard.  Let us show you how we make both of these things simple!

change:healthcare inc. is seeking a motivated individual looking to gain experience in the fast paced internet-based healthcare technology industry. Tasks for this position would range from assisting with health industry research to evaluating current and competitive products. Assist in coordinating implementation, facilitate/create new marketing campaigns, and participate in the product development process.

Distinguishing Characteristics:
Applicants should possess an interest in healthcare and its impact of society, Web 2.0, social networks, as well as the industry transition to increase quality measures, consumerism, health data exchange, and cost transparency tools. Strong social and communication skills, self-starter, entrepreneurially minded.

Email your resume and cover letter to info@changehealthcare.com.

As online physician rating sites become more and more prevalent, some doctors are asking their patients to sign waivers (provided by a NC based company – Medical Justice) to prevent them from providing online feedback without prior consent from the physician.

change:healthcare CEO Christopher Parks, shared his opinion on the matter with Getahn Ward of the Tennessean. Here are some of the highlights:

Parks says, “”It’s never worked in our society to try to constrain or restrain perceptions or feedback,” he said. “The more you tell people to be quiet, the louder they want to yell.” He, however, believes that physicians should be allowed to offer their perspectives and that the ratings sites have a responsibility to filter out comments that are libelous.

Doctors, he added, should encourage all of their patients to rate their experiences. “As a general consumer, I won’t let one horrible rating sway my perception or cause me to devalue that provider,” he said. “It’s the trend — what’s the majority of the ratings.”

To view the complete article visit the Tennessean website or download the PDF here

NASHVILLE, Tenn., (March 10, 2009) – The disappearance of 3.6 million jobs since December 2007 — and more than 1.7 million in the last three months– is enough to make anyone ill.  But the additional loss of healthcare coverage and the unpredictable cost of medical care can not only make you sick, it can put your financial future in the Intensive Care Unit.

Cost transparency firm change:healthcare has a prescription that will significantly ease a downsized employee’s healthcare and financial distress.

The web-based company is underscoring that resources which can reduce the cost of a person’s healthcare are available free-of-charge to the recently severed and current employees as well as general consumers.

“Job loss is a frightening thing to both employees who are let go, as well as those who remain,” says Christopher Parks, CEO of change:healthcare, a Health 2.0 firm that helps employees and consumers make better, money-saving healthcare decisions.  “When layoffs occur, one of the single largest concerns employees have after food and shelter is their healthcare.  But there are ways employers can provide healthcare help to their dislocated employees, as well as those that remain on staff, with little or no cost.”

For starters, access to change:healthcare’s website costs tools and information resources (www.changehealthcare.com) are completely free and directly accessible to all consumers.  The site allows anyone to view the cost of medical services, providers and pharmaceuticals in their area, based on actual medical claims, so they can see where less expensive alternatives can be purchased.   The site provides a wealth of information but becomes more personal when companies in the area, as well as consumers, input their own medical claims to gain a picture of how their purchases compare to other options.

The website is typically used by companies to help employees make more value- and quality-driven healthcare purchases.  Some companies have realized potential savings of 30-40 percent in their healthcare costs since using the site.

Other free resources available to displaced employees include ratings and social networking tools that give users a way to confidentially rate, share and compare the quality of their experiences with physicians, providers, costs and medical issues.

A series of downloadable, practical information sheets that better guide consumers in dealing with real-life healthcare issues, including “Negotiating large medical bills,” “A guide to COBRA,” “Choosing a Health Plan” and “Asking a Doctor about Generics to Cut Prescription Costs” is also available free-of-charge.

Additionally, the company’s recently released book, My Healthcare is Killing Me:  A Survival Guide for the American Healthcare Consumer, which was an early #1 health read at Amazon.com, can be downloaded (www.myhealthcareiskillingme.com) at no cost.  Written by change:healthcare’s CEO and COO, the tongue-in-cheek book helps demystify the American healthcare system so readers can better understand and navigate it.  The book is loaded with tips for saving healthcare dollars.

“We’re focused on bringing greater transparency to our healthcare system and making information and resources like these available to people currently going through great trials, is at least one way we can help,” Parks said.

About change:healthcare, inc.
change:healthcare, inc. (www.changehealthcare.com) is a technology company dedicated to helping people save money and make smarter healthcare consumer decisions. The company’s information and internet-based solutions are available to third party administrators, healthcare providers, medical bill adjudicators, consumers and employers interested in controlling healthcare costs by engaging their employees in making informed healthcare choices.

Download the PDF of this press release here.

Thanks to Elizabeth Cohen for the mention on CNN. As we continue to promote transparency and support consumers, employers and their employees, the recognition is greatly appreciated.

You can view the clip below, which ran on Monday March 2nd.

Herman Trend Alert: Consumer-Driven to Save Money  – March 4, 2009

“change:healthcare” is a leading edge informatics company created to help individuals and employers save money on healthcare expenses. If you knew you could get the same procedure or service for hundreds or perhaps thousands of dollars less than what your physician or hospital charges, you could certainly make a more informed decision about where you chose to go.

That’s just what change:healthcare (www.changehealthcare.com) offers—the opportunity to see what other providers are charging for the same product or service. Their enormous database contains cost data on literally thousands of providers and drugstores.

Over the last five years, employee healthcare costs have risen by 40 percent, while employers’ costs have increased by 29 percent. During the same period, over six million employees have migrated (mostly by necessity) to consumer-driven health plans. We forecasted this shift some years ago. (To see the full study, visit http://www.towersperrin.com/tp/showdctmdoc.jsp?country=usa&url=Master_Brand_2/USA/News/Spotlights/2009/Jan/2009_01_15_spotlight_2009_HCCS.htm)

No one would disagree that for many, the costs are simply unbearable. They respond by either not going to the doctor, taking the medication, or having the procedure. “Most people don’t apply the normal rules of consumerism to healthcare,” said Robert Hendrick, co-founder and Chief Operating Officer of change:healthcare. “They do not think of medical care as a commodity.”

However, when quality care or the very same prescription medication is available at a much lower cost in the same metro area, then many of us will choose to take action. Typical corner drugstores, including the large chains, charge 30 to 40 percent more than some other providers, such as grocery pharmacies. In this economic climate, that savings is very meaningful.

So what is the benefit for employers? After analyzing 12 to 18 months of past claims data, the company performs an analysis to look at the range of rates in the geographical area. The typical cost savings is substantial—between 25 and 40 percent. . . and the pharmaceuticals involved are not generics, but branded drugs. It is not uncommon for employer savings to exceed USD$250,000.

Making people aware of their options allows them to make more informed decisions. Particularly in these challenging times, consumers will vote with their pocketbooks in the US and overseas.

Check out the report on The Herman Group’s website at http://www.hermangroup.com/alert/archive_3-04-2009.html.

It seems that everyone is taking note of the live surgeries being reported via Twitter.  Elizabeth Cohen reported today on CNN (Surgeons send ‘tweets’ from operating room) that for the second time a surgery was tweeted live on Feb. 9, which doctors, medical students, and other twitter uses followed.

As social networking continues to make an impact on the medical world and how other individuals interact with their healthcare, its interesting to see the motivations and intentions behind sharing healthcare experiences on Twitter.  Our very own co-founder and COO Robert Hendrick shared his surgery live on Twitter (which was later posted on the blog). He cited his intentions to Ms. Cohen in an email: “It redirected my attention and allowed me to minimize some of the nervousness around what was going on. It felt like I had family and friends there to support me.”  He also says, “I wanted a record for other people who might be interested in the same surgery… It later allowed me to connect with others with the same issues.”

As Robert’s motivations for sharing his surgery highlight, advances in social media have enhanced and, in certain areas, changed the way we communicate and connect with others.  Think about the ways in which this has enhanced our lives, especially those in the healthcare space: doctors, patients, friends, relatives, and consumers can easily share their experiences for educational or recreational purposes.  It truly connects us.

This is where change:healthcare is focusing a good portion of our time. Enhancing the way individuals communicate and connect with each other about their health experiences.

Our platform uses social networking tools to let users rate, share and compare their healthcare experiences so others can make more informed healthcare decisions (or at least enter into a medical situation with eyes open – rather than tightly closed).  Everyone benefits because everyone shares their experiences, insights or recommendations. True transparency regarding costs and healthcare experiences!!

In both cases — either Twittering during surgery where other physicians learn from the experience and talent of another surgeon, or using social media tools to help strangers deal more effectively with their family’s healthcare issues — it only further exemplifies how far the power of transparency and involving consumers in their healthcare (accountability) can go in helping this country move toward a better healthcare system.

Download the PDF of the CNN Twitter story here.

Thanks to Frank Limpus for his contribution to this post!