2012 > June

Monthly Archives: June 2012

The Best of the Health Care Reform Supreme Court Ruling

Today’s big news was that the Supreme Court finally released their long-awaited ruling on the health reform bill, or Affordable Care Act (ACA). With the exception of a few pieces, mostly related to Medicaid, the Act is going forward.

Everybody’s writing about the ruling. So where are the best no-nonsense places to go to read about it? You know we like to simplify stuff, so here are our recommendations:

The shortest, simplest, plain-language summary of the ruling:

          Wall Street Journal Blog

The most straight-forward facts on how it will affect consumers:


The best way to follow the details:

          SCOTUS Blog

 The easiest way to read and navigate the official documents:

          NPR Interactive

 And of course, the Simplee explanation:

          Simlpee blog: What the ACA means for Consumers

Got specific questions about how the bill affects you? Let us know and we’ll get them answered.


Simplee Now Automatically Screens Your Claims for Billing Errors

Are you ready for an exciting new feature?

We know how painful it is to read through medical bills to make sure you were charged the right amount for the right services. And how even more painful it can be to not read through them and just pay what’s on the bottom line (hoping that you’re not getting screwed).

We’ve been thinking about ways to make it easier to understand your bills—and we came up with a feature that automatically reviews your EoBs (Explanation of Benefits) for some of the most common billing errors, reasons insurance didn’t cover a claim fully, and even strategies for how to save money in the future.

Now, when you get an email from Simplee about a new claim, it will include color-coded flags next to claims where we have identified a potential problem. Click on the claim, and we’ll explain the problem and what you should do next.

We’ve seen an average savings of about $91 on claims that the feature has flagged. Although one user who spotted a billing error through Simplee saved almost $1,000. Our hope is that this new feature will encourage everyone to start looking more critically at their claims and benefits and find ways to put more money back in their pockets.

Studies have found anywhere from 40%-80% of medical bills containing an error, so it’s worth taking a second look, right?

Some of the issues that Simplee will scan for include out-of-network claims, benefit limitations, claims for services that were previously covered, prescription drug costs, and a lot more. Learn more.

What billing errors have you noticed in your EoBs? Let us know at support@Simplee.com so we can start spotting them for you.

Here’s what you’ll see in your email. Keep your eyes out for it!


Questions to Ask When… You First Get a Medical Bill

You get a medical bill in the mail, or a notification that there’s a new claim in your Simplee account. Now what? Here are the questions you should be asking.

1) What were you charged for?

It seems obvious, but make sure you were charged for the right services and procedures—and that you were not charged for services that may have been ordered, but then cancelled. If the bill doesn’t clearly list the services, ask for an itemized bill. And if there are items you don’t understand, ask the provider to explain. If you want to be an extra rock star at checking bills, look up the CPT codes to make sure they match the service you received. The codes are not always shown on a bill, so you may have to request them from your provider.

2) What are the dates of service?

Are the dates correct? This is especially important for hospital stays. Most hospitals do not bill you for the day you were discharged if you left in the morning. For smaller services, such as lab tests, you may see a date sometime following the visit where they were ordered.

3) Who paid what?

The bill should break down the cost of the claim into at least three figures: the total charge or fee, any discounts or adjustments, and the amount your insurance covers. Your attention should be on the cost after any discounts and the portion your insurance covered.

4) Does “who paid what” line up with my benefits?

This is where you either need to pull out your benefits documents, call your insurance company, or log in to your Simplee account. Find out:

     • Have you have met your deductible? (the Simplee dashboard will show you)

     • Was the provider in or out-of-network?

     • Were the right co-pays or co-insurance applied?

     • Was there something that should be covered but was not?

If you’ve asked all these questions and you’re still wondering if the bill is correct, it might be time to call the plan or a professional billing advocate.


Medical Bills you Shouldn’t Pay: The Story of Balance Billing

Think back to that big hospital bill you got when you thought the stay would be covered—even when you made sure the medical center was in your network. Or the outpatient surgery, where there was a huge fee, even though the surgeon said he takes your insurance.

You might have been balanced billed.

In two sentences, balance billing happens when your insurance company and your doctor don’t have an agreement on how much a service should cost. And when the doctor doesn’t think he or she has been paid fairly, you get billed for the difference.

But what’s important is that often times, you are not responsible for the bill. In many states, balance billing in certain situations is against the law.

What is Balance Billing?

Balance billing can occur when you visit a non-contracted (or out-of-network) provider. That provider has no agreement with your insurance company as far as how much he or she should be paid to treat you (most likely, they couldn’t agree on what should be paid, that’s precisely why there’s no contract). That’s why balance billing is most common with HMOs (and sometimes PPOs).

Here’s what happens, in a nutshell:

1) You get care from the provider, and he sends a claim to your insurance plan.

2) The insurance plan doesn’t pay the entire amount (why would they? They’ve made no agreements to).

3) The provider is unhappy. He didn’t get fully paid for his services, after all.

4) The provider bills you for the difference.

Of course, it’s more complicated than this. Knowing whether or not your providers were in-network is not always obvious. And separating balance billing from deductibles and co-insurance (which are legitimate charges) can be confusing.

Remember that providers could include many types of people or facilities: Every doctor that sees you in the ER, the imaging center where you got an MRI, the ambulance company, or the hospital. For example, many balance billing cases occur when an anesthesiologist is non-contracted, even though the surgeon and the hospital are in your network. You hardly get to see the anesthesiologist, let alone ask ahead of time whether he or she works with your plan. The same thing happens in the ER. Most people aren’t about to stop to ask about insurance in the middle of an emergency.


What If You Think You Have a Balance Bill?

1)   Request an itemized bill if the services are not already broken out in detail. There should be separate line items for each provider.

2)   Compare the charges to your network benefits. Have you met your deductible? What are the co-pays or coinsurance? Determine whether the charges exceed your usual cost-sharing.

3)   Call your health plan and ask whether every provider involved was a network provider.

4)   Find out what the rules on balance billing are where you live—every state is different. Contact your state’s Insurance Department or go here for a quick check.

5)   If you believe you’ve been sent a balance bill when it was not allowed, contact your provider. If you can’t get the bill dropped, think about getting help from your state Insurance Department or a billing advocate.

Never ignore a bill—that could end up affecting your credit—but don’t be shy to question the amount that you owe. To learn more about why out-of-network care can cost so much, see Going Out of Network? Read This First.