TL/DR –
Munson Healthcare’s Chief Medical Officer, Dr. James Whelan, discusses flaws in the American healthcare system such as the complexity in billing, which can often lead to patients receiving multiple bills from different providers for a single Emergency Room visit. This can especially occur when medical staff aren’t under the same provider network, causing some to charge higher prices for their services. Whelan advises patients to be aware of their insurance deductible amounts and to advocate for themselves by asking necessary questions about their billing and treatment.
Confusion Surrounding Health Care Billing System
The health care system, particularly its billing aspects, can often be puzzling. Questions are regularly raised regarding the system, as affirmed by Dr. James Whelan, Chief Medical Officer of Munson Healthcare Clinically Integrated Network.
One such question arose when a patient received a bill from Texas for an emergency room visit in Cadillac. Whelan reveals that this is due to Munson Healthcare’s recent partnership with Texas-based provider group, SCP Health, in October.
Baffling many people is why they receive several bills for a single ER visit, sometimes months apart. Whelan cites this as one of the significant flaws of the American health care system. It also contributes to the difficulty of determining the cost of services and procedures.
In an ER visit, patients generally receive separate bills for the doctor, the radiology group, and the facility charges. This system becomes more complex when providers are not part of the same network.
Efforts to Simplify Health Care Billing
Whelan refers to attempts in recent years to unify all hospital providers under one network to prevent patients from unexpected, exorbitant costs, and decrease the number of bills received. However, complexities prevail, particularly in the way insurance and deductibles operate, especially for those with multiple insurance plans.
The deductible is the amount that must be paid by the insured before the insurance policy covers expenses. Whelan advises understanding your deductible as the best way to estimate actual costs. It’s also important to know if you need to submit a bill to a secondary insurance company after the primary insurance pays the provider.
Munson Healthcare’s Support and Whelan’s Counsel
While Munson Healthcare provides staff to assist with these issues, Whelan emphasizes the importance of patients acting as their own advocates. He encourages patients to reach out to him for any queries about the health care system at jwhelan@mhc.net or clamphere@cadillacnews.com.
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