Choosing the Location for Your Health Care Services
Recently there has been a trend of hospital ownership groups purchasing health care facilities and provider practices. This shift in ownership can change the way health care services are billed. Services that have traditionally been performed and billed as office visits are now being billed as outpatient facility claims, resulting in additional costs. While these arrangements can sometimes offer convenience to you as a patient, you should know how this can impact your out-of-pocket expense, as well as the overall cost of services. Where services are performed and how they are billed can make a significant difference in the cost. Here are two ways this might happen:
- Hospital-acquired Free-standing Ancillaries: When a hospital purchases a free-standing ancillary facility (such as an outpatient surgery center or a diagnostic imaging center), there is the potential for claims for those facilities to be submitted as if you had visited a department within the hospital itself. This can result in higher out-of-pocket costs for you because of the additional expenses often billed for outpatient services.
- Hospital-acquired Professional Practices: Changes in how claims are filed may also occur when a hospital purchases a physician practice. Once a hospital owns a practice, a physician who may have previously performed and billed for services in the office setting (including radiology, lab tests, chemotherapy, and others) may begin referring patients to the hospital for these services instead. These types of services tend to be more expensive when performed in the hospital setting and patients may now be receiving multiple bills (including one from the hospital for outpatient services and one from the physician for the office visit). This often results in additional costs for the insurance plan and higher out-of-pocket costs for you for services that were previously billed solely by the physician (and generally required only the office visit copayment as your out-of-pocket cost).
Costs for services such as x-rays, MRIs, CT scans, ultrasounds, and other diagnostic procedures, can vary greatly. These types of services are often more costly if you choose a provider that participates in one of the arrangements described above.
How to Maximize Your Benefits and Help Control Your Health Care Costs
Being a smart consumer starts with asking the right questions before obtaining health care services. A few important questions to begin with include: Is my provider a Blue Cross and Blue Shield of Texas (BCBSTX) network provider? Am I getting the most out of my benefits? What are the billing practices in my provider’s office? Is there a lower cost alternative? Will I get the same level of service at a stand-alone facility as in a hospital setting?
If you think you may want to explore what options are available for your specific health care needs, you can visit www.bcbstx.com/ut. Once there, use the "Provider Finder" (found under the “Doctors and Hospitals” tab) to search by "Type of Provider." Select "Ancillaries" for the Provider type and select a particular specialty to find alternatives and see which may be lower cost. You can also call the BCBSTX UT SELECT Customer Service team at (866) 882-2034 to find out more about your available alternatives and to get an estimate of what the cost of your services will be. Finally, you can consult your 2013-2014 UT SELECT Health Benefits Guide as an additional resource.
Confirm Your Benefits
After services are rendered, ALWAYS review your bill(s) and your Explanation(s) of Benefits (EOBs). Follow these recommendations to be sure you don’t overpay for medical services.