Costly Healthcare for Consumers?

By Zaneta Lowe  - bio | email | Twitter

COLUMBUS, GA (WTVM) - You may not notice it until you get a bill in the mail, or you walk into your doctor's office and a sign at the counter tells you your insurance is no longer accepted.

It's an issue that recently surfaced as a local health provider and insurance company are odds over a contract agreement.

But, some medical professionals say the debate over reimbursements isn't a new one, and unfortunately one patients could end up footing the bill for.

"From what I've seen, it is an ongoing trend for insurance companies just to make it more difficult for offices to get paid for seeing patients," says Pediatrician Dr. Richard Mansfield of Flowers and Mansfield.

Late last year his office stopped accepting Peach State, although that has since changed.

Back in 2006, the Medical Center stopped accepting Alabama Medicaid and now only does in cases of E-R and Pediatric Admissions.

Dr. Cathy Cook has been practicing dentistry for more than a decade.

She says reimbursements are especially a problem with state or federally funded programs like Medicaid.

"Each state has an annual budget if the budget is cut then it cuts the reimbursement for the services that are covered under those programs," says Dr. Cook.

So what does this all mean for you?  Fewer options or shelling out more money.

"If we're looking at a network that has like a 30 or 50% reduction of our fees, you know as a provider you may opt not to go back with them because then that patient has to pay the difference in what your fee schedule is and what the network's fee is and it may be $8, $12, $20, so then it's passed back to the patient," explains Dr. Cook.

With healthcare reform underway could this all change?  Dr. Mansfield says maybe not.

Why? He says more Americans covered may not equal greater access.

"If there are more roadblocks in the way or reimbursements are decreased anymore than it is, fewer physicians will be accepting various plans."

Dr. Cook on the other hand says she's optimistic things will turnaround for both providers and patients.

"I think that the budgets will get bigger and some of the codes we've had to eliminate and some of the codes we've had to decrease reimbursement, those will increase."

So as patient, what can you do in the process?  Experts say the first step is to really undertstand your insurance plan.

Take that hand book and call your insurer to make sure you understand what's really covered.