While the majority of doctors and hospitals are honest, a bribery and kickback trial in Texas convicting four doctors reminds us that patients need to be ever vigilant for their own health and financial interest. Patients tend to trust their doctors at their word, but need to be aware that surgery and surgical referrals are big revenue generators for hospitals and doctors and not always necessary. Powering Modern Healthcare Marketplaces, Medxoom helps provide discovery on price and quality before any medical procedure.
According to Politico, one of the biggest impacts of Obamacare is the rise in tax-exempt not-for-profit hospitals’ revenue and their concurrent reductions in charity care. High and unknown costs before service are standard procedure at most hospitals, so employers need to fend for themselves. Medxoom’s modern marketplace technologies help employers and their employees shine a light on local hospital care quality and costs so they can try to get the best outcome at the best price.
As healthcare costs continue to rise for employers, former GE CEO Jeff Immelt argues that one of the most effective ways to spark change is from CEOs themselves. If companies start to treat their own health care benefits like a business, then we should start to see some positive change in cost reductions. Medxoom helps companies lower costs, improve quality, and increase employee health benefits satisfaction with easy to use modern marketplace technologies.
The Trump Administration took a big step toward giving people more transparency for their hospital costs by signing an Executive Order on June 24, 2019. This new Executive Order should help patients and employers gain the transparency in pricing that Medxoom has been able to give through our proprietary pre-service shopping technology. While there are no immediate changes, this is the next step in the right direction. Medxoom can help now while we await the changes in the laws.
The typical self-funded employer health plan using a BUCA (Blue, United, Cigna, Aetna) PPO is paying about 275% to 350% after the highly touted BUCA “discount” of 50% off gross billed charges of 550% to 700% of Medicare for any hospital procedure. Many states are now demanding to pay less — from 150% to 180% of Medicare to save millions by not overpaying.
Medxoom can help any employer health plan member pay less by knowing what their plan’s charges are before service so employees can go to lower price higher quality providers.
As follow up to a previously posted article, U.S. Senators are proposing new laws that would require any financial incentives or other enticements paid to benefits brokers by health insurance carriers be made public. Supposedly “independent” brokers have been receiving financial incentives from various health insurance carriers, creating potential conflicts of interest that drive up costs to employers and their employees.
In the healthcare industry, price transparency — knowing the price of a procedure before it’s performed — is a well-known problem that we at Medxoom have been working to help solve. This recent Executive Order from the White House requiring public price disclosure for medical service means that there may be a change coming. While we wait for government laws to take shape, Medxoom can help. Our technology helps employers and their employees by making it very easy to do pre-visit comparison shopping for price and quality based on their plans historical claims data and public government hospital pricing data.
Patients believe their insurers are fighting on their behalf for the best prices with hospitals, but saving patients money is not insurers top priority — their own profit is. A perverse incentive of the Affordable Care Act say insurers can only keep 15%-20% of premiums as profit, so higher medical bills equal higher profits.
Thus “discounted member rates” insurance companies negotiate with hospitals tend to be 3X Medicare rates for the same procedure. Even these prices, which employers and employees are legally obligated to pay, vary markedly in the same city. Medxoom technology protects employers and their employees by allowing pre-visit comparison shopping for price and quality based on their plans historical claims data.
Good Samaritan Jeannette Parker, trying to help a stray kitten, got bitten, and ended up as another recipient of “surprise ER billing.” Jeannette needed to be treated, but had no way of knowing in advance she’d be overcharged 10-fold for a rabies drug. Had Jeannette’s employer used Medxoom, she could have taken just a few minutes to look at ER stitches and rabies pricing available to her nearby. Medxoom allows patients the ability to know about how much their plan’s hospital visit will cost before visiting and allow patients to choose a hospital accordingly, lowering a patient’s out-of-pocket expenses and employer’s healthcare expenses.
Former New York Times reporter Jeanne Pinder, Founder & CEO of ClearHealthCosts.com, gave a TED Talk highlighting the wide price discrepancies charged by healthcare providers in any city and across the U.S. for the same procedure. There are no easy clear ways for patients to obtain costs for any medical procedure before getting a bill. Jeanne asks what if you could make getting and medical service like getting a laser printer with pricing and where to go information. Medxoom’s pre-service comparison shopping technology based on a plan’s historical claims data can help employees find the lower cost higher quality providers in or near their homes.