Navigating the Health Care World

“Navigating the Health Care World” by Andrew Rogers

Andrew Rogers, a member of SAG, has been employed in the health care sector for 14 years negotiating contracts with physicians, hospitals and ancillary providers. He is also a volunteer member of the Performers Health Care Council, a committee of union members from AEA, AFTRA and SAG.

I’m writing this article in the hopes that it helps my fellow actors, both those with and without insurance, when it comes to navigating your health care needs. Those of you who currently have no health insurance coverage need to know that everything is negotiable. No one has to pay full price for medical care. Always remember to inform your provider that you have no insurance and are in a “self-pay” status. Most providers are willing to give you a discounted price, especially if you are prepared to pay the day of your visit. If you aren’t able to pay all at once ask about a payment program where you can pay monthly until the bill is paid off. Also, check the resources at the Actor’s Fund (www.actorsfund.org) as you may be able to find an affordable health insurance plan for yourself and any dependents.

Providers accept any negotiated rate as payment in full from the different insurance companies and government programs they are contracted with. One negotiating strategy is to offer to pay the lowest negotiated rate (IE-Medicaid, Medicare or a private payor rate), the same amount the doctor or hospital would be paid if you were insured.

Hospitals are being highly scrutinized by various state attorneys general and some have been drawn into class action lawsuits for violating their not-for-profit obligations to the needy and uninsured. Some hospitals are now establishing “rates” for people who are uninsured versus billing them at full charges. If you need services at a hospital you should inquire about their sliding fee schedule for uninsured or “self-pay” people. Also, most not-for-profit hospitals offer charity care so make sure to inquire if that program is available. If you are unable to negotiate any of these kinds of payment arrangements up front (IE- emergency admission), you can also try these same negotiating tactics once you start receiving bills after your discharge. Many hospitals now have a patient account representative visit you prior to discharge to begin these payment arrangements. Hospitals are also more than happy to put you on a monthly payment program that is usually interest free until the bill is paid off.

Speaking of hospitals, anyone with or without insurance needs to be aware that if you are having a surgery performed (either inpatient or outpatient), or visit the emergency room, or are sent there for blood work and/or x-rays by your doctor, there is an extremely high likelihood that you may end up receiving more than one bill. The hospital will bill you for the ‘facility’ fee and the other bills could come from the P.A.R.E. physicians.

• Pathologists are the doctors who ‘read’ or interpret the blood or specimen.
• Anesthesiologists are the doctors who ‘put you to sleep’ for the surgery.
• Radiologists are the doctors who ‘read’ or interpret the x-rays.
• Emergency Room Physicians are the doctors who you see in the emergency room.

Each of the above specialty physicians will send you a bill for their “professional” services while the hospital bill covers the “technical “ component only.

These four types of doctors will always submit a separate bill from the hospital unless they are ‘salaried’ or ‘employed’ physicians of the hospital. If they are salaried/employed then the hospital will include their fees on its bill. If you are planning on having services rendered at the hospital it is important to ask the name of the doctor and/or group, and whether they are salaried/employed so you can make sure they are participating with your insurance plan.

Ambulatory Surgery Centers are another place where you can go to have an outpatient surgery performed on the same day. Similar to the hospital situation above, make sure to ask if the anesthesiologist is salaried/employed by the center. If not, then get the name of the doctor and/or group to make sure they participate with your insurance plan.

I’ve highlighted the biggest areas that affect many of you based on stories I’ve heard on sets over the past year and a half. I hope that you now are a little more informed and can utilize this information to make healthcare more affordable.