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An ex­cerpt from our Em­ployee Bene t Views blog, writ­ten by Loretta Met­zger, bene ts con­sul­tant at Cor­po­rate Syn­er­gies, an em­ployee bene ts bro­ker­age and con­sul­tancy.

Pre­par­ing em­ploy­ees for sur­prise med­i­cal bills

When em­ploy­ees get sick or in­jured, the last thing they need is a jolt to the heart when med­i­cal bills start rolling in. Yet sur­prise bills are be­com­ing more com­mon.

As an em­ployer, you might feel pow­er­less to help an em­ployee deal with a nan­cial blow of hun­dreds or even thou­sands of dol­lars. But you can help, or rather, there are spe­cial­ized em­ployee ad­vo­cacy cen­ters that can o er as­sis­tance.

e doc­tors who charge the most are typ­i­cally those that a pa­tient did not choose. A se­ri­ously ill or in­jured per­son who is rushed to the emer­gency room may not be in a po­si­tion to check if the anes­the­si­ol­o­gists, ER physi­cians, neu­ro­sur­geons, pathol­o­gists and ra­di­ol­o­gists are all in-net­work. Re­searchers from the Yale School of Pub­lic Health and the Yale School of Man­age­ment re­viewed more than 2 mil­lion ER depart­ment vis­its and they found that one in ve pa­tients who used in-net­work emer­gency room fa­cil­i­ties were ac­tu­ally treated by an out-of-net­work doc­tor. is ex­posed pa­tients to ad­di­tional, and some­times huge, charges that were not cov­ered by their med­i­cal plans.

A re­cent study in the Jour­nal of the Amer­i­can Med­i­cal As­so­ci­a­tion found that the av­er­age physi­cian charges about two-and-a-half times what Medi­care pays, while some charge up to four times more. In­sur- ers typ­i­cally use Medi­care pay­ments to de­ter­mine what they will re­im­burse pa­tients. Out-of-net­work physi­cians re­ferred by the in-net­work doc­tor also drive high costs.

e prob­lem of sur­prise med­i­cal bills is be­com­ing a fact of life for many em­ploy­ees, as in­sur­ance net­works nar­row and elim­i­nate cov­er­age for out-of-net­work ser­vices in an e ort to save costs. is can put em­ploy­ers in a tough spot. Em­ploy­ees could get stuck with a hefty med­i­cal bill sev­eral weeks — or even months — af­ter get­ting care. en they come to HR or their bene ts depart­ment for help de­ci­pher­ing a bill or a com­pli­cated ex­pla­na­tion of bene ts state­ment.

Bene ts ad­vo­cacy ser­vices are of­ten pro­vided by health in­sur­ance bro­kers. A strong em­ployee ad­vo­cacy pro­gram can help em­ploy­ees nav­i­gate a high med­i­cal bill and even intercede to re­duce a bill for emer­gency health­care ser­vices. Bene ts ad­vo­cates can also help par­tic­i­pants re­view their in­sur­ance plans be­fore a pro­ce­dure to de­ter­mine what the plan will pay.

To read this blog in its en­tirety, check out http://bit.ly/2rGZb1J.

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