Archive for August 9th, 2014

Balance Billing & Provider Push Back

Saturday, August 9th, 2014

Adam Russo of the Phia Group explains balance billing strategies

Editor’s Note: Excellent explanation of balance billing and Cost Plus Insurance through Caprock Health Plans. If you don’t have the time to view the entire video, fast forward to the 30:36  minute mark.

What Does A Hydraulic Pump & Health Care Have In Common?

Saturday, August 9th, 2014

tractorLiving out in the country has challenges most city folk never experience. The first rule of country living is that “things” constantly break and need repair. Not a day or week goes by without some sort of catastrophe that must be addressed for life to get back to normal. It could be a well pump, fencing down, or a worn out hydraulic pump on a tractor.

Sure enough, just the other day the hydraulic pump on the tractor suffered a stroke. Living in the country, losing use of a tractor is a serious, serious development needing immediate attention.

Loading the tractor on the trailer, a quick trip 37 miles to the nearest Tractor Emergency Room in Victoria, Texas brought anticipated relief that all would be cured expeditiously. I felt we were in good hands, after all these guys are experts in their field. I trusted them.

However, anxiety levels reached new highs when told “Sir, your hydraulic pump has reached room temperature (Translation: it’s dead!) with no chance of recovery. We can perform a transplant for $2,400 plus labor.”

“Wait!. That seems outrageous! Is that the best your can do?” I said. “Yes Sir, that is the best I can do, I know it’s an awful lot of money , but it is what it is. Parts are expensive!”

“Don’t operate yet. I want to make some calls! I will get back to you shortly. I don’t have Tractor Insurance, this is self-pay!”

I called the dealer near Austin where I bought the tractor several years ago – his price? A bargain at $1,800! “Let me think about this, a funeral may be cheaper!” I said.

I turned to my “Procurement Officer” in Dallas (Number one son-in-law) for help. This guy finds stuff at good prices all the time – every family needs a guy like this. Within a day he found a source for a new hydraulic pump for $1,200, or half of the price quoted by the Tractor Emergency Room doctor in Victoria, Texas and significantly less than the tractor birthing center near Austin.

“Bill, If you had Tractor Insurance with a $20 co-pay, I bet  you would  have told the Victoia Tractor Emergency Room personnel to go ahead and operate! Isn’t this a lot like medical costs and insurance you deal with all the time in your business?” asked my new parts broker.  “Yes, and I am going to assign the Victoria Tractor Emergency Room as an out-of-network provider for my self-pay tractor insurance program!”