Hospital Compare: Compare Hospitals Online

U.S. Department of Health & Human Services recently launched a website, Hospital Compare, that allows patients to compare measures of quality of care of more than 2500 hospitals nationwide. The website, which was created by the joint effort of the Centers for Medicare & Medicaid Services of DHHS and the Hospital Quality Alliance (HQA), is to provide ratings on key measures so patients, as well as family members and health care providers, can make better decision on health care (find out more about the website here).

I tried the service to find a hospital in our area to see how it works. Since I know the hospital’s name, I searched under the Hospital Name and found the hospital I was looking for. The results are given in three categories:

• Hospital Process of Care Measures, including
  • Surgical Care Improvement / Surgical Infections Prevention Process of Care Measures
  • Heart Attack Process of Care Measures
  • Pneumonia Process of Care Measures
  • Heart Failure Process of Care Measures
• Hospital Outcome of Care Measures
• Survey of Patients’ Hospital Experiences

In addition to giving the results in numbers (including the number of patients treated by the hospital) and tables, the website can also present the data in graphs for easy compare and understanding. For example, the following is the picture of the Surgical Care Improvement part which, as you can see, compares the particular hospital against the national average and the average among New Jersey hospitals that participate in this program (hospitals voluntarily submit their data).

How useful is this tool?

I don’t really know because I don’t have any medical need right now. But I think the information is quite helpful in the sense that patients, before deciding where to get the medical care they need, can have a big picture on where they could get better treatments for their health issues.

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No HSA for Us, for Now

When I first learned that my wife’s employer will provide a high deductible health insurance plan next year, I was quite happy that the option is finally offered because using such a plan ($3,000 annual deductible for a family) can 1) save us on health insurance premium now; 2) save money on future health care cost with a Health Savings Account (HSA) account. Since the deductible amount already meets the requirement for an HSA account, why not get one?

Though I have looked at HSA account before, this is the first time that I tried to have an account. After being told by my wife’s employer that they don’t have an HSA account available for employees, the only option will be getting one from a third party providers. So I checked several HSA providers’ websites to see what they are offering and even called HSA Administrators twice to ask them about the procedures to open an account and documents required. Everything seemed to be fine until I asked HSA Administrators how to get reimbursed for expenses such as copay.

“HSA eligible insurance plan usually doesn’t need copay.”

Then I knew something wasn’t right because my wife’s plan does require copay. Somehow I was under the impression that the only requirement for an HSA account is the amount of deductible. The CSR on the phone asked me to contact the health insurance provider to make sure that the plan we want to use is indeed eligible for HSA accounts, not that we think it is.

We checked almost everything and the only thing we didn’t do is call the insurer. When my wife did call, the CSR didn’t even know what HSA is at first. After a few minutes, she came back and told my wife the plan we will be using is not eligible for an HSA account Though we still selected the high deductible plan, it’s pity that we won’t be able to stack away more pre-tax money for future use.

If you have the option to use a high deductible health insurance plan and want to use an HSA account to save for future medical cost, call your insurance provider to make sure that particular plan is eligible for HSA accounts before starting your research on finding a good HSA provider. A high deductible insurance plan doesn’t automatically qualify for an HSA account!

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Getting a HSA Account?

It’s the open enrollment season again and next year my wife’s employer will start to offer a high deductible health insurance plan (HDHP). This means we will have the chance to take advantage of the Health Savings Account.

From the material my wife received last week, the high deductible option has $1,000 deductible for a single person and $3,000 for family, meeting the requirement to be eligible for an HSA account, which has a family deductible limit of $2,200 for 2006. The way that an HSA account together with a HDHP can save money in the long term is quite simple: pay less premium with a high deductible health plan and contribute pre-tax money to an HSA account to cover future medical expenses (check out my previous post on how to save money and profit from HSA). For my wife’s high deductible plan, the bi-weekly employee contribution is $33.85. Meanwhile, a basic plan that requires $1,200 in-network annual deductible has a contribution of $70 per paycheck per family. Though we could potentially pay $1,800 more in deductibles, the $940 annual saving on premium is real.

While everything looks good so far, the only catch is having an HSA may mean we can’t use the flexible spending account, according to the Treasury:

My employer offers an FSA, can I have both an FSA and an HSA?
You can have both types of accounts, but only under certain circumstances. General Flexible Spending Arrangements (FSAs) will probably make you ineligible for an HSA. If your employer offers a “limited purpose” (limited to dental, vision or preventive care) or “post-deductible” (pay for medical expenses after the plan deductible is met) FSA, then you can still be eligible for an HSA.

However, this shouldn’t be a serious problem as, if we opt to the high deductible plan, we can contribute up to $5,650 to the HSA and use only a small portion of it to pay our current medical expenses while investing most of the money.

Another concern is the cost of using an HSA and whether it actually financial sense. Before comparing HSA providers, I checked the HSA Administrators’ website (which is recommended by Kiplinger) and found the following fees it charges for HSAs:

• Account setup fee: $ 20.00
• Annual administration fee: $ 39.00
• Mutual Fund custodial fee: .0009 times the account balance per quarter, deducted from account balance
• Resource Bank Debit Card Customers (not mutual funds)
  • $2 per month
  • Checks: $8.25 for 25 checks
• Transfer to Another HSA Custodian: $25.00

While the account setup fee and administration fee seem to be fine, the problem is the quarterly custodial fee which is proportional to the account size. It’s not a big deal at the beginning when the account is simple, but we contribute to the maximum allowed every year and hold the money in the account till we retire, the fee could be significant.

There are still some homeworks to be done before we decide on which plan we want to use and some clarifications from my wife’s employer are also needed. Assuming no big surprises, we are likely to use the high deductible option next year.

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Whether you need the latest info on stock quotes or want to know the return on certain types of bonds there is sure to be up to date information at smartmoney.com! Keep track of your money the smart way and help your investments grow!

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More on Health Savings Account from Kiplinger

In late December I wrote a piece on how to use health savings account (HSA) to save money on health care in the future. Today, an article appeared on Kiplinger's Personal Finance website further illustrated the idea of using HSA as a financial planning tool rather than simply a health care account. According to the article,

Now, people with family plans can contribute up to $5,650 for the year, regardless of their deductible (as long as they have a deductible of at least $2,200, which they need to qualify for an HSA). Individuals can contribute up to $2,850 but need only a deductible of $1,100 to qualify for an HSA.

The changes were due to the new law, "Tax Relief and Health Care Act of 2006," which was signed on December 20, 2006. As for the tax benefits of using an HSA, the article says

The longer you can keep the money in the HSA, the bigger the tax benefits you can reap. You can contribute pre-tax money to the account, where it grows tax deferred and can then be used tax free for medical expenses - a triple tax benefit that's tough to find anywhere else. The more time the money remains in the account, the greater benefit you'll get from the tax-free earnings.

To be eligible to contribute to a HSA, however, you have to have a high deductible health insurance plan. Check out the Treasury Department website for more details about the rules of getting a HSA.

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• Getting a HSA Account?

Health Savings Account: How You Can Save Money with and Profit from It

The Health Savings Account (HSA) by definition, according to the Treasury Department, “is an alternative to traditional health insurance; it is a savings product that offers a different way for consumers to pay for their health care.” And it is created to help you “pay for current health expenses and save for future qualified medical and retiree health expenses on a tax-free basis.” That is, the HSA allows you to set side certain amount of pre-tax money (if your employer participates in HSAs, otherwise you can deduct the money) each year so you can use the money to pay for the medical expenses that are currently not covered by your insurance plan or during retirement. To qualify for a HSA contribution, however, you must have a High Deductible Health Plan (HDHP) which has the following deductible limits:

• Self-only coverage: $1,100
• Family coverage: $2,200

If you meet the above limits, you are eligible for a HSA and can make annual contribution that doesn’t exceed the health insurance deductible. Since the contribution in HSA is tax deductible, participating in HSA can save you money on taxes by reducing your taxable income by the same amount. What’s more, the contributions in HSA can be invested in the same way as you make IRA investments into stocks, bonds, mutual funds, and CDs. Therefore, if you can select a HDHP and contribute the annual limit into a HSA without really using it (i.e., you still pay the medical expenses out of your pocket and let the money in HSA grow tax-deferred), it will be “a tax-free way to help you build savings for future medical expenses.” Last Friday, a Reuters article outlined several ways to get the most from a HSA:

• Load it to the max. For 2007, you’re allowed to put away as much as $2,850 for single coverage or $5,650 for family coverage in your HSA account, even if your policy’s deductible is less than that.
• Invest it. Treat the money in your HSA as a long-term investment.
• Pay out of pocket for your health-care costs and don’t use the HSA money unless you absolutely must so you can build a HSA nest egg for retirement when you need it the most.
• Push your employer a little. See if your employer can offer HSAs by simply moving money from existing Flexible Spending Account or Health Reimbursement Accounts into an HSA.
• Make a full contribution in your first year. Even if you establish a HSA late in the year, you can still make the full deduction.
• Pass on the IRA transfer. You can one-time transfer from the IRA to an HSA, up to the maximum HSA contribution for that year.

For more information (eligibility, limits, penalty, ect) on HSA, click here and HSAInsider is a place to find the providers in your area.

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*Photo from Rimato & Association.

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50 Ways to Save on Medical Bills from CNNMoney

First, I'd like to remind you that I am having a small "Investor Psychology Contest" with a prize of $20 before 4:00 pm this Friday. If you are interested in participating, click here and leave your best guess of the closing number of the Dow on November 22nd. 

Ok, now the main story.

For many of us, this time of the year is for the health care open enrollment period. While selecting the right plan with the right coverage for the fmaily may save hundreds, if not thousands, out-of-pocket medical expenses, there are many (actually as many as 50) ways to cut costs as well. Yesterday, I read an article on CNNMoney which offers many money-saving tips on medical bills. Following are the highlights from the article.

1. Ask for a deal: Call your insurer and ask about the rates it pays physicians in your area. Then ask your doctor if he'll accept a similar amount.
2. Get the facts: The more you know about the real cost of your care, the better you'll be able to negotiate discounts.
3. Pay up front, in cash: If you shoulder your own medical bill, paying in advance of treatment can get you a 10% discount.
4. Look for mistakes: As many as eight out of 10 hospital bills contain errors, increasing the tab by 25% on average. Keep a log of every test and medication you get, and check it against your medical file.
5. Check up before you check in: Call your doctor to get the names of the medical providers who will be involved in your treatment, and verify with your insurer that they're in the network.
6. Track your spending: Use programs such as Quicken's Medical Expense Manager to track your spending and alert you to potential savings such as overlooked tax deductions and possible billing errors.
7. Follow doctor's orders: Simply doing what you're told can save you your out-of-pocket share of the average $8,200 cost of a hospital stay.
8. Equip yourself: Bring (or buy) your own equipment such as crutches or braces instead of letting your hospital get them for you.
9. Seek smart counsel: Use a certified counselor or clinical social worker (average fee: $90 an hour) instead of a psychologist for mental-health therapy.
10. Visit a retail health clinic: Visit a walk-in clinic found at retail stores like CVS and Wal-Mart for minor illness such as Got an earache or upset stomach to save up to 25%.
11. Choose wisely: Don't keep the same health plan year after year. Use your past annual medical spendings as a guideline to choose a plan that best suits your family's medical needs.
12. Widen your network: If you have to use out-of-network providers, call your insurer's pre-certification department to explain your situation and ask for coverage at in-network rates.
13. Follow the rules: Read the fine print on your plan to find out your insurer's requirements for referrals and pre-certification.
14. Get what you deserve: Check your insurer's website or call the help line to see if your plan covers alternative medicine treatments.
15. Don't be denied: Don't just let it go if your insurer denied your claim. Fight back by calling customer service or putting your appeal in writing. Document everything, including the times of calls and the names of the reps you spoke with.
16. Hire expert help: Consider hiring a professional billing and claims specialist to help you resolve disputes. The fees may be steep, but your savings could be big.
17. Check yourself out: Before signing up for a new insurance policy, go to MIB.com to see whether this insurance industry antifraud group has a file on you. Request a free copy to make sure the information provided about your health status is right.
18. Consider an HSA: If you have a high-deductible health plan (at least $1,050 for individuals; $2,100 for families), you are eligible to fund a health savings account (HSA).
19. Stay insured: Leaving your job next year? Switch to the lowest-cost plan during this year's open enrollment. Then, after you quit, federal rules (known as COBRA) will let you stay on your employer's health plan for up to 18 months, although you'll usually have to pay the full cost.
20. Be flexible: Add up your co-pays, deductibles and other out-of-pocket medical expenses from last year to figure out how much to put into your flexible spending account. For every $1,000 you put in, you'll slash about $300 in taxes.
21. Don't lose it: You'll forfeit any funds in your FSA that you don't use by the end of the year or by March of the following year. Why not stock up on over-the-counter medical supplies like Band-Aids, cold and flu tablets and aspirin?
22. Game the system: If you're close to the dollar limit for doctor or dental visits in a calendar year, book half your appointments in December and the rest in January.
23. Take the write-off: The IRS allows you to deduct medical bills that exceed 7.5% of your gross income.
24. Grab generics: Whenever you can, opt for generic drugs, which on average cost less than a third as much as their brand-name counterparts.
25. Go postal: Call your drug insurer and ask if you can order your prescriptions directly from the plan, which can save you 15% to 35% on your monthly co-payments at the pharmacy.
26. Split 'em up: Ask your doctor if you can safely split a higher-dosage pill in half as high-dose pills are generally priced the same as their low-dose counterparts.
27. Ask for samples: Your doctor may be able to supply you with several weeks' worth of medication at no charge.
28. Shop Mom and Pop: Your medicine costs can vary widely depending on where you buy. Go to discounters like Costco, Wal-Mart, and other drugstores for the best prices.
29. Find a cheaper alternative: Ask your doctor about a therapeutic substitute or an older drug in the same category as the brand-name drug.
30. Buy online: The best deal may be just a few clicks away.
31. Sign up for Medicare part D: If you're 65 or older and don't currently have drug coverage, sign up the government's drug plan for seniors as soon as you can.
32. Go for the discount: Visit the Partnership for Prescription Assistance website (pparx.org) for more than 400 patient-assistance programs offering discounts on more than 2,500 medications.
33. Stick with the plan: Use in-network dentists as well.
34. Join a discount club: Enroll in a discount dental plan, offered through major insurance companies like Aetna, Cigna and WellPoint if you don't have dental coverage.
35. Go to dental school: A clinic at a major dental school may save you even more on dental bills.
36. Choose cheaper fillings: Choose amalgam fillings over resin-based fillings. They are not just cheaper, but last longer too.
37. Don't pay retail: Don't buy your contact lens from optical retailers or your doctor's office. Go to Costco or go online for better prices.
38. Forgo pricey extras: Forget about the anti-reflective coating on your lenses and pass up ultralightweight titanium frames.
39. Take an aspirin: because it can sharply lower your risk of a heart attack, especially for men over 40, women past menopause or a smoker.
40. Stress less: Reduce stress by taking a yoga class, listening to music and exercising for at least 30 minutes a day.
41. Stub your butt: Quit and save on health-care costs, homeowners insurance, individual life insurance, and dry-cleaning and dental bills.
42. Put a cork in it: Save money and stay healthy - have no more than one drink a day if you're a woman, two if you're a man.
43. Get moving: Keep yourself in shape so you don't have to worry obesity and related medical costs.
44. Get a lunchbox: Why not? Taste good, save money, and consume less fat.
45. Drink from the tap: Bottled water has no proven benefit yet you keep drinking it.
46. Wash up: The best way to prevent flu: soap and water. Get into the habit of scrubbing your hands for about 15 seconds.
47. Let the boss help: Take advantage of any wellness benefits that your company offers.
48. Adult-proof your home: So you won't have an accident at home and won't need emergency room visits.
49. Floss daily: It's the best way to prevent periodontal disease.
50. Question your tests: When it comes medical tests, sticking to the baseline exams rather than going for cutting-edge medical tests may means thousands in savings. And be sure to check U.S. Preventive Services Task Force (ahrq.gov/clinic/uspstfix.htm) for recommended tests.

Click here to read the full article. 

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No Immediate Danger of Our Health Plan

During our last visit for a scheduled checkup, we were informed that our help plan, Aetna HMO (we didn’t choose PPO or POS plan mainly because we are still young, in good health, and only use our doctor for annual physical), will no longer be accepted by the hospital. The reason, as we heard from our doctor, was that Aetna wants to put a ceiling on the cost of each delivery and the hospital rejected the proposal as the amount wasn’t enough to cover the whole bill.

Since then, we have contacted Aetna, the hospital, and our doctor, and found we still some breathing room. Actually, only Aetna PPO and POS will be terminated by September 19^th. For HMO plan, the hospital’s contract with Aetna will expire next January , and by then we should have a new health plan that is in the hospital’s network (the annual renew starts next month). The hospital also told us that since my wife is already in the second trimester and did all her first trimester tests with the hospital, her scheduled Amnio, which is late this month, will not be affected anyway. This gave us some relief as we were really worried when we first got the news. It won’t be too much trouble to change hospital, but finding a good OB/GYN (yes, a good doctor) isn’t an easy job, not to mention rescheduling the test, which has to be performed during certain period of time. Glad we don’t have to go through this at least for now.

As for the future, the hospital proposed an alternative to us: we switch to Aetna PPO or POS plan next year and continue to use the hospital till delivery. Aetna will pay the hospital at the out-of-network rate which covers about 70% of the cost and the other 30% will be our responsibility. However, since even at 70% what the hospital will receive is still higher than what Aetna plans to pay under the new proposal, the hospital can waive the 30%.

The proposal is interesting, but I am afraid we don’t want to go this route as it’s kind of risky. Even if there is a written agreement from the hospital, the potential trouble outweighs any benefit the plan (PPO or POS) has to offer. The simplest solution may be just getting an in-network plan.

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