We waste a lot of time at Howard’s! Not really if you look at it from a business perspective; however, the average oxygen patient for us to get their paperwork covered by Medicare requires eight faxes and two trips to the doctor’s office. A complex rehab wheelchair runs around ten faxes, three trips to different provider’s offices, and a final patient file that usually is over forty pages long. Even something as simple as a basic brace comes with a prescription and at least five pages of documentation and intake forms.
Why not use a HSA account instead?
The HSA or health savings account in my opinion could solve our country’s health insurance problem. For those that do not know what a HSA account is, it is a tax advantaged savings account for people who are enrolled in high-deductible insurance plans.
From a personal family standpoint, I decide how to spend our family’s money. Instead of being limited on what our insurance covers, we can use it on what our family feels serves our health needs best. There are requirements to things you can and cannot spend the money on. For example, a health club membership would not count. But items our family has used the money on: chiropractic care, massages, drug prescriptions, copays at our doctor’s offices for check-ups and test, etc. are covered under a HAS plan and tax-free (in 2015 $3350 for individuals and $6650 for families).
Now if it were up to me, I would give a cash discount to anyone who wanted to buy at Howard’s because this would make a lot of sense because it would allow us to focus on taking care of the customer instead of chasing chart notes and paperwork. Unfortunately, Medicare does not want us to do this because there is actually a law that states we need to give the same price to Medicare as everyone else. So what have we done at Howard’s? We have two lines of braces and products: one for our insurance patients made by a specific brand; we also have another brand (non-coded for you high-compliance lawyers out there) that we have specifically for our HSA patients or cash pay patients.
For example, our carpel tunnel wrist brace through Medicare and insurances we charge about $79.99*. A very similar brace from our similar vendor for our HAS or cash pay customers runs between $19.99 to $29.99. See the difference in price? Likewise our insurance scooter (coded at K0008 for our lawyers) runs $1499.99. A very similar scooter (coded E1399 which is a misc. non-covered code by Pride Mobility our scooter provider) sells at $999.00.
Now there are usually two people out there who come into the store who figure out what we are trying to do at Howard’s. The first group applauds what we are trying to do. The second group will frequently get mad at us for circumventing the rules of Medicare. However for this second group who wants us to give Medicare the same pricing, I want to remind this is the same Medicare who requires us to use costly methods of paperwork, faxing, visiting doctor’s offices, etc. to meet their documentation requirements.
In summary, know that if you are paying for an item with cash or a HSA account you can get a nice discount if you buy specific items. If you are a patient who has Medicare or Medicaid (DSHS in the state of Washington) please be patient with us because your insurance has us jump through a lot of hoops before we are paid.
Erik Mickelson—Team Lead and ATP at Howard’s Medical
*Now on these prices that we charge, most insurances including Medicare have something called an “allowable” which is what we are actually paid on the item. At Howard’s we comply with these allowables. For carpel tunnel wrist braces they run between $45-70 and if you have a copay, your copay would be off of the allowable amount and not the charged amount. We work and bill with over 100 insurances so this means over 100 different allowables. I leave this up to our incredible billing team!