Cut the Cost of Healthcare Without Cutting the Benefits

1. How many hospitals offer free care?

ANSWER: 3,000 non-profit hospitals of 5,700 hospitals in the US offer free care via a requirement for a financial assistance program (FAP). Non-profit hospitals have a federal obligation to provide a charity care program as a part of their federal requirement by the Affordable Care Act and Internal Revenue Service 501(r) requirement. 2,000 for profit hospitals also have financial assistance policy, bring 5,000 total hospitals to our platform.

2. How many people are eligible for free or discounted care?

ANSWER: 100,000,000 people are estimated to qualify for free or discounted care at non-profit hospitals across the US.

3. Will the non-profit hospital financial assistance policies be applied to a co-pay, coinsurance or deductible?

ANSWER: It depends. Many financial assistance policies (FAP) specifically state that these types of care are covered while others do not. Some FAPs remain vague on this issue. FAPs are applicable for denied claims and out-of-network claims where there is no insurance coverage.

4. Is there a minimum or maximum dollar amount applied to the non-profit hospital financial assistance policy (FAP)?

ANSWER: It is common to set for a hospital to set the minimum dollar value at $1,500 in order to apply. The FAP does not apply to routine, outpatient preventive care. There is no maximum dollar amount to be applied to the financial assistance available.

5. What is the federal poverty level (FPL) and how is it used to determine free or discounted care?

ANSWER: The federal poverty level (FPL) is established annually by the US Department of Health and Human Services (HHS). The FPL is determined based upon household income and number of household members. 200% FPL threshold below which almost all non-profit hospitals honor free care as well as over 2,000 for-profit hospitals. This is set at about an annual household income of $50,000 for a family of three and $60,000 for a family of four.

It is common from 201% to 400% of the FPL for a hospital to have a sliding scale discount. The closer a household income approaches 400% of the FPL, the lesser the discount. The more generous free care and sliding scale discounts does fall along political lines, with blue states providing free care more frequently out to 300% or even 400% of the FPL.

6. What is catastrophic financial assistance coverage?

ANSWER: If a medical bill is greater than 20% of the annual household income, in many instances, this is considered catastrophic and eligible for financial assistance at non-profit hospitals. Other hospitals set this percent higher. The specific percent applicable can be found in each financial assistance policy on our website. If a household does not qualify for financial assistance based upon the federal poverty level (FPL) guidelines, this alternative method may be available for an additional consideration as a form of charity care.

7. How late after care occurs can one apply for financial assistance?

ANSWER: 240 days.

8. How long does the process take to determine if a person qualifies for free care?

ANSWER: 30 days. By federal law, the hospital must provide a response within 30 days of receipt of the application. Most get an application in within a week of CareGuide providing it to them. CareGuide will help its members complete the application and we will also speak with the financial counselor, if needed.

9. Hospital Bill Eraser help keep me out of collections?

ANSWER: Yes. While applying for financial assistance, the hospital is not permitted to send a patient to collections until the financial assistance application has a final determination that is denied. In addition, CareGuide knows healthcare consumer laws. We have other effective techniques we use to keep hospitals from participating in predatory billing habits.

10. What does the amount generally billed (AGB) mean? Why is it important?

ANSWER: The amount generally billed is a poor term as it really means the amount generally paid. Per medical care item, the average amount generally paid across all payer types, including, for example, Blue Shield, United, Cigna, Aetna, Medicare and Medicaid is determined. If a medical care item had a charge (retail) price of $10,000, the AGB, or what the hospital gets paid on average, might be $2,500. In this example, the AGB is 25%. The AGB is the amount that the hospital is used to getting as a fee for service for a care item. As it relates to a financial assistance policy, many of them state that from 201% up to 400% of the federal poverty level (FPL) that no one will have to pay more than the AGB. In other words, the hospitals will not make a person pay more than it usually gets paid for that care item.

11. My hospital has sent me an unitemized bill for thousands of dollars. It has threatened to send me to collections. What should I do?

ANSWER: Call CareGuide at 888-221-1140. We know how to protect you from predatory hospital billing. If you are applying for financial assistance, the hospital is not permitted to send you to collections. If you are disputing your bill because you have not received an itemized bill, the hospital is not permitted to send you to collections. While a hospital bill is in dispute, CareGuide notifies the hospital that they are not to contact you due to the Fair Debt Collection Practices Act of 1978, a consumer protection law. We make them speak with us. If you already forgot everything you just read, that's ok. CareGuide is an expert a hospital bill charity care and bill negotiation and we do all the work for you.

12. What if I make too much money and don't qualify for financial assistance? Can Hospital Bill Eraser still help me?

ANSWER: Yes. CareGuide has two words for you "sign here." We take assigned agency and negotiate your hospital bill for you. With our proprietary national pricing database, you never overpay for care when we know the price of care. CareGuide also uses bill negotiation techniques that only industry insiders like us have to get the best deal and most often pay less than most. Don't do your hospital bill. Do Hospital Bill Eraser.

13. How does a member initiate the Hospital Bill Eraser service?

ANSWER: Members without insurance and those with high deductibles reach us by phone at 888-221-1140. We love talking with our members. Our expert advocates will listen to your hospital bill concern, assign you a case member and you can submit your hospital bill via a privacy compliant portal on the bottom of the web page https://cgasaves.com/member-journey.html. We most commonly receive the bill in a pdf file format. If an itemized bill was not received by our member, we initiate the request and take over the Hospital Bill Eraser process.

14. How do you get participation by employees in a group setting?

ANSWER: CareGuide works with the health plan third party administrator (TPA) and both parties agree to a dollar figure trigger. For example, if it is agreed that CareGuide will work all hospital claims over $5,000, then all claims over $5,000 will be sent from the health plan TPA server to our server. One of our advocates will reach out to the health plan member by email and cell phone to offer to provide assistance in erasing the hospital bill.

15. How does Hospital Bill Eraser help the employee?

ANSWER: Hospital Bill Eraser can help erase the patient deductible and coinsurance, or in layman's terminology, the out-of-pocket expense not covered by insurance. For members who experience a denied claim, an out-of-network claim or do not have insurance, we assist to erase as much of the entire hospital bill possible. Note that after erasing a deductible for those that qualify, that person can get care for the rest of the calendar year with no out-of-pocket having met his or her deductible without paying his or her deductible.

16. How does Hospital Bill Eraser help the employer?

ANSWER: We help keep claims above the stop loss attachment point at or near the attachment point to keep stop loss premiums lower. We also help save health plan money for the average 8% of health plan dollars that are out-of-network. For out-of-network claims, there is no health insurance company rule that the hospital must be paid what the insurance company dictates. Hospital Bill Eraser can seek free care for the employee and the employer benefits also with no out-of-pocket expense. This can greatly reduce the employer's health plan spend for out-of-network claims. By offering a better health benefit to employees with less out-of-pocket care costs, we help the employer with recruitment and retention. CareGuide also can alleviate human resource (HR) and benefits department burden by having them direct all hospital bill and explanation of benefits (EOB) questions to us.

1. What is Money Map?

ANSWER: Money Map is a low cost provider locator for blood work, imaging, surgery center care such as GI scopes, and urgent center care. Money Map is used to help direct you to affordable routine care options.

2. Why was Money Map developed?

ANSWER: The same care item in the same insurance company network is most often priced with over 1,000% pricing variation. For example, a CT scan can be $400 and up to $4,000 in the same city in the same network. A blood test can cost $50 or that same blood test could cost $500. Warning: staying in-network does not save you money on your routine health care - Money Map does.

3. What is the average savings by using Money Map for my care?

ANSWER: In large health insurance company networks, an average savings of $150 per blood draw, $700 per MRI or CT scan, $2,000 for surgery center care, such as a GI scope or $2,000 by using an urgent care and going home instead of the ER and going home has been established by analysis of billions of dollars of claims.

4. How does a medical facility become a Money Map provider?

ANSWER: CareGuide uses its pricing database, in addition to calling each provider each year to establish who owns the medical facilities, who does the billing and what type of billing codes are used. Our deep knowledge of medical billing helps us establish the proper questions and answers for those who are deemed qualified to present on our Money Map. If a provider refuses to answer our questions, then it does not make it to our Money Map.

5. Are doctors listed on your Money Map as a category?

ANSWER: No. The decision on who is your doctor is a personal choice that we do not interfere with. In addition, doctors are inexpensive and office visits are mostly between $100 and $200 a visit. On the other hand, entering a medical building to get care such as blood work or imaging or surgery center procedure care can get very expensive and that is where tremendous savings opportunities exist. That's our focus.

6. Is there pricing for care listed on Money Map?

ANSWER: No. Pricing Portal, a separate software platform, is used by our advocates to know what to pay and to secure pricing.

1. What is Pricing Portal?

ANSWER: A proprietary database of Medicare pricing as well as healthcare pricing from Blue Shield, United, Cigna and Aetna. It represents the reverse engineering of the Medicare and health insurance company fee for service schedules so that our advocates no what a care item price tag is and can secure a price for you. Never overpay for care when you know the price of care.

2. How did you get this pricing when nobody else has it?

ANSWER: CareGuide has been successful and acquiring pricing data from Medicare, self-insured employers, self-insured unions, independent third party administrators (TPAs), healthcare data analytics companies and occasionally machine readable files (MRFs).

3. How were you able to share this pricing when health insurance companies call it proprietary?

ANSWER: CareGuide has been careful to never sign a non-disclosure agreement (NDA) with the publicly traded health insurance companies. We also have been careful to handle only privacy compliant claims data, meaning your name, diagnosis and other sensitive information is not a part of our database. Thus, we have no restrictions on the use of privacy compliant data and can share pricing information with all of our members. According to the United States Department of Health and Human Services (HHS), there are no restrictions on the use of privacy compliant data. Lastly, Under federal law, hospitals and health insurance companies are to make their pricing publicly available. While they may not do so according to the law, the law is on our side to publish it and report it to our members.