MyMedicalShopperTM: Broken Healthcare System Bait-and-Switch, Hidden Costs to Consumers

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Today’s insurance industry is riddled with confusing and hidden costs, leaving consumers at a disadvantage in managing their healthcare. Transparency of actual costs is needed for both consumers and employers.

Whether consumers buy their insurance themselves or are insured through their employers, they are subject to high deductibles, increasing coinsurance, and skyrocketing premiums. Because of costs, some people skip necessary medical visits, which can adversely affect their health1. But high costs are not the only issue—there are also examples of bait-and-switch and hidden costs in medical insurance. As noted by MyMedicalShopper, The Affordable Care Act (ACA) requires a number of tests and procedures to be covered by health insurance at zero out-of-pocket cost to the patient. This means that a range of preventive care, from annual physical exams to colonoscopies, mammograms, flu shots and other vaccines must be given without charging a copayment or coinsurance, often referred to by patients as “free.”

Unfortunately, “free” is rarely free when it comes to healthcare. As an example, according to MMS Analytics, Inc., the average amount paid to medical providers by health insurance carriers and/or patients for influenza vaccines in the past 12 months is $27.30. But, they point out that some providers have collected as much as $270 per flu shot. Flu shots are very often marketed to patients as “free,” and providers do usually “seem” to keep that promise from the patient’s perspective, as the out-of-pocket cost is often $0. HOWEVER, EVEN WHEN the patient pays $0 for a flu shot, the average cost paid to the provider is still $27.30, which is paid by the health insurance carrier, as well as the employer and covered employees in the form of insurance premiums. 3

"The healthcare marketplace in the U.S. is seriously broken," said Mark Galvin, co-founder and CEO of MyMedicalShopper. "When patients are tricked into thinking that services are free, they don’t realize that there are still very real, and highly variable costs associated with that care. They don’t have any way to know the difference between a ‘free’ flu shot that costs $10 and a ‘free’ flu shot that costs $270, but the one they ultimately choose can make a huge difference to the underlying medical loss to their health plan and employer, which directly affects their future premiums.”

There are other issues that can blindside insurance consumers. For example, many consumers will attempt to keep their costs down by seeking out and receiving in-network services (services provided by health care providers who have contracted with a consumer's insurance company to accept certain negotiated (discounted) rates). A consumer might have surgery at their local in-network hospital, but later receive a bill from an out-of-network—and thus higher-priced—assistant surgeon. Or, a person might have a visit with their in-network primary care doctor, but then receive an out-of-network bill from the lab used for blood work. 4

A tool which compares actual post-procedure, out-of-pocket expenses for non-emergency services between care providers gives a consumer the ability to make decisions based on their own criteria. It's simply a matter of entering the procedure in a database, and being able to instantly see the provider that would save them the most money. “Patients could unknowingly pay five to ten times more than needed, simply because they don’t have the ability to shop. We estimate that our users saved over 32% on their out-of-pocket medical expenses last year when MyMedicalShopper was provided through their employer-provided insurance,” Galvin said.

About MYMEDICALSHOPPER

MMS Analytics, Inc. dba MyMedicalShopperTM is a big data company with big dreams for healthcare. Co-founder and CEO Mark Galvin gave rise to the company out of the need to provide consumers and companies who provide healthcare benefits to their employees with transparency—the leverage needed to make informed decisions on their healthcare and improve their quality of life. Consumers previously unfamiliar with price variations in medical procedures and testing utilize real-time health insurance plan pricing information that makes it possible to choose care based on price, quality, and convenience. Experts document that as much as $1 trillion could be slashed annually from the cost of healthcare in the U.S. The company’s goal is to transform the healthcare industry into a fair market for consumers.

For more information visit https://www.mymedicalshopper.com/.

1. Reports, Consumer. “9 Ways to Save Money On Your Healthcare Costs.” Consumer Reports,

2. Reports. “Will the Affordable Care Act Cover My Flu Shot?” Health and Human Services.Gov.

3. Proprietary claims data and algorithms. MMS Analytics, Inc. January 2018.

4. Fontinelle, Amy. “Why People with Good Health Insurance Go into Medical Debt.” Investopedia, 11 December 2017.

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Karla Jo Helms
JoTo PR
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