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Health Fairs Direct offers free health & wellness fairs in Midtown and Lower Manhattan for most corporations and we charge a reduced coordination fee across the country. We are able to offer a free health fair in New York, NY as well as a reduced coordination fee across the country because we charge an administration fee to each of our exhibitors.
Professional business men and women understand that nothing worthwhile in business is acquired for free. Charging our exhibitors a modest administration fee establishes a professional relationship and a specific commitment for each event.
In addition our corporate clients gives us exchange in other ways. Our events are held in their offices, we borrow their tables & chairs and they assist us in marketing our events to their employees. So Health Fairs Direct’s corporate events are a cooperative effort between our corporate clients and us.
IN-NETWORK PROVIDERS
In order to bring you and your employees affordable medical care your insurance company prescreens and makes agreements for reduced prices with medical doctors. These in-network medical doctors agree to accept a reduced fee for their services and in return they will be listed in the insurance company’s list of preferred providers. These prescreened medical doctors are the most cost effective way for you and your employees to obtain medical care.
OUT-OF-NETWORK PROVIDERS
There is nothing wrong with going to a doctor who chooses to not become part of your insurance company’s preferred provider network. You just need to be aware that out-of-network providers cost you, your company and your employees more money than in-network providers.
According to the Actuaries at Lockton Companies LLC, Employee Benefits Specialists, if 10% of a company’s employees see out-of-network medical doctors your company will see an additional 9% increase in your next medical insurance renewal. Since most corporations share their medical insurance costs with their employees, everyone in your company will be paying more for their insurance benefits next year. (For more information contact Matthew Schmidt: matthew.schmidt@lockton.com)
Here is an example of how much more expensive out-of-network providers are!
|
Category |
Service |
Procedure Code |
In-Network Costs |
Out-of-Network Costs |
Difference per visit (Procedure) |
Visits used for example |
Difference per average annual treatment plan |
|
Podiatry |
Bunionectomy |
28292 |
$581.61 |
$6,500.00 |
$5,918.39 |
1 |
$5,918.39 |
|
|
Outpatient Visit |
99213 |
$52.00 |
$175.00 |
$123.00 |
3 |
$369.00 |
|
Chiropractic |
Adjustment |
98941 |
$33.00 |
$100.00 |
$67.00 |
20 |
$1,340.00 |
|
|
Exam |
99213 |
$52.00 |
$175.00 |
$123.00 |
2 |
$246.00 |
|
|
Massage |
97140 |
$26.54 |
$85.00 |
$58.46 |
20 |
$1,169.20 |
|
Additional expenses based on 1 employee picking up 2 out-of-network services: |
$9,042.59 |
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HOW OUT-OF-NETWORK PROVIDERS AFFECT YOU AND YOUR COMPANY
The medical bills for an out-of-network provider can be two (2) to ten (10) times more expensive than if your employee received the same services through an in-network provider. Your insurance company understands this and as a deterrent, makes your employees pay more for out-of-network services.
For example, if an employee has a $500 deductible and is responsible for 30% of any out-of-network services, they will be expected to pay $3062.78 out-of-pocket for the above services. If your employee went to an in-network practitioner and has a $15.00 co-payment for each office visit they would only have to pay $360.00 for the same series of treatments.
Additionally your insurance company would have to pay $5979.81 extra. It will pass these extra costs along to your company in your next insurance premium rate increase.
Since most corporations split the total cost of their medical insurance liability with their employees, when your company receives a price increase it will pass part of this increase along to each employee. A 10% increase could easily cost each employee $400 to $600 extra by the end of the year. Any way you look at it you, your company and your employees will all pay more money whenever out-of-network providers attend your health fair.
DO YOU HAVE OUT-OF-NETWORK EXHIBITORS IN YOUR HEALTH FAIR?
What is an out-of-network exhibitor? They are, by and large, health professionals giving tip top service and independently market their services. Unfortunately, a percentage of these exhibitors have adopted some practices that are questionable.
Some health fair providers work with out-of-network exhibitors that do not follow proper insurance regulations. These health fair providers assure corporations that their out-of-network exhibitors will not cost your employees anything more than in-network providers. You may be told that their doctors will make special arrangements so your employees will not have any additional out-of-pocket expenses for obtaining out-of-network services. Some ways of saying this are:
· Our exhibitors will “treat your employees as if they are in-network”.
· Our exhibitors will “take your insurance company’s payment as payment in full”.
· Our exhibitors will “only charge your employees their normal copayment”.
This is a violation of insurance regulations.
They may also say that:
· Our exhibitors “accept your insurance”.
This is not the same as providing in-network exhibitors. When contracting with a health fair provider it is important to know the difference and how much extra out-of-network providers will cost every employee of your corporation.
PROPER OUT-OF-NETWORK BILLING
In order for an out-of-network medical doctor to bill your insurance company for their services they have to comply with the insurance industry’s rules and regulations. Specifically, the medical practice HAS TO BILL AND ATTEMPT TO COLLECT THE PATIENT’S PORTION OF EACH AND EVERY treatment. The only way that a doctor can bill a medical insurance company for a procedure and not Bill and Attempt to Collect the patient’s portion of the bill is in the case where the patient has a legitimate financial hardship. In such cases the doctor is required to notify the insurance company of the patient’s specific financial hardship. This is not the case for your average corporate employee so this exception does not apply to corporate health fairs.
For Better Business Practices it is prudent to only work with health fair companies who will guarantee in-network providers for each and every corporate health fair and steer clear of any health fair provider who tries to convince you that it is OK to bend the rules.
DOCTOR OWNED HEALTH FAIR PROVIDERS
The majority of the corporate health fair providers in the United States are owned by out-of-network medical doctors. Corporate health fairs can be very profitable if the event is designed to produce new business for one specific practice. On the other hand, Independently Owned health fair companies police their exhibitors to make sure there is no over-solicitation of employees or direct selling at your corporate event.
Some doctor owned health fair providers will let you know that they are owned by a doctor’s office. This gives you the opportunity to decide if a doctor owned health fair provider would be the best fit for you and your employees.
It is a common practice in the health fair industry to find doctor’s offices that are promoting health fairs under a different name so that the relationship between the doctor and the health fair provider is not known to the corporation. In the extreme a doctor’s relative might use a different last name when promoting to a corporation.
So how can you tell the difference between an independently owned health fair company and a doctor owned health fair provider? By the list of unusually generous freebies and non-standard billing practices that some doctor owned health fair providers use to generate more business for their medical practice.
- Free Lunch that is paid for by the health fair company
- Free Total Cholesterol and Glucose Screenings
- Out-of-Network Medical Providers that will "treat your employees as if they were in-network"
- Medical practices that will "waive the deductible" or "apply the co-payments toward the deductible" for out-of-network office visits
- Offer a "Free Massage" to every employee who visits their medical offices
- A doctor's office that will offer Free Massage to any employee who signs up for a Physical Therapy program
- A Health Fair Company who will offer monthly or quarterly "Free Massage" in your office
- A Health Fair Company that can book a health fair with less than 4 weeks notice
Doctor owned health fair providers make most of their money after your health fair is over with new patients. This is one of the reasons they do not want their corporate clients to know who really owns them. It is important for every corporation to do their due diligence and protect themselves from unwelcome surprises.
THE INDEPENDENT DIFFERENCE
Since Health Fairs Direct is independently owned and operated our income is limited to what we are able to charge our exhibitors, our corporate coordination fees and the profit we make from our medical screenings & flu shots. We believe this is the way it should be and have built our reputation on this simple fact.
Your corporate health fair is a reflection of you and your company. If professionally coordinated, your health and wellness fair will be a fun and educational event that your employees will love. Corporate health fairs should be designed to benefit you and your corporation by producing healthier and more productive employees. This is the main goal of Health Fairs Direct Inc.: Healthier, Happier and more Productive employees who know how to be healthy and are taking steps to improve their health and wellbeing.
A True Story From a Manhattan, NY Advertising Firm
An employee had to have surgery and chose to go to an out-of-network doctor over an in-network doctor due to a specific referral. I explained to the employee that by choosing to go to an out-of-network provider she would incur more expenses than if she chose to go to an in-network provider. Instead of paying a $50 co-pay, she would have to pay for the services out of her own pocket and submit for reimbursement. She would be reimbursed 80% of expenses as long as the charges were deemed reasonable and customary, which our plan determines as the 90th percentile of providers by zip code. She decided she'd use the out-of-network provider. At the completion of the surgery, she learned that her provider's charges exceeded reasonable and customary guidelines. In addition to paying the 20% co-pay, she paid an additional $4000 for charges in excess of our reasonable and customary parameters. SH Benefits Director - NY, NY
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Insurance Fraud at Your Health Fair?
(Please Don’t Shoot the Messenger)
The Problem:
Some Health Fair Companies, Mom & Pop Health Fair Providers and Doctor Owned Health Fair Companies have specialized in bringing out-of-network exhibitors into corporations and convincing corporations that this is OK. They have used gimmicks such as “Our exhibitors will TREAT your employees AS IF they are in-network”. They do this by not charging corporate employees for their deductibles, their coinsurance and in many cases their copayments as they will accept whatever the insurance company pays them as payment in full.
Well, please do not shoot the messenger but, THIS IS INSURANCE FRAUD. This is not our opinion.
The following Case Law speaks for itself:
The Law:
Long Island Pulmonary Assoc. v. Metropolitan Life Ins. Co.,
2/14/2003 N.Y.L.J. 24 (col. 6) (Sup. Court, Nassau Co.2003).
The Nassau Co. Supreme Court granted summary judgment to United Healthcare on a cause of action for tortious interference on the theory that a physician that waives co-pays is tortiously interfering with the contract between the insurer and the beneficiary.
The New York Comptroller has taken the position that a non-par provider that waives co-pays is illegally inducing the patient to otherwise seek out-of-network care at a higher cost to the insurer. The fact that the waiver circumvents the normal financial impediment to seeking out-of-network care is the "fraudulent insurance act" that is in violation of Penal Law § 176.05(2) and Insurance Law § 403(c).
What should you do if you discover that your health fair company has been working with out-of-network exhibitors who have employed this dubious practice?
1. Report the doctor(s) involved to your insurance company’s fraud department.
2. Copy your insurance company on this case law/summary judgment.
The Solution:
Contact Health Fairs Direct Inc (HFD) for a Due Diligence Checklist to help guide you through the decision making process when choosing your next health fair provider. 732-563-9749
HFD has been promoting the importance of insisting on in-network medical exhibitors at all corporate health fairs since 2004. In fact HFD was the first company to guarantee 100% in-network exhibitors for all of our corporate health fairs and to this day HFD is the only company who will back up this guarantee in writing. Call us for details at 732-563-9749.
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For more Health Fair Ideas Call
732-563-9749 x0 or email at
healthfairdesign@healthfairsdirect.com
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Health Fair Direct's corporate offices are located in New Jersey and New York, NY. Most of our health fair, flu shot, employee health program and employee wellness events are in New York City, NJ, CT and other major US cities.
Learn how much those offers for Free health fair medical screenings cost you and your employees and how medical doctors use slight of hand to maximize their profits at your expense:
