Further complicating this issue is the creation of health insurance exchanges, in which New Jerseyans could soon be able to purchase their insurance online. In this informal transaction, there will be no one that can go to bat for the patient, ensuring he or she receives the benefits entitled.

Patients also need to be better informed. I highly recommend asking doctors and their support staff if they can confirm a service is going to be billed as preventive.

Preventative Becomes Diagnostic

Let's say you visit a physician for a colonoscopy. You don't have any symptoms but you have reached the age where it is a recommended preventive service. If the doctor finds nothing unusual, it shouldn't cost you a cent - it will be billed to your insurance company.

But if the doctor finds a polyp and removes the offending growth to send it for further testing, you have now received a billable, diagnostic procedure. It's like getting a free piece of birthday cake, but then finding out that it's only free if you don't eat it.

In-Network Vs. Out-of-Network

This is something policyholders may actually be used to. If you go to a health-care provider that isn't in your insurance company network, you probably expect to be billed at a higher rate. Just because a preventive service is supposed to be free, that doesn't mean you can get it for free anywhere.

I call on legislators in New Jersey and Washington to craft sensible legislation to make it easier for people to understand what is free and what isn't in this new era of health care reform. I call on doctors to be fair, open and transparent in their billing. I call on patients to be informed and to ask questions.

As a health insurance broker, it's my job to stay up-to-date on regulations and answer policyholders' questions but I'd rather see these problems avoided in the first place. Preventing a billing issue is always easier than curing one.

Wendy Ebner, a resident of Marlton, is the president of the New Jersey Association of Health Underwriters and Director of Business Development with Savoy Associates. She can be reached at 609-584-812 ext.25.

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