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Worked 40 years, now disabled, can’t get care – What Happened?

January 10, 2013 in health care costs, Medical Care

I have have a low back problem since 1992 when I became hurt at work. I needed a laminectomy @ L/4 L/5, I was fine for a while until my wife and I were rear-ended on the 91 frwy. in Orange County, Ca. 1997. Then my back slowly got worse. In 2003 I had a Dorsal Column Stimulator” inserted in my body, it worked for a while but in 1995 the battery died and they removed the unit. Although the Doctor removed the spinal lead implanted in T/6-T/7 area it still gives me problems to this day. I am now 57 and on permanent disabilty through (SSA).

I also started having stomach problems in 2009, serious doubled over pain like no other. I was diagnosed with chronic pancreatitis and have been hospitalized 3-seperate times for this issue. The medication I need is ”creon” and there is no generic brand so it costs $380.00 per month. I am now on Medi-cal which doesn’t pay anything because the government/county program thinks I receive too much money to qualify. So I have to pay for ”ALL” my medications. Thats over $600 a month, towards a $1512 (soc) or share of cost. That’s monthly by the way. What the hell has happened to our medical in this country? I have worked 40 years and did not want to be disabled, but it happened. Now I can’t get the medical care I need.

The Rise of U.S. Health Care Consumers: Lessons from Abroad

January 5, 2013 in health care costs, Health Insurance, International Health Care, Medical Care, Quality of care

Can you imagine buying gas from a station with no signs to let you know the prices? Or having the clerk at a clothing store pick the “right” jeans for you, with no opportunity to figure out for yourself which ones fit best? In a sense, this is how Americans buy something far more important: health care.

Economists and policy makers have long emphasized the challenges in treating health care as a consumer good. Supply generally drives demand; there is little correlation between cost and quality; and end users have neither visibility into costs, nor much incentive to find out. Lack of price transparency makes it nearly impossible to find health care cost information even for someone motivated to look for it. Consumers also have little basis for evaluating quality; often the data that is available is dense and hard to interpret. In other words, most Americans do not have the practice or capacity, let alone the information they would need, to make informed health care decisions.

But it does not need to stay this way – and, indeed, it cannot if health care reform is to succeed. Under the Affordable Care Act, 12 million consumers are expected to purchase their own health insurance via a health insurance exchange by 2014, growing to 28 million in 2019. Americans, including lower-income individuals qualifying for subsidized health insurance, will have new health plan choices, and new means of comparison shopping. Even without reform, health insurers are designing and employers are increasingly offering products that shift costs and choices to the consumer.

Remarkably, as a nation and a health care industry, we have not prepared our population for the increased responsibility and decision-making power they will soon assume. Yet there are places around the world that have a lot to teach us in this arena, and they’re not necessarily the ones you might guess – or the ones health economists tend to focus on. Read the rest of this entry →

Protect Yourself from Medical Debt Overload with Self-Advocacy

December 27, 2012 in health care costs, Health Insurance, Hospital Bills, Insurance Bills, Medical Debt

You or someone you know may be closing out the year with large amounts of medical debt even after insurance payments or what you thought were relatively minor surgeries or other procedures. In fact, you may feel like you’ve been hit by a blizzard by the sheer number of bills related to that one procedure. And they keep on coming.

One step you can do is confirm or validate the bill, especially if a lot of time has elapsed since the initial service. This simply means you want proof that you had the services rendered and do in fact owe the balance due. Under the Fair Credit Reporting Act, credit agencies are supposed to help consumers to ensure that bills are correct and fair before payment is rendered. But without good knowledge of these laws and taking the time necessary to investigate, you could end up paying much more than you owe. Here are a few other ways to stand up for yourself and your bottom line.

Keep Proof of Charges

The bad apples that pollute our debt collection environment may be operating on an entirely fraudulent basis. There have been many news stories of consumers receiving calls from phone bank operators, posing fraudulently as legitimate debt collectors. A tip off is that in many instances, the caller will fail to fully identify him/herself, their company, and the nature of the call. There are also reports that unprincipled companies are using ‘bread crumbs’ of financial data in order to manufacture phony debts that their workers demand payment for during outbound telephone calls. Collectors have been known to threaten litigation or other legal action without any legal basis as well as fail to provide written proof that a debt is owed when requested by the consumer.

One big part of your arsenal is the paper trail of charges, as well as Explanation of Benefits (or EOBs) that show whether or not the insurance company paid their fair share. Keep all of these documents on hand so that you can prove any overcharges and trigger an analysis by a credit agency.

Get Credit Bureaus In On the Action Read the rest of this entry →

consumer perspective – cost of inguinal hernia repair surgery – First steps.

December 18, 2012 in health care costs, Member Stories

I’ll be undergoing this procedure  later this week and reviewing costs is part of the process.

I understand that hernia surgery is routine. I called the hospital, surgeons office and insurance company. As I just summarized for a friend:

Hospital says $18,385. Surgeons office says $1450. Insurance company says don’t worry, the most you will pay is $5k.  Why is it that I feel like the mafia is running healthcare? There is truth in all those numbers. What is the truth exactly?

I expect I will get a bill like I got for my colonoscopy. Horrifying billed cost, miraculous adjustment from insurance company but still a high bottomline relative to the rest of  the country.



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by HCSavvy

How healthy is your state?

December 17, 2012 in health care costs, lifestyle, News

Vermont is no. 1, again, in the annual health ranking of states from the United Health Foundation. Here’s more from the foundation’s summary:

Hawaii is ranked second this year. New Hampshire is third, followed by Massachusetts and Minnesota. Mississippi and Louisiana tie for 49th as the least healthy states. Arkansas, West Virginia, and South Carolina complete the bottom 5 states.

My state, Massachusetts, is 4th overall, but 40th when it comes to binge drinking (is that because we have so many universities?) and we have a high rate of preventable hospitalizations (is this a case of supply driving demand?).

Are Transparent Hospital and Medical Bills on the Rise?

December 3, 2012 in health care costs, Hospital Bills, Insurance Bills, Medical Care

News from an Ohio media news site indicates that “hospitals around the country” are trying to make their medical bills easier to read, citing the Healthcare Financial Management Association and a case study for the Cleveland Clinic, one site that has renovated the look of its paper bills.

Most of the changes focus on the idea that traditional bills just have too many lines and lack clarity about who has current responsibility for debt amounts vs. who has already paid. To this end, photos of new billing structures show that complicated sets of line items can be replaced with headings like “You Paid X on X Date” and “Insurance Company Paid X Amount.”

Changing the format for medical bills can help both you and your provider. Because when you can read a bill effectively at a glance, you are more likely to respond immediately to what you receive in the mail. Bills that are too cryptic often just end up getting thrown in the trash or added to the pile. This means the provider receives delayed payment or non-payment and you risk credit damage.

What These Medical Bill Improvements Don’t Address

Although it can be really helpful to make bills more readable, this still doesn’t address some of the most common challenges we encounter. Read the rest of this entry →

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by HCSavvy

Medicare’s money problems in pictures

November 28, 2012 in health care costs, Medicare

Another great infographic from the Kaiser Family Foundation (published in the Journal of the American Medical Association this week).

What’s a “good” colonoscopy?

November 23, 2012 in health care costs, Medical Care, Quality of care

No bad jokes.  I’m serious.

I’ve reached the wonderful age at which I’m supposed to have this test as part of my general health care.  I had one 10 or so years ago, so I know what I’m in for.  The best thing to be said is that the drugs gave me a deeply restful nap.

The first time, I went wherever my doctor told me to go.  This time, I have a couple of references from my doctor, but I’m going to ask some more questions before I decide whom will perform the delicate procedure.

I’ve talked to a few docs and looked at some websites.  Here’s my list of questions.  Is there anything I should add?

1)     About the prep – what will give me the best cleaning out with the least discomfort?  There’s no point in going through all this if the doc can’t see what s/he is doing.

2)     What’s the doctor’s detection rate?  One medical society (the American Society for Gastrointestinal

Borrowed from Asian Scientist where study found that 30% of colonoscopy patients had polyps.

Endoscopy) says a doctor should find a polyp in 25% of men and 15% of women (why the difference?), but I know that some physician groups around Boston say the average is 40-50% among docs who really look for polyps.

3)     How much time does the doctor spend, on average, on the test?  I think more is better, is that right?

4)     Does the doctor always get to the end of the colon? OK, I may not be able to ask this. Read the rest of this entry →

What is Being Done About Medical Billing Fraud?

November 19, 2012 in health care costs, Health Insurance, Insurance Bills, Medical Care, Member Stories

Over the last few years, healthcare insurers have been focusing on fraud detection. Their efforts have been undertaken with the cooperation of the National Health Care Anti-Fraud Association (NHCAA). The increasing numbers of suspected fraudulent medical claims are related to the economy, legislative attempts to help the consumer and general changes in ethical behavior. Also, a real danger exists because when medical service providers and attorneys are working in cahoots with fraudsters, prescribed treatment can be unnecessary and may even cause harm to patients.

The property and casualty insurance industry is also stepping up to implement fraud control. That’s because a significant amount of healthcare fraud starts with an incident related to property casualty insurance. For example, in the New York City area, about one in five no-fault auto insurance claims appear to contain elements of fraud. In addition, as much as one in three claims appear to be inflated.

Recently the National Insurance Crime Bureau (NCIB) asked leading property/casualty insurers to participate in a project to analyze medical billing data and place it in a single database. It is hoped that the ongoing participation of these insurers on supplying data for this project will enable the industry to be aware of emerging trends regarding potential fraud around medical billing. Read the rest of this entry →

Plan Ahead for International Travel Medical Bills

November 2, 2012 in health care costs, Health Insurance, Insurance Bills, lifestyle, Medical Care, Medicare, Member Stories

You may be closing out 2011 with a holiday trip, domestically or internationally. If you plan to leave the country, you may want to consider the following when it comes to your health:

  • You may not have health insurance coverage for illnesses or injuries that are treated abroad, even if you have US based medical coverage. Confirm with your benefits administrator.
  • Generally, Medicare does not provide coverage for hospital or medical costs incurred abroad, however, rare circumstances may be covered.
  • AARP can assist with obtaining foreign medical coverage and offers valuable travel tips.
  • US consulate personnel will help you locate health care providers and facilities and even contact family members, if necessary.
  • You can purchase travel insurance that covers health care needs and pays for medical evacuation if you need to be transported back to the US for treatment.

Obtaining medical treatment in another country can be expensive and a medical evacuation can cost over $50,000. Plus, you may encounter challenges with deciphering charges while abroad. Be vigilant, prepared, and follow the same self-advocacy steps you would while receiving medical care in your home state.

If you choose to purchase medical expense coverage while travelling abroad, double check you’ve carefully researched the following:

Blue Cross paid $1,650 for my $8,000 MRI

October 22, 2012 in health care costs, Hospital Bills

Well, this world of medical billing and costs is really wild.

I wrote a few weeks ago about getting bills that totaled just under $8,000 for an MRI (actually I got two tests while in the machine although I didn’t know this at the time)

Last week, the hospital sent me a more detailed bill that shows how much of what they charged Blue Cross actually paid. The total charge from Newton Wellesley Hospital (two tests plus fee to read the test) was $7,876.  Blue Cross paid $1,650 (that’s $1,360 for the tests and $290 in physician’s fees).

Two things jump out at me.

1) the difference between what Newton Wellesley charges anyone who pays cash, and what they pay the largest insurer in Massachusetts is $6,226. Patients who pay cash for these tests are getting a really horrible deal if they don’t shop around.

2) the difference between what Blue Cross pays Newton Wellesley and what Blue Cross paid the cheapest place I found for an MRI, Shields, is not much.  Read the rest of this entry →

Your health data could be worth over $3,000 / year

October 21, 2012 in health care costs, Health Insurance

In a recent post about the new MA Health Information Exchange, I suggested that a patient-accessible connection to the HIE could save a patient thousands of dollars per year. And now there’s a real-world, peer-reviewed example of what we/’re talking about. Research of medicare Part D beneficiaries published in October 2012 issue of Health Affairs (sorry, it’s paywalled) shows:

“Nationwide, beneficiaries on average spent $368 more annually than they would have spent had they purchased the cheapest plan available in their region, given their medication needs. More than a fifth of beneficiaries spent at least $500 a year more than they needed to.”


“Our findings suggest that beneficiaries need more targeted assistance from the government to help them choose plans, such as customized communications about the most cost-effective plans that would cover their medication needs.”

Prescription drugs, as covered by Part D, represent about 10% of the nation’s overall healthcare cost. If, as a gross estimate, we took $368 from this study to be 10% of what a person would save if their overall health insurance was appropriate to their specific needs, then the annual per/beneficiary saving would be over $3,000.

To save this kind of money, patients will need to be able to pay an accountant or similar trusted advocate to match their specific health care costs Read the rest of this entry →

What is going on with some familiar OTC products?

October 19, 2012 in health care costs, News

I have noticed that a number of familiar OTC drug store products are difficult to come by for the last several months, including Maalox, Triaminic, Lamisil, and seemingly much more.. Looking online, I see that production was suspended by Novartis in Lincoln Nebraska and Boucherville Quebec due to some troubles, according to reports.

The company is apparently just fine for a considerable length of time without these products, thank you, because for example, sales from Lincoln plant production are reported to have been less than 2% of Novartis sales.

I am not a big consumer of these products but have used some, and have found them to be of occasional positive benefit.  Now that they are not available, I ask myself if I have actually been wasting my money buying them.

In an online search, the most recent news as to what is going on appears to be a local report from way back in Mar 2012.   I can’t find any information on when the previous availability may return.

Hospital cost infographics

October 19, 2012 in health care costs, Hospital Bills, International Health Care

We already know about spiraling health care costs, but more information doesn’t hurt.  Here is a comparison with other industrialized countries.  The data is from a group affiliated with GWU’s School of Media and Public Affairs.  The direct link is here. A shorter summary is here.

MA Health Information Exchange Live Today

October 16, 2012 in health care costs, Member Stories, News

Our new health information exchange went live today starting with the ceremonial transmission of Governor Patrick’s health record from one hospital to another. The best description of the event is on John Halamka’s Blog today and yesterday. The exchange is interesting to the healthcaresavvy for a couple of reasons including its Direct secure email roots and future tie-ins to payment reform.

The Massachusetts Health Information Highway (the HIway) is based on the Direct secure messaging protocols mandated as part of federal EHR Meaningful Use Stage 2. As of 2014, all electronic health records that are eligible for federal incentive payments will have to send and receive Direct messages. Although patients do not have access to MA HIway yet, patients do have access to Direct messaging. Microsoft HealthVault offers free Direct email addresses, for example. I don’t know how long it will be before your doctor can send your health record to your Direct email address but there’s no fundamental reason it could not be done today using the MA HIway. Having your doctor receive a secure message from you, the patient, is also technically now possible. The questions of spam filtering, reimbursement and the doctor’s liability in receiving possibly unsolicited messages from patients (and, for that matter from other doctors) remain to be sorted out.

The tie-in to payment reform will come in future enhancements to the exchange. Read the rest of this entry →

Check This! @amandapalmer’s #insurancepoll

October 16, 2012 in health care costs, Health Insurance, Insurance Bills, Medical Debt

As you read this, there’s a fascinating conversation about health insurance in America and abroad taking place on Twitter and on musician Amanda Palmer’s blog. It’s an outpouring of stories about medical bankruptcy, asking a friend to stitch up a deep finger wound, skipping medications and losing loved ones who couldn’t afford needed care.

The conversation started shortly after Palmer read Nick Kristof’s column about a college buddy with stage 4 prostate cancer, cancer he didn’t catch sooner because he didn’t have health insurance.

Palmer decided to poll her 698k Twitter followers about their health insurance, She asked these four questions:

1) COUNTRY?! 2) profession? 3) insured? 4) if not, why not, if so, at what cost per month (or covered by job)?

Palmer has a couple of volunteers now tallying the results, which keep coming in (check the hashtag #insurancepoll).

Many of Palmer’s followers live in Germany, the UK or France and are baffled by the stories on Palmer’s blog about the cracks in the American health care system.

In Massachusetts, Read the rest of this entry →

Share Your Medical Bill Story in 2012 Cost of Care Contest

October 15, 2012 in health care costs, Health Insurance, Hospital Bills, Insurance Bills, Medical Care, Member Stories

In listening to you, we’ve found, time and time again, that outrageously high medical bills are not a rare occurrence in this country. Many glitches and loopholes in today’s American health care system often leads to unexpected, mysterious billed amounts that threaten individual families and force many Americans to the brink of bankruptcy or worse. But too often, those with serious medical financial problems have no outlet for their rage and consternation.

Now, a non-profit consumer advocacy group called Costs of Care is sponsoring a contest that’s based on listening to the American patient – yes, you! Anyone who has ever had to deal with a surprise high-dollar bill for medical care is invited to participate.

The Costs of Care 2012 Essay Contest provides a listening ear for struggling Americans, and even a chance to win a portion of $4000 in cash prizes. Contest creators seek “anecdotes,” not policy positions, about big medical billing problems, and “high value healthcare decisions.” Judges include former U.S. Secretary of Health and Human Services Donna Shalala and other panelists, including doctors and health care officials. The deadline for this contest is November 15, so would-be contestants have just a short time to send in their stories of up to 750 words for consideration.

What’s behind the Contest

In soliciting stories from American patients, Costs of Care and other participants are seeking to put needed pressure on today’s community of medical providers. Read the rest of this entry →

An unusual medical encounter

October 10, 2012 in health care costs, Medical Care, Member Stories

My son was diagnosed at age one as having life threatening allergies to peanuts. He was given skin tests after what appeared to be a reaction to peanut butter. The tests showed he was allergic to everything. So, we spent the next 14 years religiously keeping him away from all nuts. Being an underutilizer, I never took my son back for further testing as given his history of asthma, it was unlikely he would outgrow this allergy. And, he never had another reaction. This summer (at age 15) my son went on a canoeing trip in the adirondacks…..miles away from any medical facility. To my shock, it was here that He decided he had had enough of his “special diet” and gave himself a “food challenge” by eating two peanuts. What happened? Nothing. When he proudly announced that he was no longer allergic to peanuts upon returning home, I was ready to murder him. How could he take such a risk? But, after calming down, I also wondered what had happened. Had he been misdiagnosed as a baby? Had he outgrown his allergy? Both his skin and blood tests provided evidence that he has this allergy, didn’t they? We made an appointment with a specialist, someone who could answer all our questions.

This appointment was really what I wanted to write about. Those who know me know that I am an underutilizer of health care services. So I was leery seeing this specialist. Would he want to run a zillion more tests? Would they want my son to undergo another food challenge? Well, not this allergist. Read the rest of this entry →

Gold-plated stitches with a ruby stud

October 8, 2012 in health care costs, Hospital Bills

Remember that story about my colleague who got an $1134 bill from Mount Auburn Hospital for two stitches?  Turns out that total didn’t include the physician’s charge: $364.

So those stitches were $799 apiece.  My colleague cut her finger on the job and has been told she’s on the hook for these bills until the workers comp claim is approved. She doesn’t want to pay and have to deal with seeking reimbursement, but is worried now that the bills will go to collection.  Messy. Expensive. Annoying, just for two stitches.

Sticker Shock: an $8,000 MRI?

October 1, 2012 in health care costs, Hospital Bills

In June and July, I had a series of migraines.  I chalked them up to stress and a lack of sleep but I went to see my doctor just in case.

I spoke to my colleague Sacha Pfeiffer about my attempts to shop for an MRI based on price.  I ended up at a hospital I thought would be moderately priced.  Last week, when I got a bill for $7,468 (plus an additional charge for reading the tests), I was stunned.

I only have to pay $25 of this and my insurer, Blue Cross won’t pay this total either.  If you want to hear more about why this charge is so high, listen here.

Have you had a “sticker shock” moment with a health care bill?