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Managing High Health Care Costs on Your Family’s Budget

July 22, 2012 in health care costs, Health Insurance, Hospital Bills, Insurance Bills, Medical Care, Medical Debt

Recent news on the costs of health care, in the U.S. and around the world, is focusing on what experts call “double digit levels” of annual increases. This is bad news for us, and troubling for the country as a whole. What it translates to is annual increases over 10%, where health care costs could conceivably double in a decade. Since this kind of price spike has been going on for a while already, many American families already consider major medical care to be priced above their ability to afford it.

Who Pays the Bill? 

Part of the particular desperation that has surrounded the American medical industry in the past few years has to do with who usually pays the bill.

In the past, employer group plans provided coverage for the majority of Americans. A few decades ago, this model was built on stable, long-term contracts between workers and companies, where those who stayed loyal to a business could expect to keep a job for life. Also, employers paid a major part of all premium costs.

In the present, however, we’ve felt the rise of health care prices. First, employers started to lower the premium amounts they were willing to pay. As jobs went overseas, employers laid off workers. Then, as the economy grew weaker, more lost jobs. An unemployment rate of over 10% means much more than lost wages: it means that many thousands of American families are suddenly left without coverage.

Meanwhile, the group plans that are left often do not pay the majority of premiums and often include high deductibles, which are also extremely expensive for the average family. In fact, some employers hardly pay anything toward premiums at all, while others provide “mini-medical” plans or other virtually useless coverage, or move full-time positions to part-time and thus avoid offering plans.

What Can You Do? Read the rest of this entry →

Maintain Open Communication with Medical Bill Debt

July 14, 2012 in health care costs, Health Insurance, Hospital Bills, Insurance Bills, Medical Care, Medical Debt

The Affordable Care Act is cracking down on some of the most aggressive ways that hospitals categorized as charitable or nonprofit facilities for tax exemption can seek to shake money out of patients. Reports of the new laws also often offer some of the most common advice to protect you and your family from unfair or excessive medical debt.

Always Talk to Your Providers

One of the biggest pieces of advice is to always ask up front about available charity and financial assistance programs. It’s a great idea to ask about health care costs, and detail payment options, before you sign up for any given course of treatment. But beyond this, dialogue with the provider is also a key to keeping medical bills from showing up on credit reports. It’s true that even with the best back channel dialogue, some hospital administrators will still send bills to collections, but having an open communication with the provider will prevent this in the majority of cases where reasonable financial offices simply ask that patients keep in touch about their debt and pay to the best of their ability.

Make Sure You Are Covered

Essentially, the Affordable Care Act can be seen as a double-edged sword – depending on what side of the table you are on. Read the rest of this entry →

How to handle a bad charge on a medical bill

July 9, 2012 in health care costs, Hospital Bills, Insurance Bills

The Today program at MSNBC recently published a report about errors in medical bills, with the comment that ‘Medical billing is rife with errors …’   The report has many comments from readers, most of whom also reinforce the frustrating state of affairs in  medical billing.

http://lifeinc.today.msnbc.msn.com/_news/2012/07/03/12545813-how-to-handle-a-bad-charge-on-a-medical-bill?lite

The report includes general suggestions for the patient from HealthCPA, a company that helps manage medical bills and health insurance paperwork..  We probably already know that error prevention is not easy or simple.  Furthermore error prevention may not even be possible for  the sick patient and helpers (if help is being given).  Still further, error prevention may involve unreasonable amounts of time and effort by those who do not have the energy or resources to deal with errors.

How to be Your Own Best Advocate

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

Being Your Own Advocate

In case you haven’t been paying attention to changes in America’s health care system, there’s a general idea that needs to get out to as many people as possible: the gist of it is that, in most cases, today’s consumer needs to be much more engaged in their care and ready to act as their own advocate in order to get the health care and treatment that they need, no matter what their health is like.

You may have heard something like this already: from all corners of the health related media, patients are hearing that they need to “be their own advocates” and get vigilant about not just what they pay for health care, but what kinds of health care they receive and whether or not it fits their specific needs.

But what does it mean to be your own advocate? Looking beyond the cliché, you can obtain good, concrete ideas of how to go about interacting with a family doctor in ways that will help you get better access to the health care you need.

Patient Engagement: What it Involves

The good news on this front is that you may already do a lot of what you need to do to advocate for yourself in a healthcare environment. Read the rest of this entry →

Are You Being Treated by a Subcontracted Doctor?

May 28, 2012 in health care costs, Health Insurance, Hospital Bills, Insurance Bills, Medical Care, Medicare

A recent story from Dayton, Ohio, caught our attention, where according to news reports, some patients remain responsible for emergency room charges when a hospital happens to ‘subcontract’  doctors who may not accept health insurance at all. This adds another layer to the oftentimes confusing in network vs. out of network debate. In many cases, especially in an emergency situation, patients who visit a local hospital or facility may experience unexpected costs after they are cared for by a doctor who may not be ‘in their network’, even if the facility itself is listed as an in network provider. There’s been a lot of discussion whether this, which may seem deceptive, especially to those without specialized knowledge in the medical billing and health insurance field, is fair. In fact, state officials, like in New York, are  looking to pass legislation which mandates better transparency for out of network charges. Taking the time to understand your health insurance plan and what defines a covered provider or facility can save you hundreds if not thousands of dollars in non-covered charges.

It seems providers tend to respond to these scenarios in two ways: Some indicate they will change their policies to include more transparency while others claim to be bound by federal laws that do not allow them to reveal to patients whether an on-call doctor or a physician on shift will accept their insurance or not.

We find the second argument to be completely unacceptable at face value. In fact, it’s reasonable that consumer advocates would expect state regulators to crack down on these well documented examples of seemingly unfair provisions in delivering medical services. It’s not outside the realm of possibility that a patient facing bankruptcy after a bill like this would have a basis for legal appeal, especially as new legislation is introduced and passed. It’s vitally important that you discuss your options and ask questions before treatment to minimize impact to your financial future. How prepared are you in the event of an emergency room visit?

Beware of Balance Billing in Hospital Bills

May 12, 2012 in health care costs, Health Insurance, Hospital Bills, Insurance Bills

Balance billing occurs when a healthcare provider bills a patient for some or the entire amount that should have been declared an insurance discount (contractual allowance). The fact that Prime Healthcare Services in California recently settled a suit for $1.2 million and discontinued the practice suggests that this is a problem. In fact, several states have statutes that prohibit balance billing.

How do you tell if you’ve been balanced billed? First, you have to determine if your treatment was performed by an in or out-of-network healthcare professional. Then, you have to check your EOB (Explanation of Benefits).

In- Network

Check an erroneous charge simply by seeing if the bill for the service exceeds the amount on the EOB. If it does, let your insurance company know and let them handle it.

Out-of-Network (OON)

There are two scenarios:

  • If you have an OON benefit, the OON deductible and co-insurance will apply first. The insurance company pays the balance above that like always. However, if the provider billed you for more than the deductible and co-insurance you may be the victim of a scam. Check the EOB. Did insurance pay the provider? If so, report it. It’s a scam and it is wrong.
  • If you do not have an OON benefit and accidentally got treated by the provider, tell them you want to be treated like an uninsured patient. A standard discount will be applied.

When in doubt, check with a medical bill advocate.

Past Due Medical Bills: When Do I Have to Pay?

May 5, 2012 in health care costs, Health Insurance, Hospital Bills, Insurance Bills, Medical Debt, Medicare

Have you received a medical or hospital bill with no clear due date? This can be because of how bills are laid out or because of design issues. Typically, a bill or patient statement will show medical debt as 30, 60, or 90 days past due, providing the kind of urgency that can make you drop a check in the mail. Bills may also be labeled “second notice” or “third notice” to show that the biller has already tried to contact you. But, all of that doesn’t always tell you what you need to know: how long you have to pay before the bill goes to collections. There are several reasons you may choose not to pay your medical debt right away including having a lot of bills or long-term debts to juggle. Prioritizing which ones to pay can take precedent to stay afloat. And, some billing statements require real, actionable steps while medical bills seem to be written in some strange, esoteric language.

Medical Debt Collection: Common Practices

Every medical provider has their own system for handling past due bills. Some are quicker than others to send a past due bill to collections. Many have different billing systems that represent debt in different ways. Some may be explicit about a due date, others will not. In some cases, when patients call, the medical office admits that they don’t even know the exact date when a bill will go to collections. That’s what motivates many experienced consumer advocates and others to recommend “playing it safe” and promptly paying all past due medical bills aged longer than 30 days, which is a common grace period for payments.

Some patients, though, will make active attempts to talk to providers. Those who pick up the phone can often get on payment plans that will make due dates and everything else much clearer, while allowing for deferred payment according to the patient’s finances. Some can even qualify for charity. In many cases, it’s this direct communication which can yield benefits for both parties: you know where you stand and your provider receives data on how and when you are likely to pay a particular bill. It’s a win-win, and that’s why when it comes to vague patient statements, the direct approach is often best. How do you promote open communication with your provider on past due medical bills?

Overused and Unnecessary Medical Procedures

April 28, 2012 in health care costs, Health Insurance, Hospital Bills, Insurance Bills, Medical Care, Medical Debt, Medicare, Member Stories

Nine physician specialty societies are each reporting a top five list of commonly used procedures that are often unnecessary. These societies represent 375,000 physicians across the country.

Some of the procedures cited include:

  • Brain scan after fainting (without other relevant symptoms)
  • Antibiotics for sinusitis (while typically resolving itself in two weeks, 80% of patients are prescribed antibiotics. CT scans are also usually unnecessary.)
  • Admission and pre-operative chest X-rays (routine X-rays are not needed.)
  • Colonoscopies (not recommended but once a decade.)
  • Cardiac stress tests (they do not need to be part of a checkup for a healthy adult.)
  • Lower back pain (unless another ailment is suspected, X-rays are not needed in the first six weeks.)

Unwarranted testing can lead to stress, over treatment, higher medical bills, and even unneeded invasive procedures.

In fact, the natural tendency to screen for heart disease prior to having any symptoms, like getting a stress test as a 50th birthday present, hasn’t “panned out,” according to a preventive cardiologist at Northwestern Memorial Hospital.

Study members suggested that patients and doctors have to thoroughly discuss any tests/procedures even if they are suggested by patients because they are not always needed.

If you live near Pasadena, CA…

April 21, 2012 in health care costs, Hospital Bills

check out Huntington Hospital’s procedure pricing tool.  This is an astonishing display of price information. It’s astonishing because posting prices for anything is almost unheard of at hospitals in the US.

If you’re uninsured and you need bariatric surgery, the price is clear and fixed: “$12,000 flat fee $14,075 includes pulmonary and endoscopic workups.”  The hospital is also upfront about the cost of an inpatient psych visit: “Daily per diem rate of $960.00 covers admission to any of the three inpatient psychiatric units (Adult Voluntary, Geriatric, ICU). Daily per diem rate for a private room is $1,260.00.  Professional fees not included. All other hospital services included. This does not include inpatient admission for ECT.”

In another break with tradition, Huntington offers an uninsured “discount.”  Most hospitals charge the uninsured more than the rate paid by insured patients.

I read about Huntington Hospital in the LA Times earlier this week.

On its website, Huntington Memorial Hospital in Pasadena allows people to select several common procedures and get an instant price quote, including an estimate of the patient’s share after plugging in their deductible and coinsurance. But even those numbers exclude the thousands of dollars that physicians, anesthesiologists and other specialists would tack on for most surgeries. Read the rest of this entry →

25 Million Americans Underinsured Including Middle and Upper Income Families

April 18, 2012 in health care costs, Health Insurance, Hospital Bills, Insurance Bills, Medical Debt, Medicare

As current government initiatives wrestle with the issue of millions of uninsured Americans facing potential medical bankruptcy, new studies are revealing that it’s not just the uninsured who are at risk. The issue of underinsured American individuals and families is becoming a major part of today’s healthcare conversation and alerting many more Americans to the dangers that they face, even if they have access to affordable health insurance policies.

Current statistics show a startling trend, where being underinsured is becoming a common way to fall into extreme medical debt and eventual bankruptcy or bad credit situations. Research by the Commonwealth Fund that appeared in recent industry journals shows that America’s underinsured community has doubled in the past four years to over 25 million people. While the highest number of underinsured Americans are in the income range below the poverty level, research shows that middle and upper income families are being affected in larger numbers each year. Research also shows that some individuals with what others would consider healthy annual incomes are still very likely to become underinsured in the immediate future.

In general, being underinsured has to do with the cost of one’s medical bills against that person’s annual income. Read the rest of this entry →

Confusopoly – The mystery of medical bills

April 16, 2012 in health care costs, Hospital Bills

Scott Adams introduced “confusopoly” in his book “The Dilbert Future” defining it as “a group of companies with similar products who intentionally confuse customers instead of competing on price”.

Two articles in the past few days have raised this issue. Robert S. Kaplan and Michael E. Porter of Harvard Business School NY Times op-ed “Why Medical Bills are a Mystery” and the LA Times “Healthcare pricing still a struggle for consumers”.

Why am I bringing Dilbert into this? Because the two articles highlight the detachment from patient reality by both hospitals and physician organizations. I doubt most physicians would be similarly detached if asked directly by a patient. The next time you face the confusopoly, consider asking your doctor for help and let’s see who’s side they’re on.

 

Great PBS Documentary on Cheaper AND Better Healthcare

April 14, 2012 in health care costs, Health Insurance, Hospital Bills, Insurance Bills, Medical Debt, Member Stories

Just watched ”U.S. Health Care: The Good News” (Episode: The Good News in American Medicine, with T.R. Reid) on PBS.   I was flipping through the channels and it caught my attention.  I watched ”Sicko” when it came out in movie theaters and before I finished my Coke I was convinced that we needed a major overhaul in medical care in the U.S.  It just doesn’t seem humane that people could die because of insurance loopholes or die because they don’t have enough money to pay for their healthcare.

Obviously nothing in life is free. Everything requires energy- which always equates to money in some way or another. Since energy (and money) are finite resources, the only solution seems to be in overhauling the entire system to make it cheaper to get and stay healthy.  And when I saw the part of the show’s title that said ”The Good News in American Medicine”, I had to watch.  Good news.  What is that?

I was very pleased to see there is good news out there. Many communities are doing a lot to overhaul the system and provide care to everyone, regardless of coverage, while bringing the costs way down. It was refreshing to see that people are trying and finding ways to succeed in this area.

I’d recommend watching this show and passing the link along to friends. The more people know about this, the more we have a chance at getting medical care costs down to manageable levels (and be a more humane society). The full video is here:

http://video.pbs.org/video/2198039605/

Upcoming Coding Changes Can Create Confusion

March 31, 2012 in health care costs, Health Insurance, Hospital Bills, Insurance Bills, Medical Care

As Americans continue to absorb the healthcare reform and projected modifications, the federal government is updating the way that medical services are coded and billed to consumers. The first mandate is HIPAA 5010, which is an update to the existing HIPAA format and the healthcare information processing systems. 5010 compliance is currently set for July 1, 2012. This will be followed by implementation of an updated coding system, ICD-10, which is to be effective October 1, 2013.

The existing coding system has approximately 13,600 codes while the updated system will have approximately 69,000 codes. The detailed coding system will allow for better analysis and treatment outcomes while providing payers with an initial claim submission that is much easier to understand. However, you may find interpreting your medical bill to be even more confusing as you may see more line item charges.

An example of this was recently reported in a Pennsylvania’s Fox News story. The patient was charged for an office visit and on top of this, she received a separate charge for a “consultation” when the doctor advised her to quit smoking.  Read the rest of this entry →

How much do I owe for out-of-network care?

March 30, 2012 in health care costs, Health Insurance, Hospital Bills, Insurance Bills, Medicare, Member Stories

Looking at Medicare- vs. “usual and customary”-based reimbursement

By Robin Gelburd

Many Americans with private health insurance have plans that reimburse for out-of-network care. But consumers often don’t realize the wide variation in reimbursement rates among insurers and the implications for their wallets.

At FAIR Health, the independent not-for-profit corporation dedicated to bringing transparency to healthcare costs and out-of-network reimbursement, we have noticed that differences in formulas can make a big difference in reimbursements.  A number of private health plans are now basing out-of-network reimbursement rates on a percentage of Medicare fees – as opposed to the usual, customary and reasonable (UCR) standards that reflect actual provider charges. Read the rest of this entry →

Before the Affordable Health Care Act, Were You Locked Out?

March 17, 2012 in health care costs, Health Insurance, Hospital Bills, Insurance Bills, Medicare

Locked out of medical care, that is. Who? Individuals with pre-existing conditions. Now, 50,000 of them have healthcare coverage via the Pre-Existing Condition Insurance Plan (PCIP) in their state. This is a temporary high-risk health insurance program that makes healthcare not only available but much more affordable.

For example, a patient named Deborah fell victim to a back injury. It left her unemployed and unable to afford health insurance premiums. However, when she discovered the Michigan PCIP plan, she was able to enroll in it, receive the back surgery she needed and get on the road to recovery.

PCIP makes a difference. It has allowed many Americans to get connected to health insurance and receive the medical care they sorely need. That’s because PCIP enrollees can receive that care immediately.

The Affordable Health Care Act has also helped students up to age 26 receive coverage and assisted seniors by allowing access to more affordable prescription drugs.

You can see how your state administers PCIP by clicking here.

Add To The List Of What’s Better In Maine: Hospital Price Information

March 13, 2012 in health care costs, Hospital Bills

Just posted on CommonHealth…Hoping some Savvy folk might want to check out the price info and let us know how good it is…

 

You know how you cross the border into Maine and suddenly the air feels cleaner and the pine trees tower higher? And the big blue sign welcomes you to “The way life should be”?

Turns out the sign applies to hospital price information, too — at least, more than it does in Massachusetts. I happened to be in a York Hospital lobby in southern Maine yesterday, and came upon a notice informing me that under state law, I had the right to ask for a list of the average price tags on all the most common procedures. Very transparent, I thought, impressed. It sure would be great to post that list on WBUR’s Healthcare Savvy social network.

Turns out it’s not so simple, though. I called York Hospital this morning and they haven’t gotten back to me yet, so I tried the Maine Hospital Association. Jeffrey Austin, the group’s vice president and lobbyist, gave me a very helpful rundown of the background on Maine’s price list. Our conversation, lightly distilled:

What’s the story of this price list?

Around ten years ago or so, Maine law was amended to require hospitals to provide the prices of common procedures. But paper lists are something of a “horse and buggy” version of price transparency, and about four years ago, Maine established an online database — run by the Maine Health Data Organization and funded by the hospitals and the health insurers. It’s publicly accessible and interactive, so you can “one-stop-shop” for common procedures. (The “HealthCost” section is here.) Read the rest of this entry →

Eric’s Elbow

March 8, 2012 in Hospital Bills, Member Stories

Eric Herot and Dr. Abraham Nick Morse are on WBUR today deciphering a package of bills Eric received after fracturing his elbow last spring.  Here’s a link to the audio and here’s the transcript:

There’s a push in health care to make all of us more informed consumers or smart shoppers.  But  if you’ve tried to decipher your medical bills, you know how hard that can be.  Here at WBUR, we have an online social network that helps people understand health care costs.  It’s called Healthcare Savvy.  We spoke with two of its members,  patient Eric Herot and Dr. Abraham Nick Morse, of Brigham and Women’s.  Last Spring, Eric fell off his bike onto his elbow and after several visits to an orthopedist, ended up with about 30 bills and claims summaries.  We asked him to what degree he was able to make sense of those statements.

Eric Herot: I’m say about 50%.  Some of these things seem like they should be straightforward, but then when you delve into it, there’s the same thing listed with different prices and then there’s a completely different bill I received that says, emergency room, med surg supply, pharmacy, what do all these things mean?

Sacha Pfeiffer:  Right, in most cases you received two or more bills for the same visit.  There’s one example I was looking at, it was your trip to the emergency room.   There were three bills: one for an x-ray, another for reading the w-ray plus something labeled “med surg supply,” and a third for the visit itself. Did you know what you were paying for?

Herot: To some extent, yes.  It helped that I conscious during the visit, so I remembered everything I got and I sort of worked backwards based on what things were priced. I’m fairly certain that the $1 pharmacy charge was the Aleve I was given, and the $25 med surgical supply was probably the sling I was given.  But there’s no explanation on here of what any of this stuff was. Read the rest of this entry →

When is a Medical Bill Sent to a Collection Agency?

March 5, 2012 in health care costs, Health Insurance, Hospital Bills, Insurance Bills, Medical Care, Medical Debt

A recent article in the Chicago Tribune’s March 4, 2012, issue “Small, Paid-off Medical Debt Can Mar Credit, Upend Financing for Unknowing Americans” highlighted how quickly a pristine credit can plummet when unexpected medical bill balances show up on credit reports including previously paid off medical debt. According to the Commonwealth Fund, 30 million Americans were contacted by collection agencies in 2010, an increase of over 25 percent from 2005. And, the Access Project, a research group funded by health care foundations and advocates of tougher laws on medical debt collectors, estimate that over 3 million Americans who have paid off their debt in full still have their balances appearing on their credit reports. Most of the collection actions are attributed to medical bills with the majority of outstanding balances under $250.00.

Medical bills are sent to collection agencies quicker than you think. In fact, it is common to receive a bill within a few days or so of your procedure or hospital stay and the clock starts ticking. So, what can you do to minimize your account from being turned over to a collection agency?

A bold claim – posting prices leads to huge savings in health care

March 1, 2012 in health care costs, Hospital Bills


This white paper from Thomson Reuters estimates the savings if patients get mammograms, colonoscopies and 298 other common procedures at labs or clinics that charge the median (or lower) prices for these services. But there’s one BIG problem:

“The reality is that many consumers do not know what their healthcare costs and what portion their insurers are paying for the services they receive.”
 

Now, lots of people will tell you that price is just one reason health care costs have risen much faster than inflation. The other reason is that we use a lot of care. But hey, if just giving consumers the prices so they can compares costs from one hospital to another can save even a piece of this $36 bil, that will be great step forward.

Avatar of eherot

by eherot

A crazy mess of bills

February 27, 2012 in Hospital Bills

I receive fairly generous care through my software company employer. Had a relatively routine run in with the health care system (broke my elbow when I crashed my bicycle). This simple ER visit and four followup visits lasting ~15 minutes each generated several dozen pieces of billing paperwork, all mailed to me individually. The process was incredibly confusing and incredibly wasteful and I really have no way to know if I was ripped off or what I was paying for. I’d love to see a story picking apart why this has to be so complicated.