Along with being able to talk to providers and insurance companies from an informed standpoint, you will also benefit from knowing more about how criminals work to fraudulently bill others for various items including health care services. There has been a flurry of reports about a growing practice that’s pretty disturbing, especially to new parents. It involves criminals simply using children’s identities to bill medical services and other items to credit accounts.
Doesn’t The Government Check a Consumer’s Age?
You would think that children would be safe from identity theft because of their age. But, the reality is that with the complex database systems of many governments and private businesses, it’s often possible for criminals to commit fraud by using the Social Security number and other identifying information of a minor. At the same time, many of these efforts are successful specifically because nobody else is checking the credit account for a minor. Since a child can’t usually make purchases or access his or her credit, everyone figures the accounts will be dormant. What some unlucky parents are finding out, though, is that to many government agencies and businesses, one Social Security number is as good as another, and the issue of age does not factor into many of these fraudulent accounts. In some cases, criminals who open these kind of accounts can keep using them for months or even years.
What To Do About Child Identity Theft
Much of what consumer advocates recommend in terms of deterring child identity theft is the same as what you would do to prevent adult identity theft. Read the rest of this entry →
By Undersecretary of Consumer Affairs Barbara Anthony
Until now, if consumers asked their doctors or hospitals how much a particular service will cost, they would be told that the price depends on their insurance plan. When consumers asked their insurance carriers the same question, they would be told that price of a health care service depends on each provider’s contract.
Thanks to Massachusetts’ recent health care quality and cost containment law, that’s about to change. Insurance companies must now develop toll-free numbers and websites through which consumers can determine the prices of provider services. Most notably, the law requires carriers to tailor the information presented to the insured’s plan, taking into account plan-specific information such as co-pay, deductible, and co-insurance.
To their credit, major Massachusetts insurers are already preparing to roll out these consumer information tools—see my January 8th op-ed and Rob Weisman’s excellent reporting in this past Sunday’s Boston Globe. This is a great example of what industry can do to lead the way through innovation and technology that benefits competition and consumers.
We have seen an appetite on the part of insurers to get this information out there and a hunger for consumers to have it in an easily digestible way. For this reason – my office will be launching a Health Care Consumer Empowerment campaign to bring together carriers, providers, non-profits, employers, and consumers to put consumers in charge of the way they shop for health care services.
Health care consumers, like consumers in other markets, should be able to shop around and compare services including price and quality. We cannot reign in health care costs if consumers are kept in the dark about the price of health care services.
Empowering consumers with pricing information is a necessary first step toward a patient centered culture that can result in the more efficient delivery of lower cost, high quality health care services. Armed with price, consumers can continue to consider quality, location, and other factors when selecting health care services.
OK, I bet you thought “Medicare open enrollment1” for 2013 ended December 7, 2012.
That’s the conventional wisdom. Actually enrollment time for Original Medicare is now through March 31, 2013 and those who sign up will start receiving their benefits beginning July 1, 2013. And they’ll start paying their Medicare Part A and/or B premiums (unless qualified for “free” Medicare Part A and/or B) from that point in time forward. And they will start paying their Part A and/or B premium penalty (if due) from that point in time forward.
Actual Original Medicare open enrollment gets minimal publicity because most seniors don’t wait until Medicare open enrollment time to sign up.
Therapists who accept health insurance submit a bill that includes a code for your visit. 90862 was, for example, a very common code for a medication adjustment visit to a psychiatrist. As of this month, almost all the mental health codes are changing and this is causing a lot of anxiety.
Therapists aren’t sure which code to use and, they aren’t sure how much they’ll be paid. Insurers say the new codes, which are reviewed and set by the American Medical Association, will likely mean lower reimbursement rates for therapists who don’t prescribe drugs. Insurers say they won’t cover some of the codes at all. Many therapists are angry and discouraged.
“The Governor and the President are asking for more emphasis on mental health, but then the coding requirements increase and the reimbursements go down,” says Jonas Goldenberg with the Massachusetts chapter of the National Association of Social Workers.
Psychiatrists may see an improvement in payments for some visits because they’ll be able, for the first time, to bill for medical care they provide while monitoring the effects of medications. But the new codes do not resolve ongoing concerns about whether mental health providers are paid at the same rate as are doctors who deal with physical health. Under the new codes, it does not appear that psychiatrists who evaluate a patient’s physical response to medication will be paid what an internist would to make a similar evaluation.
OK folks – we’re starting a new tab up there at the top of the page called, “You Won’t Believe This One….”
The inspiration is David Lazarus’ story about a cat bite that became infected and cost $55,000 to treat.
David tells the story and lays out the costs here.
Unfortunately, we hear lots of stories like David’s. And, there are lots of us who never even see the bills we pile up, so aren’t aware of how much we’re spending, and in some cases wasting, when we go to a clinic or hospital for care.
David, so glad your hand healed. We have to take issue with one claim in the your story…that the Affordable Care Act will get rid of “funny money” in health care…not a chance.
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.
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 →
I’ve been thinking about this push from e-Patient Dave to redefine and rename “transparency.”
“If I mention ‘transparency’ to people in my community,” says Dave, “most have no idea what I mean. But when I say ‘We need to see what things cost – and nobody can tell us,’ everybody does see what a problem that is.”
And so, says Dave, what we need is “Visible prices, please. Before we make our purchase decisions.”
OK – no disagreement. Transparency is one of those wallpaper words. Everyone uses it; but it feels plastic. And, I strongly agree that we can’t make wise spending decisions about where to go for care if we have no idea how much anything costs.
But cost is only part of what we, patients, need to see in clear, user-friendly terms.
The other critical factor in choosing where to go for care is QUALITY. Which doctor or hospital will give me the best results after knee surgery or the best chance of catching problems through a colonoscopy or the best normal delivery?
I don’t think any of us want to get to the point where we are buying care based on price alone. So transparency, or whatever we call it, has to help us decide where to get the best care at the lowest price. So Dave – what do we call that? Don’t say “value.” Anyone?
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 →
Cookies, candy, cheese rolls, eggnog…the temptations of the holidays are everywhere you turn. So we put together a list of our favorite tips for avoiding the sugar/fat blahs and the extra pounds. Please add yours!
Drink a big glass of water before you eat or drink anything else at a party.
Use a napkin, not a plate – it can’t hold as much.
Go for color: carrots, peppers, broccoli, celery.
Give yourself a pedometer and challenge someone to beat your step count every day.
From Kathleeen Zelman at WebMD:
Wear snug clothes and keep one hand busy. When you wear snug-fitting attire, chances are you’ll be too busy holding in your stomach to overeat. While you stand around looking posh in your holiday finery, hold a drink in your dominant hand so it won’t be so easy to grab food.
Chew gum. When you don’t want to eat, pop a piece of sugarless gum into your mouth. This works well when you’re cooking or when you’re trying not to dive into the buffet. Breath mints work too.
Be a food snob. If you don’t love it, don’t eat it. Read the rest of this entry →
I’ve written here about migraines that sent me shopping for an MRI, my search for a “good” colonoscopy, my kids’ dental bills and a bunch of other stuff. But I realized this week, in all the conversations after Sandy Hook, that I haven’t written anything about mental health.
And you know what, I don’t think anyone else has either.
So let’s talk. If a line about our anxiety or depression or phobia or addiction is as easy to throw into a conversation as a reference to our asthma, then maybe we can unravel the embarrassment or shame of living with these conditions.
Here’s a little about my experience with mental illness. My dad killed himself when I was 17. I lost most of my 20s to depression. I wouldn’t be where I am without lots of therapy. In August I started seeing a counselor again about some issues with my kids. It’s helping a lot.
And you? Gotta story? Most of us do.
I look forward to reading yours.
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.
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?).
RW Johnson and Health Affairs just updated their policy brief on waste in the US health care system. It’s 5 pages short and clear and definitely worth reading.
I got my first health care Robo call last week.
It was from my insurer, Blue Cross, telling me that I was overdue for a mammogram. Yes, it’s true, it’s been more than a year. But that’s by choice. In the heated controversy about how often women should have an MRI, I’m going with every two years.
Judy Norsigian and other women’s health advocates question whether women should get mammograms as a routine test at all.
So why is Blue Cross recommending annual tests? The customer service rep I spoke to today said she didn’t know. She thought that the reminders went out automatically to all women over a certain age.
It’s cool that Blue Cross is sending me reminders, although I was a little surprised that my robo gal didn’t have “don’t think I need an annual mammogram” as one of the reasons I could choose for being overdue. Surely there are at least a handful of us who have taken the advice of an independent panel to heart.
Here at Aetna, we read with great interest, Martha Bebinger’s story chronicling her difficulties in finding the price of an MRI at different health care facilities in her area. As Martha notes, it is difficult for consumers to “shop around” or make “wise choices” on health care decisions when they can’t find the price of a service.
We agree, and have been working to make that price information available for the last decade. Through free member tools like our Aetna Member Payment Estimator, we provide cost information for more than 550 commonly used, non-emergency medical services, including traditional or C-section births, colonoscopies, MRIs and CT scans. Members can compare up to 10 cost estimates at a time for the selected procedure in a geographic area, so they can see cost differences among different health care providers. Better still, the Member Payment Estimator gives members a personal picture of the costs by providing real-time out-of-pocket cost estimates based on a member’s benefits plan.
Our members use this tool more than 70,000 times per month, each keeping as much as $170 in their own pockets after comparing costs on more than 30 common procedures. In 2011, the U.S. Government Accountability Office recognized the Member Payment Estimator as the only tool from a private health insurance company that “provides estimates of a consumer’s complete cost.” Read the rest of this entry →
In Order for us to fight obesity, we need to understand all the factors that causes it and we need to start from there.
Today, according to statistics, there’s 127 million or 64.5 percent of Americans are considered obese and most of them are adults and it was noted that obesity caused 300,000 deaths in the US alone. When it comes to health care for adult obesity, the cost reached up to $100 billion and still the number of obese people, death related cases connected to obesity and the health care expenses is increasing every year. Aside from their physical appearance that they look so big and could not do regular things every day, these obese people are very prone to serious diseases such as cancer, stroke, heart problems, diabetes and a lot more.
Childhood obesity rate is also fast increasing. Many children now days in the US alone have seen some symptoms that even at early age, they could gain weight easily and no longer the standard weight basing from their age. Obesity needs to be stopped at early age before they will become adult. Obesity now a day is considered as an epidemic that affects millions of people. Over the past ten years, it was observe that the obesity rate for children has significantly increased and even reached to a very alarming number.
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 →