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Avatar of Neel Shah

by Neel Shah

The Need to Know is Powerful

February 6, 2013 in Medical Care

The following story is by Dr. Robert Fenster, a psychiatry resident based at Brown University in Rhode Island , and a winner of the 2012 Costs of Care Essay Contest.

“I’d really feel better if we got the MRI,” Ms. James said. “I understand you think it’s a migraine, but I want to know, just in case. Wouldn’t you?”

Ms. James and I sat in her darkened hospital room—the light bothered her eyes and exacerbated her headache. She was a dialysis nurse with many years of experience in the healthcare field, and I was a first-year doctor trying to convince her that she was most likely suffering from a migraine and did not need additional tests.

Ms. James had woken up the morning before with very concerning symptoms. Her head hurt terribly. She got out of bed, but she felt nauseated and had to lie back down. She thought she needed her morning coffee, but she felt too sick to go downstairs to make some. Her headache had worsened, and she began to notice shooting pains in her left arm. She was scared. A few hours later, her daughter arrived to find her mother’s speech was slurred. The daughter called an ambulance.

By the time Ms. James reached the Emergency Department, her speech had improved, but her headache remained. The fluorescent lights bothered her, and the loud noises of the hospital grated her nerves.  A neurology resident was called to evaluate her. He felt that she was most likely experiencing a migraine and recommended that she be given some medication to help with her pain. He thought it was possible that she could have suffered a TIA—a transient ischemic attack, in which the blood supply to a part of the brain is temporarily blocked—but he felt that this was a less likely possibility. He did not think she would need an MRI scan of her brain unless her slurred speech returned.

The craft of medicine requires doctors to constantly manage probabilities. Read the rest of this entry →

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Avatar of Sue (Sunni) Patterson

by Sue (Sunni) Patterson

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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Avatar of Sue (Sunni) Patterson

by Sue (Sunni) Patterson

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 →

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Avatar of Sue (Sunni) Patterson

by Sue (Sunni) Patterson

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 →

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Avatar of Sue (Sunni) Patterson

by Sue (Sunni) Patterson

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 →

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Avatar of Carey Goldberg

by Carey Goldberg

Tools For Estimating Health Costs Getting Better — Or So They Say

May 16, 2012 in health care costs, Insurance Bills

Boy, is this a trend, from plans for Massachusetts health reform to the private sector to health insurers, but if it’s such a trend, how come we still seem to be so nowhere on it??

The excellent amednews.com has a new post titled: Health plans providing detailed cost estimates of doctors visits. It begins:

Health insurers have replaced online tools that showed only rough guesses as to how much a doctor’s visit will cost with new ones that estimate specific dollar amounts for both overall and patient out-of-pocket costs.

During the past year, several health plans have released new versions or made significant updates to their cost estimation tools. The newer tools show not just a negotiated price but also the anticipated cost to a patient based on his or her benefit plan, as well as how much of the deductible is met. The projection is accompanied by a disclaimer noting that the insurer can’t guarantee its accuracy, but insurers say their updated tools are far better than the old versions.

All well and good, but all you Savvy patients out there, has anybody ever actually gotten useful cost info from your health plan in advance?

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Avatar of Carey Goldberg

by Carey Goldberg

More On Prices: In Mass., They’re Very High For In-Home Care

April 11, 2012 in health care costs

I knew the cost of living was higher in Massachusetts, but still found this release comparing prices a bit shocking. It came from a PR newswire, which I think means I can excerpt it generously:

RICHMOND, Va., April 10, 2012 /PRNewswire via COMTEX/ — According to Genworth’s GNW +4.04% 2012 Cost of Care Survey, the cost to receive care in the home through home health aide services in Massachusetts has risen over the past five years.

“Overwhelmingly, Americans prefer to receive long term care in the home and the relatively muted rise in home care costs nationally over the past few years can be viewed as a positive for consumers in Massachusetts,” said Steve Zabel, senior vice president of Long Term Care at Genworth. “Consumer demand for home care services has led to a proliferation of home care services providers and more choice for consumers. This competition has kept home care costs relatively stable, especially when compared to the cost of care in a nursing home or assisted living facility.”

Nationally, the median hourly cost for homemaker services and home health aide services is $18 and $19, respectively. In Massachusetts, by comparison, the median cost for homemaker services is $23 per hour and the median cost for home health aide services is $25 per hour. The median hourly cost for homemaker services in Massachusetts has increased 1.6 percent annually over the past five years, while the hourly cost of home health aide services has increased 2.2 percent over the same period of time.

By comparison, the median annual cost for care in an assisted living facility is $39,600 nationally. The comparable cost in Massachusetts is $55,050. The national yearly cost for assisted living has increased 5.7 percent a year over the past five years, while long term care costs in Massachusetts have increased 1.4 percent a year during the same time period. Nationally, the median annual cost for a private nursing home room rose 4.3 percent annually over the past five years to $81,030, while costs in Massachusetts increased 3.8 percent a year during the comparable time period to $127,750.

SOURCE Genworth Financial

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