You are browsing the archive for medical bill.

Avatar of Sue (Sunni) Patterson

by Sue (Sunni) Patterson

How to Protect Yourself from Higher Than Expected Medical Bills

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

If you are insured and visit your local emergency room at a hospital network in your area of residence, you expect to pay the stated co-pay that shows on your insurance card, right? This is, in some senses, a reasonable expectation, but it’s not always what happens. News media outlets around the country have aggressively broadcast many cases where huge out-of-network charges for secondary providers have led to excessive medical billing amounts for patients who simply visited the wrong hospital at the wrong time.

The Problem: Hospital Network Staff Outsourcing

This major problem, that results in more out of pocket dollars than expected, really has to do with how hospitals staff. Hospitals may simply bring in outside doctors, nurses, technicians and other staff who aren’t effectively on staff at that facility, in order to help fully staff an emergency room or other hospital department. This is a convenient fix for hospitals, but what’s enraging is the idea that hospital administrators don’t think about the dramatic impact that out-of-network charges can have on patients.

What happens with out-of-network charges is that when outside physicians or other staffers happen to provide care to a particular patient, that patient is simply billed for the balance of that care because of an automatic insurer denial. Insurance companies won’t usually pay for the work of out-of-network professionals, but hospitals hire them anyway. Read the rest of this entry →

Tags: , , , , , , 2 Comments »

Avatar of Sue (Sunni) Patterson

by Sue (Sunni) Patterson

Will Medicare Changes Result in Better Quality?

September 3, 2012 in health care costs, Health Insurance, Hospital Bills, Insurance Bills, Medical Care, Medical Debt, Medicare

As the price of health care in America keeps rising, you may be among those that are frustrated by the kind of generic approach taken by  health insurance companies and government entitlement programs. The traditional fee-for-service format of health care reimbursement means that the best hospitals and doctor’s offices don’t get rewarded and the lower performing offices don’t have consequences. But, this is all likely to change with new Medicare rules that are slated to pursue more of a ‘meritocracy’ in the way that health care dollars get paid out.

New Medicare Rules

Reports from the Centers for Medicare and Medicaid Services show that Medicare is going to begin making some changes in the way that it reimburses health care providers starting late this year. In what Medicare officials call a ‘value-based purchasing’ program, Medicare will consider various aspects of a provider’s operations in setting the reimbursement rates for that particular office. Key factors will include observation of outcomes, or in other words, whether the procedures and services performed at an office actually help patients to recover from illnesses and improve quality of life.

Responses to the Changes

For you, this represents a major change and a big potential edge in making sure you get what you deserve for the money, especially when you have out of pocket expenses. On the downside, though, some providers are arguing that hospitals and offices in rural areas, or those with other significant disadvantages, may be punished unfairly. Read the rest of this entry →

Tags: , , , , , No Comments »

Avatar of Sue (Sunni) Patterson

by Sue (Sunni) Patterson

How Much is Health Insurance Coverage Really Costing You?

August 30, 2012 in health care costs, Health Insurance, Hospital Bills, Insurance Bills, Medical Care, Medical Debt, Medicare

Just when you think you have the health care business figured out, new reports come out showing even more dark details about how American patients are simply charged massive amounts of money for health care services on a pretty arbitrary basis.

The newest wrinkle in this story actually turns the conventional wisdom about payment for health care on its ear: where many assume that most uninsured patients get the highest bills, new reports are showing that, in many cases, the “cash-up-front” deals given to cash-paying patients may be as little as less than half of a contractually agreed price that the hospital would bill the insurance company. Why is this a problem? Because it means that many of those who pay high deductibles, premiums and coinsurance on a health plan may still be paying more for each service, visit or procedure than someone who doesn’t have any insurance at all. It also injects a huge monkey wrench into the now established idea that everyone needs health insurance to make health care affordable. On the flip side, if you have a high deductible but choose to self-pay a medical bill, how will you ever meet your deductible? This is particularly troublesome should you have a catastrophic event. Read the rest of this entry →

Tags: , , , No Comments »

Avatar of Sue (Sunni) Patterson

by Sue (Sunni) Patterson

Practice is Proactive in Patient Relationships

August 25, 2012 in health care costs, Health Insurance, Medical Care

The Commonwealth Fund’s 2010 study found that almost 50% of US adults were either underinsured or uninsured.  This is a 7% increase from 2007 for the underinsured population. It used to be that having coverage was simply enough. Today, however, having the right type of coverage and amount are key factors in choosing a plan. What happens when you don’t have coverage for a specific procedure? One forward thinking practice in the Chicagoland area takes the time to explain your options and provides the cash discount rate – up front. Before you even ask. That’s mightily refreshing given the lack of communication in many healthcare organizations. And, it’s a win win for both parties. The practice receives a bill paid in full without expending additional dollars in the collections process and the patient is educated a little bit more on how the billing and insurance process works. Let’s hope that more practices implement this customer service level in the near future.

Tags: , , , , , , , No Comments »

Avatar of Sue (Sunni) Patterson

by Sue (Sunni) Patterson

Small Debt Medical Bills Can Add Up to Large Debt

August 13, 2012 in Medical Debt

Here’s another tip about a specific debt situation that often affects those who have a false sense of security from owing just a little bit of money to a medical office or other business:

Pay attention to the less significant debt letters and small bill statements you receive. The major problem with ignoring these is that even the smallest debts, debts that may total only a couple of hundred dollars, can balloon into massive amounts of money when you don’t understand the collections process, the accrual of interest, or other factors.

So, how does your small dollar medical bill become a giant drag on your finances? It usually happens when the borrower simply decides not to pay anything and lets the bill lapse into collections. When third party collectors receive this account, they may be able to add certain types of charges. This may include additional fees for filing the debt in a legal office, as well as other fees related to documentation of the existing debt. Any costs that involve trying to shoe-horn the borrower into a local court can also show up on that person’s credit. Then there is the issue of ‘communications costs’ related to overdue bill notices, phone calls and more. While there are federal collection laws, each state also follows its own set of laws.

Avoiding critical communications with the original creditor, the doctor’s office, can get you into a lot of financial trouble. Remember this when small dollar claims for co-pays, deductibles and other expenses come in the mail, and you could be helping yourself out of many hundreds of dollars of additional debt. When it comes to handling various types of debt, and medical bills in particular, staying out of the loop and waiting until the last minute is almost always a poor choice.

(Update yourself on Senate Bill 2149 – Medical Debt Responsibility Act 2012: A bill currently in review to exclude medical debt from consumer reports that has been in collection and has been fully paid or settled.)

Tags: , , , , No Comments »

Avatar of Sue (Sunni) Patterson

by Sue (Sunni) Patterson

Challenging Rejected Health Insurance Claims

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

According to the AHA (American Hospital Association), 87% of hospitals expect bad medical debt to continue to grow.  And it’s no wonder with situations like a very common one experienced by patients across the nation. You are seen by your healthcare provider for a service or procedure that should be covered under your insurance plan per plan benefits. However, when the Explanation of Benefits is received from the insurance carrier, charges have been denied for coverage. What happened?

Reimbursement is based on a few key areas including plan benefits and coverage period, medical necessity, correct patient information, diagnosis code, and procedure/service code (CPT), etc. An incorrect key stroke can cause your claim to be rejected. Or, an erroneous code can result in zero dollars paid. What can you do?

Begin by appealing the rejection to your doctor and the insurance company. As described above, it may have been a simple clerical error that caused charges to be dismissed. In other situations, you want to confirm that the CPT and diagnosis codes are cross referenced. What may have happened is that the CPT code did not support the diagnosis or the reverse. Codes are chosen based on the physician’s notes, documentation, and national coding guidelines. Sometimes, the CPT code may not be specific enough or it may have incorrectly described the level of care. Most insurance companies have their own unique process and timeline for appeal submissions.

If you’ve exhausted your appeal efforts and your claim remains unpaid, you may want to file a complaint with your state’s health insurance commissioner and or enlist a medical bill advocate to navigate the process for you. Whichever route you choose, be persistent, professional, and follow through.

Tags: , , , , , , , No Comments »

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 →

Tags: , , , , No Comments »

Avatar of Sue (Sunni) Patterson

by Sue (Sunni) Patterson

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?

Tags: , , , , , No Comments »

Avatar of Sue (Sunni) Patterson

by Sue (Sunni) Patterson

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?

Tags: , , , , 39 Comments »