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Sixteen percent of Americans unable to pay medical bills, according to Consumer Reports’ Trouble Tracker Index

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Medical Cost Advocate recently appeared in the September issue of Consumer Reports. One of the key points of this article is the assertion that consumers should line up a medical billing advocate or their own alternatives proactively. Don’t wait until its too late to do your research and find a health care negotiator.

Consumer Reports: How to Haggle With Your Doctor or Hospital

YONKERS, NY — When we visit our doctors, we don’t typically think of ourselves as “consumers” or buyers of health care, but in these tough times, that is precisely the role a patient needs to play to avoid drowning in a sea of medical bills. What are the best strategies for haggling with your doctor or hospital? A new report in the October issue of Consumer Reports and online at www.ConsumerReportsHealth.org features advice from Consumer Reports’ medical expert and M.D., John Santa.

According to the latest Consumer Reports Index, which gauges the health of the economy from the consumer perspective, 16.3 percent of Americans are unable to afford medical bills.

“Americans are overwhelmed by health costs and many people simply can’t pay their bills, can’t afford their medications,” says John Santa, M.D., M.P.H., director of the Consumer Reports Health Ratings Center. “The last thing most patients want to do is haggle with their doctors, but a little bit of negotiating can go a long way. It’s also important to know that there are tremendous variations in health care costs—knowing this can help a consumer get a hand up and politely insist on the fairest possible price.”

Here’s Consumer Reports’ advice for three possible scenarios:

You’re healthy.The optimal time for patients to talk with their healthcare providers about costs is before any have been incurred. While doctors have a professional obligation to take a patient’s financial resources into account, patients should raise the issue with their doctors to let them know that costs are important to them. “For a variety of reasons, doctors are likely to suggest the most expensive options first. But you might be surprised by your doctor’s willingness to change course, for example prescribing fewer expensive brand name drugs or choosing watchful waiting over a costly diagnostic test,” says Santa.

The unexpected occurs. A patient lands in the hospital without the benefit of any planning and gets slammed with a huge bill, say $15,000 for a coronary angiogram, and insurance ends up covering only a fraction of the bill. Consumer Reports recommends these approaches to get the greatest reduction to their bill:

  • Sit down with the doctor who ordered or performed the hospital services to find out how the hospital costs ran so high. Were all the services needed and reasonably priced? Consumers can judge for themselves by checking www.healthcarebluebook.com which lists the going rates for many medical services for free. Closely examine each bill to identify errors, which are common.
  • Consumers should not assume the price on their bill is set in stone. Providers often discount rates substantially to insurers and others, so why shouldn’t a consumer ask for the same rate reduction? Consumers should dispute any charges they think their insurance company ought to cover.
  • Patients should not pay their bill until they have exhausted all of their options, but they should make clear to the hospital’s billing department that reaching a resolution is important to them. They might consider making a discounted offer they think would be manageable within a set time period. Consumers can consult one of the reputable groups that, for a fee, can help reduce the size of medical bills, such as Medical Cost Advocate (localhost/wp1).

You’re having an elective surgery. This situation allows for more planning and research into the best procedure, doctor, hospital, drug or other option. “Use your time wisely to do the research because variations in health-care costs can be significant, and providers will gladly let you overpay for a service that you could get for less,” says Santa. Keep in mind the following advice:

  • Consumers should shop around, talk to different providers, and bargain for what they think is a fair price.
  • Consumers shouldn’t hesitate to ask for the price upfront and get it in writing. Request an itemized list of all potential charges.
  • As with any purchase, consumers should beware of any offer that sounds too good to be true. If a provider suggests a shortcut, be wary and ask a lot of questions, and check out providers that are unfamiliar.

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Rivals Jockey for Roles in Insurance Exchanges

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The implementation of Health Care Exchanges has begun as part of the ramp up to the large changes in health care scheduled for 2014. The benefits of these websites will be selection and transparency of pricing for the individual and small business market. A couple of early sites are already available, including the one in New York City. This is a trend we will keep you updated on.

Wall Street Journal 11/16/2010 – By AVERY JOHNSON

 Health-technology companies are hoping that the new state insurance “exchanges” required by the federal health-care overhaul will offer them big new growth opportunities.

 EHealth Inc., an online insurance broker, has won two new government contracts for insurance websites, and has established a separate unit to go after a share of the exchange business. Benefitfocus Inc., which makes software designed for enrolling employees and others in health plans, says it is in talks with nearly 20 states to run their exchanges. Xerox Corp.’s ACS unit is circulating a white paper to states to make its case for integrating exchanges into Medicaid systems the company already runs.

 At stake is some $4 billion a year in revenue, according to an estimate by HealthConnect Systems, a tech company that aims to compete for the new business. The Department of Health and Human Services raised the stakes in September when it awarded roughly $1 million each to 48 states and Washington, D.C., to help build exchanges. Last month the agency announced it would award additional grants to help develop the necessary information-technology systems.

 Health-insurance exchanges are online marketplaces mandated by the law to promote competition and offer a way for the uninsured to find coverage. Many low-income consumers will be eligible for tax credits to help pay the premiums.

 The exchanges must be up and running by 2014, but many states hope to beat that deadline. Utah and Massachusetts have exchanges that predate the overhaul law, but the exchanges are in the early planning stages in most states. That means it may be months, or even years, before major contracts go up for bid.

 Setting up the exchanges may prove to be too complex for any one company. The 50 states could decide on as many different ways to run them.

 Companies say that some of the challenges they may face include working with insurers to get plan and price information. The exchanges will likely need to be able to verify consumers’ eligibility for federal tax credits and for Medicaid, the program for the poor, which will be expanded by the health law. They may also need safeguards to protect personal-health data and payment information, the companies say, and they will need consumer-friendly interfaces.

 Some of the potential competitors for the exchanges specialize in the consumer end of the business, while others are experienced in back-office functions, such as eligibility verification.

 EHealth, of Mountain View, Calif., operates ehealthinsurance.com, a site the company says is the largest online vendor of health insurance. It sells plans from major insurers in each state, much the way Amazon.com sells books or music.

 Last month, Florida picked EHealth and human-resources and benefits consultant Ceridian Corp. to set up Florida Health Choices, a website where small businesses can shop for coverage.

 HHS tapped EHealth this summer to collect pricing and benefits data for healthcare.gov, a federal site where consumers can compare, but not yet buy, individual health plans.

 EHealth recently established a separate government-services business focused on courting the states. “This could be a really, really good business,” says Gary Lauer, the company’s chief executive. “We are a tested solution that could work well for state governments.”

 EHealth faces some tensions in leaping into the business. For starters, the exchanges will be competing with its existing website. Mr. Lauer says the exchanges might lure consumers online, but not all of them will want to buy there. It isn’t clear how much customer support the state exchanges might have. EHealth said it offers round-the-clock support and expects to sell subsidized health plans to people who qualify.

 Insurance brokers like EHealth have little choice but to find new sources of revenue. Broker commissions are likely to be pinched by new rules which take effect next year, that require health plans to spend less on profits and overhead, including commissions. EHealth on its current system earns commissions averaging 10% to 11% on each sale —and more in the first year of a contract, says Mr. Lauer.

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Medical Advocates Save Money on Medical Bills

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The error rate in medical bills is astoundingly high. Fully 8 out of 10 medical bills contain errors of various kinds. At Medical Cost Advocate we believe there is no better way to reduce your medical costs than to have a professional review your medical bill and then negotiate the final reviewed amount as well. We provide these services to all our negotiation customers. The below story appeared on ABC’s Good Morning America this morning, April 7th. You will find a description of some of the errors we typically encounter when reviewing your medical bills.

 

Fighting Mistakes in Muddled Medical Bills

Advocates Can Help Find Typical Medical Billing Errors

ABC News

 

Expensive mistakes on medical bills are hard for most of us to detect, because the bills are written in a mysterious language that we don’t speak.

 

But eight out of 10 medical bills have mistakes on them, according to Medical Billing Advocates of America.

 

What if you could hire somebody to translate your bills and then do battle for you?

 

Turns out, you can. And it might not even cost you anything.

 

Finding the Mistakes and Fighting Back

Artist Cynthia Kulp thought being diagnosed with breast cancer was the worst thing that could happen to her. But, then, the hospital where she received her breast cancer treatment overcharged her.

 

“To have to fight a hospital going through cancer treatment, overcharging me, they have to be the lowest of the low,” Kulp said.

 

Before her lumpectomy, she said, the hospital told her the operation would cost $5,000. Instead, she got a bill for $12,700, right in the middle of her course of chemotherapy.

 

“You can barely function, you can barely get out of bed,” she said. “How can you fight hospitals?”

 

So she hired Holly Wallack, a medical billing advocate, to help. Wallack found all kinds of errors on Kulp’s bill, such as:

 

 Mismatches. These are drugs that appeared on the medical bill, even though they weren’t listed in the medical records.

 

 Double charges.The hospital charged Kulp for two “first” hours in the recovery room. So Wallack asked, “How many ‘first’ hours do you get? Last I heard, there was only one, then he was very happy to take that charge off.”

 

 Inflated charges. The hospital billed $192 for a postoperative support bra that Wallack found on the Internet for $19 — a tenth of the cost.

 

“That was one morning in one operating room in one hospital in one little town in the country,” she said. “If you extrapolate that out to what’s going on every day, it’s mind boggling.”

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Scary Trends In Employer Based Health Care

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The US economic situation has conspired with ongoing health care cost inflation to increase financial issues that employers face in offering health care benefits to employees. Couple that with uncertainty about how the Obama Administration will handle health care reform and we are not surprised to see some of the trends reported in the Latest Hewitt Associates Report on trends in health care.

•     Nearly 20 percent of employers responding to a new survey are planning to stop offering health benefits over the next three to five years, nearly five times as many as the 4 percent that said they were planning an exit strategy last year.

•     Most employers plan on reducing both employer health care subsidies (65%) and benefit design offerings (49%).

•     Many employers are planning to increase the prevalence of consumer-driven health care plans (40%) and wellness programs (33%).

 

Source: Challenges for Health Care in Uncertain Times, 2009: Hewitt’s 10th Annual Health Care Report. www.hewittassociates.com.

 

At Medical Cost Advocate we recommend that consumers take a more active role in locating and using consumer driven health care services so they can better adapt to the changes that are coming and better manage health care liabilities they may unexpectedly be saddled with.

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Health Care Costs Increase Strain, Studies Find

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In a recent article by New York Times reporter Reed Abelson, she highlights findings of two studies describing the financial toll that health care is placing on working families – even those with health insurance.  The studies, by the Kaiser Family Foundation and the Center for Studying Health System Change, were completed earlier in 2008 before the economy and financial markets reached their current state of crisis. It is clear that many Americans are struggling with medical costs including those that are insured, under-insured or uninsured. With the continuing degradation of the economy, these financial struggles are only getting worse, necessitating that consumers take steps to control costs themselves

By REED ABELSON

Even as Washington and Wall Street debate the best way to avert an economic disaster, increasing numbers of Americans are struggling with another financial crisis: the growing burden of unpaid medical bills.

Two studies released Wednesday provide further evidence of the toll that health care is increasingly placing on working families, even for those with health insurance. And as employees are paying more medical expenses out of their own pockets, they are having a harder time coming up with the money.

The studies, by the Kaiser Family Foundation and the Center for Studying Health System Change, were completed earlier this year before the financial markets reached their current state of crisis. But policy analysts say the findings underscore the mounting additional strain that medical care is placing on working Americans.

“The problems people are having paying for health care and health insurance are a central dimension of the economic and pocketbook concerns right now,” said Drew E. Altman, the president of the Kaiser Family Foundation, a nonprofit health research group that conducts an annual survey of employer medical benefits.

The studies, policy analysts say, underscore the need for the government to address the growing unaffordability of care, despite the distraction — and cost to taxpayers — of a proposed $700 billion bailout of the financial sector.

“This makes clear the cost of doing nothing is high and growing,” said Len Nichols, a health economist at the New America Foundation, a nonpartisan policy group in Washington that advocates universal medical coverage.

While policy analysts acknowledge that finding any new money to expand coverage may prove difficult, some also say the terms of the debate may be changing as policy makers and the public rethink their positions on the need for regulation and the role of the government in industry — including the health care system.

“We can now imagine a government takeover that we could not imagine before,” Mr. Nichols said.

Although inflation in insurance premiums has moderated in recent years, the Kaiser survey found that employees were continuing to spend more in medical costs, including their share of yearly insurance premiums. Employees are paying an average of $3,354 in premiums for family coverage, more than double the amount they paid in 1999. The total cost for family coverage now averages $12,680 a year, up 5 percent from 2007.

And as people are paying more, they are finding the higher expense less affordable. In the study by the nonpartisan Center for Studying Health System Change, based on its national survey of households, nearly one of every five families had problems paying medical bills last year. More than half of these families said they borrowed money to pay these expenses, and nearly 20 percent of those having difficulty said they contemplated declaring personal bankruptcy as a result of their medical bills.

The study estimates that 57 million Americans live in families struggling with medical bills, and 43 million of those have insurance coverage. “It’s hitting both the insured and the uninsured, and it’s hitting middle-class families,” said Karen Davis, the president of the Commonwealth Fund, a nonprofit research organization that financed the study.

Because they are already in debt over their medical care, some families start forgoing treatments, even for serious or chronic conditions, Ms. Davis said. By deciding not to fill a prescription for high blood pressure medication or failing to go to the doctor for diabetes, they are at risk of incurring more serious and costly problems that can land them in the emergency room.

“It’s a serious health problem and it’s a serious economic problem,” she said.

As the nation has moved toward greater cost-sharing of medical expenses, “what we’re seeing is families are not in a position to shoulder that financial risk,” Ms. Davis said.

While large employers remain a strong and generous source of coverage, the Kaiser study pointed to the widening divide between employees working for big companies and those at companies with fewer than 200 employees.

Virtually all large employers offered coverage, but only 62 percent of small companies did. People working for big companies were also paying less — about $3,000 a year for family coverage — compared with $4,100 for those in small companies.

Faced with the choice of dropping coverage altogether, many small companies have opted for health plans that ask employees to pay much more in the form of deductibles and out-of-pocket expenses. One in three workers in small businesses has annual deductibles of $1,000 or more, in contrast to one in five in the previous year’s survey.

“We still strongly believe health care is an economic issue for small business, not only to the owners but to their employees; they are both paying for it,” said Amanda Austin, a lobbyist for the National Federation of Independent Business, a Washington group that represents small employers.

 

Copyright 2008 – New York Times

 

 

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