Patient Advocate

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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Cancer costs put treatments out of reach for many

J Roberts

Medical costs are on the rise again. Read about the high costs of cancer treatments that are unfortunately becoming more and more out of reach, not only for the uninsured, but for the insured as well.

By Debra Sherman

(Reuters) – The skyrocketing cost of new cancer treatments is putting advances in fighting the deadly disease out of reach for a growing number of Americans.

Cancer patients are abandoning medical care because the costs are simply too high and medical bills — even among the insured — are unmanageable and put patients at a greater risk of bankruptcy, studies show.

“There’s a growing awareness that the cost of cancer treatment is unsustainable,” said Dr. Lee Schwartzberg, an oncologist who did a study examining the factors that contributed to patients quitting their oral cancer drugs.

Cancer is one of the most costly diseases to treat, largely because many patients are treated over a long term, often with expensive new drugs that are complicated to produce and not available in generic form. As insurance companies cut all benefits, reimbursements on cancer treatments have also declined.

“When it’s an expensive drug, we have to have the hard discussion about a very substantial out-of-pocket payment. I ask: ‘Do you want to spend this money for an average improvement of just a few months of life?’ I’m very uncomfortable having those discussions because I want to focus on the patient getting better,” Schwartzberg, medical director of the West Clinic in Memphis, Tennessee, said in an interview.

Schwartzberg’s and other cost studies presented at the American Society of Clinical Oncology (ASCO) annual meeting come as U.S. lawmakers battle over ways to reduce the national debt, including cuts in healthcare funding. (For full ASCO coverage, see [ID:nN05141382] )

ASCO president Dr. Michael Link, a pediatric oncologist, said access to healthcare should be a national priority.

INSURMOUNTABLE BARRIERS

“We’re thrilled with what we consider to be breakthroughs and wonderful new therapies … yet the barriers for some patients to get them is insurmountable. It is an indictment of how we take care of patients in the United States,” Link said.

Cancer is the second-leading cause of death in the United States, after heart disease. The incidence is expected to increase with an aging population.

The costs for cancer care topped $124 billion in 2010 in the United States, led by breast cancer, according to the National Cancer Institute (NCI). That number is expected to rise as more advanced treatments — targeted therapies that attack specific cancer cells and often have fewer side effects — are adopted as the standards of care. The NCI projects those costs to reach at least $158 billion by 2020.

Until recently, almost all cancer drugs were administered intravenously. Today, about a quarter of them can be given orally, which means fewer visits to the doctor. But pills are often more expensive, have higher co-payments, and are reimbursed by insurers at lower rates than IV drugs, he noted.

Using a database of pharmacy claims paid by private insurers and Medicare, he found, not surprisingly, that those with higher co-payments quit their drugs more often.

Patients with co-payments of more than $500 were four times more likely to abandon treatment than those with co-payments of $100 or less, Schwartzberg said. Claims with the highest co-payments had a 25 percent abandonment rate, compared with 6 percent for co-payments of less than $100.

“Prices of drugs can’t be set so outrageously high,” he said. “We have a problem with cancer care … All stakeholders have to get together and compromise to translate this great science into great patient care without breaking the bank.”

Dr. Yousuf Zafar, an internist at Duke University Health System, did a separate study on the impact high medical bills have on patients’ cancer treatment. (more…)

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Control of health costs up to you

J Roberts

By Robert Nelson WORLD-HERALD STAFF WRITER

Medical Cost Advocate is in the news. This time CEO, Derek Fitteron talks with a reporter from the World Herald about consumer medical liabilities. Read on to learn how Medical Cost Advocate can assist you in reducing some of those large medical bills.

I recently had part of my neck rebuilt with corpse bone and titanium. A week ago, the itemized bill arrived for my surgery.

At the end of page 4, I found the “sub-total of charges”:

$48,303.44.

The only charge that seemed to have any connection to any free-market reality was about $15,000 paid to the world-class spine surgeon.

Well, OK, the nurses certainly deserved to be paid well. And the room was comfortable and modern. From arrival to departure, my stay was Nebraska-friendly with German-like precision.

And I guess the fellow who managed to keep me between oblivious and oblivion during surgery should be well compensated also.

But still, outrageous.

Especially when you start digging into the “smaller” charges.

I paid $369 for what must have been a very special dose of vitamin D. Something that covered my feet was $149.28.

I see a $16 charge for a pill I have been taking every night for several years at a cost of 8 cents per pill.

Seventy-five itemized charges.

Including $1,200 for each of six titanium screws used to bolt down two small titanium plates that cost $4,918.

Feeling disconnected from the free market, I went online, joined a medical trade organization, identified the eight pieces of medical-grade titanium alloy in my neck and then emailed one of the manufacturers of the equipment in China – Zhejiang Guangci Medical Device Co. – requesting a price quote.

I’m not a doctor, or an international importer, but I’m pretty sure my sources in China could get me identical parts to those in my neck for under $50.

It’s apples to oranges for all sorts of reasons, not the least of which are the huge costs of making sure safe objects are put in your body by the right people using the right equipment.

Still, I feel ripped off.

“A lot of what you’re seeing in that bill is you paying for all the people who can’t pay,” said Derek Fitteron, president and CEO of Medical Cost Advocate localhost/wp1, a New Jersey-based company made up of health care attorneys who negotiate with providers to lower the bills of patients they represent.

“Most of the problem really isn’t greed,” he said. “You’ve got a host of reasons that drive even those providers with only good intentions to give you bills that look outrageous.

“You might notice that some of those numbers that seem outrageous to you are even a negotiated price that your insurer has agreed to.

“That doesn’t mean a provider isn’t going to try to make you the person who covers the extra costs they’re seeing or the debts they aren’t getting paid,” he said.

His company makes its money because his staffers know the wholesale prices and going rates for all things medical.

His people argue with the provider. Then, like an attorney who wins a settlement for a client, his company takes a percentage of the money it saved the client.

Fitteron said that controlling outlandish medical costs ultimately is up to the consumer. You need to study the details of your health coverage. You also need to discuss with the provider the costs of a procedure prior to having the work done, he said.

“It’s the old adage: Five different people walk into the hospital with the same problem, and all of them pay vastly different amounts to get the problem fixed,” he said. “You have to be a smart and savvy shopper to be the one who pays less.”

Less? I asked. Seems like the wrong word choice considering the huge numbers.

“That’s a relative term,” he said. “That’s ‘less’ of an increasingly huge amount of money.”

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Tired of fighting medical providers? Hire a negotiator

J Roberts

 Check out Aaron Crowe’s recent article about Medical Cost Advocate which recently appeared on WalletPop.com. One thing is for sure, Aaron is right on when he states, “…one of the worst bills to receive is a medical bill.” Medical Cost Advocate is the resource that can assist you in reducing your medical bills.

Aaron Crowe

Of all the bills that arrive in the mail, one of the worst has to be a medical bill.

Whether from your insurance company or medical provider, the expensive bills are difficult to understand and patients don’t know if they’re getting ripped off.

Add in the fact that by a conservative definition, 62% of all bankruptcies in 2007 were because of medical bills, with 92% of those debtors incurring more than $5,000 in unpaid medical bills, and a hospital bill is enough to send you back to the hospital.

With an 80% success rate of getting patients’ bills lowered, Medical Cost Advocate, or MCA, negotiates with medical providers to get lower bills. It’s a service that makes everyone happy, said Derek Fitteron, CEO and founder of MCA. Patients pay less and doctors get paid.

“It’s not a lose situation for the doctor,” Fitteron told me in a telephone interview from his office in New Jersey.

With most of MCA’s negotiators being attorneys, they know how to negotiate a lower bill by providing data showing how much the same procedures cost across the country, and get the doctor paid soon instead of having to send out multiple bills to patients, Fitteron said.

I recently wrote a story for WalletPop about a Web site that lets customers bid for prices on health care before they visit a doctor. MCA turns that around and helps people lower their bills after their care. It’s rare for people to know how much something will cost before walking into a hospital, Fitteron said.

“When you go in for work, or a procedure, you don’t know how much it’s going to cost,” he said.

MCA doesn’t charge upfront fees for its service, but charges 35% of whatever savings it gets. Customers don’t pay if no savings are found. Once a settlement is reached, the customer’s credit card is charged to pay the medical provider and MCA’s 35%.

Here’s an example on the company’s Web site on how the process works:

If you submit a bill for $750 and MCA gets it reduced by $170, you’ll pay the difference, or $580 to your medical provider. MCA’s 35% cut of the $170 savings is $59.50, making your net savings $110.50.

Most bills submitted to MCA are for $1,000 or more, although they can be for as little as $200.

The most typical bills it gets are for elective surgeries, Fitteron said, such as gastric bypass and cosmetic surgeries that out-of-network providers must do because in-network doctors aren’t covered under most insurance. Large surgeries that are known about ahead of time are also popular bills submitted, he said.

Either through deductibles, co-insurance payments or uninsured or partially uninsured medical procedures, the typical family spends $1,500 per year on out-of-pocket medical expenses, Fitteron said. For 10% of Americans, those expenses add up to $14,000, he said. That’s a big enough reason to submit a bill for review.

Fitteron recommends getting a tax deferred health spending account through work to help pay medical bills, and for checking what coverage you have before you have to go to a hospital.

If they have the time before a major operation, for example, people should check how much insurance coverage they have for it, Fitteron recommended. Out-of-network prices are like the first offer a car salesman makes, so it’s worth negotiating.

He cited a recent MCA case that dropped a Florida woman’s hospital bill from $53,000 to $22,000 for knee replacement surgery. She had catastrophic, high deductible medical insurance, and her insurer only paid $3,000 — what it was legally obligated to pay under her insurance plan.

After MCA determined what the “market oriented rate” for a knee surgery was and received some support from the hospital, the bill dropped dramatically.

It’s one less bill to worry about when the mailman arrives.

Aaron Crowe is a freelance journalist in the San Francisco Bay Area. Reach him at www.AaronCrowe.net

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How to curb runaway medical costs

J Roberts

Here’s an article that details some of the factors behind the ever increasing costs of healthcare in the US.

Ken Alltucker

A good doctor can help guide us to a healthy lifestyle. A hip or knee replacement can ensure mobility and relief from pain. A well-run hospital can be the difference between life and death.

But physicians, medical devices and drugs cost a lot. Americans will spend $2.4 trillion on health care this year.

Hospital and doctor bills, especially for the uninsured or those without enough coverage, already can be devastating.

Without a health-care overhaul, the price tag is projected to grow, particularly as Baby Boomers swell Medicare enrollment.

Beware errors in your bill

One way for consumers to take charge of their own medical costs is by scrutinizing doctor and hospital bills, patient-advocacy groups say.

Medical Billing Advocates of America, a Virginia-based consultant, estimates that 80 percent of hospital and medical bills it reviews have some type of error. And those errors can be costly, inflating bills 17 to 49 percent more than they should be, according to Chief Operating Officer Christie Hudson.

Medical Billing Advocates has found a wide swing in pricing among hospitals and doctors nationwide.

For example, one hospital charged $15 per dose of Tylenol or $10 for use of a disposable cup. The hospital charged a patient twice for items such as gloves, swab alcohol, a warming blanket and a daily charge for an IV pump.

To monitor their costs, Hudson said customers should request a line-item bill from a doctor or hospital. She said coding errors are common. So is double billing – for example, charging for a hospital gown when it should already be covered in a hospital’s room fee.

Also, she said patients should make sure a doctor gets prior authorization from an insurance company before conducting a procedure. (more…)

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A Guide Through a Medical Wilderness

Doug

 

As the government churns through health care reform, the media has realized that consumers can negotiate their health care with doctors and hospitals.  The article indicates that it is best to choose an advocate with a successful track record in health care cost reduction.  Medical Cost Advocate is a leader in health care cost reduction through expert negotiation.

 

 

 

New York Times

 

By WALECIA KONRAD

 

THESE days, dealing with medical bills and insurance claims makes April 15 look easy. The medical jargon and inscrutable coding on invoices and explanations of benefits are indecipherable for most lay people. Worse, seriously ill patients may simply be too sick or too broke to deal with the mountains of red tape. That can lead to unpaid medical debts and even bankruptcy.

 

It’s no wonder that a cottage industry has sprung up to fill this void. Known as medical billing advocates, these middlemen and women help patients deal with the paperwork and haggling often associated with medical costs.

 

 

In general, medical billing advocates help you find errors in your bills, negotiate with your insurer to appeal coverage denials, or negotiate lower fees with your medical care providers. Some advocates do all three tasks equally well. But others, because of their training or background, may specialize in one area or another.

 

Still others give the client the ammunition he or she needs to negotiate. That’s what happened to Susan Redstone, a freelance fashion stylist and author. When she broke her back in a horseback riding accident last summer, she held only a bare-bones insurance policy. So Ms. Redstone, who has since recovered, knew that she would be responsible for the bulk of her medical expenses.

 

 

Five months after the accident, just when she thought she had paid everything off, she got a bill for $16,000 from the helicopter ambulance service that ferried her from the remote location in Colorado where the accident occurred to a large medical facility 75 miles away. “I was completely taken by surprise to get this bill so long after the accident happened,” Ms. Redstone said. She consulted with Victoria Caras, a medical advocate in Aspen, Colo., who coached her on how best to approach the medical transportation company to lower her bill. With Ms. Caras’s advice, Ms. Redstone was able to negotiate a 25 percent discount in exchange for paying the bill in full. (more…)

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Insured, but Bankrupted by Health Crises

J Roberts 1 Comment

Health advocates warn of the dangers of the underinsured – the millions of Americans who have a basic form of health insurance, but not enough to cover a chronic or catastrophic illness. This group of people represents a “great hidden risk to our health care system” according to the below article published in the New York Times.  More and more people are facing financial hardship and burden due to the rise in healthcare costs and increased out-of-pocket expense.

New York Times

 

Health insurance is supposed to offer protection — both medically and financially. But as it turns out, an estimated three-quarters of people who are pushed into personal bankruptcy by medical problems actually had insurance when they got sick or were injured.


And so, even as Washington tries to cover the tens of millions of Americans without medical insurance, many health policy experts say simply giving everyone an insurance card will not be enough to fix what is wrong with the system.
Too many other people already have coverage so meager that a medical crisis means financial calamity.


One of them is Lawrence Yurdin, a 64-year-old computer security specialist. Although the brochure on his Aetna policy seemed to indicate it covered up to $150,000 a year in hospital care, the fine print excluded nearly all of the treatment he received at an Austin, Tex., hospital.


He and his wife, Claire, filed for bankruptcy last December, as his unpaid medical bills approached $200,000.


In the House and Senate, lawmakers are grappling with the details of legislation that would set minimum standards for insurance coverage and place caps on out-of-pocket expenses. And fear of the high price tag could prompt lawmakers to settle for less than comprehensive coverage for some Americans.


But patient advocates argue it is crucial for the final legislation to guarantee a base level of coverage, if people like Mr. Yurdin are to be protected from financial ruin. They also call for a new layer of federal rules to correct the current state-by-state regulatory patchwork that allows some insurance companies to sell relatively worthless policies.
“Underinsurance is the great hidden risk of the American health care system,” said Elizabeth Warren, a Harvard law professor who has analyzed medical bankruptcies. “People do not realize they are one diagnosis away from financial collapse.”
Last week, a former Cigna executive warned at a Senate hearing on health insurance that lawmakers should be careful about the role they gave private insurers in any new system, saying the companies were too prone to “confuse their customers and dump the sick.”


“The number of uninsured people has increased as more have fallen victim to deceptive marketing practices and bought what essentially is fake insurance,” Wendell Potter, the former Cigna executive, testified.


Mr. Yurdin learned the hard way.

(more…)

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