Negotiate medical bills

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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Tallying the Cost to Bring Baby Home

Doug

Another informative article from the Wall Street Journal about the lack of pricing transparency and how difficult it is for consumers to get an estimate of charges, understand the cost, and their portion of the payment.

By ANNA WILDE MATHEWS

Bringing my newborn son home was a joy. Figuring out the hospital bill wasn’t.

Cedars-Sinai Medical Center in Los Angeles provided excellent care and thoughtful treatment during my uncomplicated traditional delivery in December. Then the invoices started coming. The hospital sent one for me, and another for my baby. The doctors billed separately. The total charge for three days: $36,625.

People lucky enough to have good health insurance, including me, don’t have to come up with such sums. Insurers typically pay a lower, negotiated price for hospital care, and patients pay a portion of that amount. Even people without insurance often get sharp discounts from list prices on their hospital bills.

Still, consumers have a big financial stake in the cost of care. People who get health insurance through their workplaces have been paying higher premiums in recent years, and more people have been enrolling in plans that include very high deductibles. A recent survey by the International Foundation of Employee Benefit Plans found that two-thirds of employers are increasing, or considering an increase in, workers’ deductibles, co-insurance and co-payments.

It’s important for patients to get good information about what they have to pay and why. That’s not easy. Before my son was born, it was difficult to figure out what I was going to owe. And I struggled after the birth to learn whether the amounts I was told to pay were appropriate. I could have done a better job at calculating some of my costs. But often, information wasn’t available, or was hard to decipher.

My own health plan is a so-called PPO, or preferred-provider organization, which means I pay less when I use doctors and hospitals that have contracts with Aetna Inc., the insurer that administers my employer’s coverage. For hospital and surgery services from these providers, I am on the hook for 15% of Aetna’s negotiated price. I also have a $400 annual deductible. Fortunately, there is a $2,000 cap on how much I might have to spend out of pocket each year for my in-network care.

From the Wallet

    Having a Baby? How to Prepare for the Hospital Bill

My research started before my due date, with a call to Aetna. I asked the customer-service representative how much the birth would cost me, and she didn’t answer the question directly. She did confirm that Cedars-Sinai was in my network. Aetna’s Web site offered typical maternity costs for other Los Angeles-area hospitals, but there was no such listing for Cedars-Sinai.

The Aetna representative did say that I had $1,370 remaining before I reached my out-of-pocket maximum for the year. So I decided to set aside $1,370 toward maternity costs, and hoped that I’d have some of that left over for a crib.

It didn’t turn out that way. In fact, I owed a total of $2,118.90, a sum I arrived at only after adding figures from five separate documents. Why the difference? Along with dark hair and blue eyes, my son was born with his own $400 deductible. Also, the maximum annual out-of-pocket charge for the two of us was $4,000, double what mine alone had been. I should have re-read the fine print of my plan.

Before paying the bills, I wanted to double check them to make sure I’d actually received the services I was billed for. At my request, Cedars-Sinai sent itemized invoices, with 14 items listed for my baby and 34 items for me, not including doctors’ fees.

Those charges I could decipher seemed stunningly high. A “Tray, Anes Epidural” cost $530.29. (After inquiring, I learned this was the tray of sterile equipment used to give me an epidural anesthetic injection.) An “Anes-cat 1-basic Outlying Area” was billed at $2,152.55. (I was told this was the cost of the hospital’s resources related to the epidural.) These items were in addition to the separate anesthesiologist’s charge of $1,530 for giving the epidural. Even though the pain-killing epidural shot felt priceless during my 20 hours of labor, I was amazed that its total cost could run so high.

To decipher other items, I decided to check out consumer services that advise people about medical bills. Candy Butcher, chief executive of Medical Billing Advocates of America, wondered why the hospital listed a price of $2,382.92 for my recovery, when I hadn’t had a Caesarean section. It turned out the charge was for the 90 minutes I spent in the birthing room after my delivery. I recalled lying exhausted there while a kind nurse checked my vitals and cleaned me up. Important help, for sure, but was it really worth that much money?

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Out-of-network Insurance Practices Face Scrutiny

Doug

Great article from The Washington Post about the investigation into deliberate low-balling of out of network reimbursements for consumers.  Accountability and transparency is needed in how insurance companies determine out-of-network rates, and patients need to understand how it’s done to avoid sticker shock when they get their medical bills.

 

By ERICA WERNER

The Associated Press

Saturday, March 28, 2009; 10:01 PM

 

WASHINGTON — Ever wonder how that bill was calculated if you had to pay to see a doctor outside your insurance network?

 

Might be a scam, says a senator investigating the issue.

 

Sen. Jay Rockefeller, chairman of the Senate Commerce, Science and Transportation Committee, wants answers at a hearing Tuesday from the chief executives of UnitedHealth Group Inc. and its subsidiary Ingenix Inc., a claims database used by insurers nationwide to calculate out-of-network rates.

 

The inquiry follows lawsuits and an investigation by New York Attorney General Andrew Cuomo alleging that UnitedHealth and Ingenix manipulated rate data so insurers had to pay less and patients more for out-of-network services.

 

“They’re lowballing deliberately. They deliberately cut the numbers so the consumer has to pay more of the cost,” Rockefeller, D-W.Va., said in an interview with The Associated Press on Friday.

 

“It’s scamming. It’s fraud,” he said.

 

In January, UnitedHealth agreed to pay $350 million to settle a suit by the American Medical Association and others over the issue. UnitedHealth did not admit wrongdoing. But, under pressure from Cuomo, the company agreed to pay $50 million toward creation of an independent claims database and eventually close down the Ingenix databases.

 

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Bargaining Down the Medical Bills

Doug

Below is a recent New York Times article suggesting that consumers take responsibility for lowering the cost of their health care bills.  Most consumers find it difficult to negotiate with health care providers because they don’t have the experience or don’t feel comfortable discussing finances with their physician.  We recommend using experts like Medical Cost Advocate, which leverage health care market data and use experienced negotiators to reduce consumers medical bills.

 

 By LESLEY ALDERMAN

 

When money is tight, everything is negotiable — including your health care bills.

 

As the economy sheds jobs and more people lose their health insurance or are forced to switch to less generous plans, doctors and hospitals are becoming accustomed to patients who are struggling financially. According to the American Hospital Association, half of their members reported an increase in the number of patients needing help with their bills. And that was in November, before the national unemployment rate hit 8.1 percent.

 

“It’s rough out there,” said Dr. Jacques Moritz, the director of gynecology at St. Luke’s-Roosevelt Hospital Center in New York, who also has a private practice in Manhattan. (Full disclosure: He delivered my son five years ago, but my insurance at the time covered me in full.)

 

Lately, Dr. Moritz said, “The first thing I say to my long-term patients is, ‘Do you still have a job?’ ” If patients say no, or otherwise indicate that paying will not be easy, Dr. Moritz says he assures them that bills are negotiable.

 

And keep in mind that doctors, hospitals and medical labs are accustomed to negotiating. After all, they do it all the time with insurers. A hospital may have a dozen or more rates for one procedure, depending on whether Medicare, Medicaid or a private insurer is paying the bill, said Ruth Levin, corporate senior vice president for managed care of Continuum Health Partners, a nonprofit hospital system in New York. Your request for a special arrangement will hardly confound their accounting department.

 

And it is usually in everyone’s interest to avoid dealing with a bill collector.

 

If you recently lost your insurance or have a plan with minimal benefits, here is what you need to know if you want to seek a price break from the doctor, hospital or lab.

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In California, Pricey Insurance Plans Get Pricier

J Roberts

Buyer beware! Americans are feeling the squeeze of rising health care costs including insurance. It’s no news that the number of uninsured continues to rise as health insurance becomes unaffordable. The below article depicts two California Health Plans that excessively overcharged premiums to those subscribers who were the sickest and likely the most in need of coverage.

Health Blog – Wall Street Journal Blogs

Two California health insurers have been overcharging patients for a special type of coverage for people with pre-existing health problems, the Los Angeles Times reports .

The federal law known as HIPAA, often cited in the health-care industry for its health-privacy provisions , also helps sick patients get health coverage. When somebody loses a job, for instance, they first get Cobra coverage. When that expires, if they’re too sick to get insurance on the open market, they can continue with so-called HIPAA-plans.

But, as you might imagine, with pools of sick patients, the plans are often enormously expensive. This explainer we wrote a while back showed HIPAA premiums for one individual were around $1,000 a month, compared with at most $400 a month for non-HIPAA plans.

California in 2001 passed a law that attempted to control the plans costs by capping them at the “average premium paid” in the state’s high-risk pool, another option for sick patients, but Blue Shield of California’s rates are as much as 55% higher, and Anthem Blue Cross’s have been as much as 36% higher, LAT reports.

Here are two examples the newspaper cites: Blue Shield’s monthly premium for a family of four in Los Angeles with a 40-year-old primary policyholder is $1,461. That’s $401 a month, or $4,812 a year, above the cap. Anthem’s 2009 monthly premium for the same family was $1,356 — $296 a month, or $3,552 a year, above the cap.

After hearing from the paper, Anthem reviewed and found overcharges for enrollees age 60 to 64 since 2006. The company, which is owned by WellPoint, said it would reimburse policyholders for overpayments, with interest. Blue Shield denied that its rates were incorrect and added that it lost about $7 million in its HIPAA coverage last year.

The Times said Aetna and Health Net priced their plans according to state law.

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