consumer medical bills

Effort to Decipher Hospital Prices Yields Key Finding: Don’t Try It at Home

Greg Greenfield Leave a comment

Although the No Surprise Act and Transparency in Coverage Rule have become the law of the land and consumers are technically protected, price transparency is still ridiculously complex.  For those hoping to anticipate the total cost of their medical procedures and compare prices among hospitals you still may want to enlist the assistance of a professional advocate.

By Bernard J. Wolfson – JULY 9, 2021

Sutter Health negotiates separate deals with numerous health plans, and its prices can vary by thousands of dollars for the same service, depending on your insurance.

A federal price transparency rule that took effect this year was supposed to give patients, employers and insurers a clearer picture of the true cost of hospital care. When the Trump administration unveiled the rule in 2019, Seema Verma, then chief of the Centers for Medicare & Medicaid Services, promised it would “upend the status quo to empower patients and put them first.”

Asking Never Hurts

A series of columns by Bernard J. Wolfson addressing the challenges consumers face in California’s health care landscape.

Send questions to bwolfson@kff.org.

I set out to test that statement by comparing prices in two major California hospital systems. I am sorry to report that, at least for now, that status quo — the tangled web that long has cloaked hospital pricing — is alive and well.

I have spent hours toggling among multiple spreadsheets, each containing thousands of numbers, in an effort to compare prices for 20 common outpatient procedures, such as colonoscopies, cataract surgeries, hernia repair and removal of breast lesions.

After three months of glazed eyes and headaches from banging my head against walls of numbers, I am throwing in the towel. It was a fool’s errand. My efforts ultimately yielded just one helpful piece of advice: Don’t try this at home.

I was most of the way to that realization when a conversation with Shawn Gremminger helped push me over the line.

“You are a health care reporter, I’m a health care lobbyist, and the fact that we can’t do this ourselves is an indictment of where things stand at this point,” said Gremminger, health policy director at the Purchaser Business Group on Health, which represents large employers who pay their employees’ medical bills directly and have a big stake in price transparency. “The subset of people who can do this is pretty small, and most of them work for hospitals.”

I heard similar comments from other veterans of the health care industry, even from the former managed-care executive who inspired the story.

He had come to me with a spreadsheet full of price info that appeared to show that a Kaiser Permanente hospital in the East Bay charged significantly higher prices for numerous procedures than a nearby hospital run by archcompetitor Sutter Health.Top of Form

Bottom of Form

That was a compelling assertion, since Sutter is widely viewed in California as the poster child for excessive prices. Nearly two years ago, Sutter settled a high-profile antitrust case that accused the hospital system of using its market dominance in Northern California to illegally drive up prices.

I knew from the outset it would be tricky to compare Kaiser and Sutter because, operationally, they are apples and oranges.

Sutter negotiates separate deals with numerous health plans, and its prices can vary by thousands of dollars for the same service, depending on your insurance. Kaiser’s hospitals are integrated with its insurance arm, which collects premiums — so, in effect, it is playing with house money. There is just one Kaiser health plan price for each medical service.

Still, the story seemed worth looking into. Those Sutter and Kaiser prices matter, because they are used to calculate how much patients pay out of their own pockets. And helping patients know what they’ll owe in advance is one of the goals of the transparency rule.

The federal rule requires hospitals to report prices for all the medical services they provide in huge spreadsheets that can be processed by computers.

It also obliges them to provide prices in a more “consumer-friendly” format for 300 so-called shoppable services, which are procedures that can be scheduled in advance. And it requires that they report the cost of any “ancillary services,” such as anesthesia, typically rendered in concert with those procedures. Of the 300 “shoppables,” 70 are specified by the government and the rest are chosen by each hospital.

Kaiser Permanente is both a provider and an insurer: Its hospitals are integrated with the insurance arm, which collects premiums — so, in effect, they are playing with house money.

Most of the 20 common medical procedures I attempted to compare were among those 70. But a few, from lists of top outpatient procedures provided by the Health Care Cost Institute, were not. I decided to use the more comprehensive, less friendly spreadsheets for my comparisons, since they contained all 20 of the procedures I’d chosen.

Each carried a five-digit medical code known as a CPT, a term trademarked by the American Medical Association that stands for “current procedural terminology.” The transparency rule requires hospitals to include billing codes, because they supposedly provide a basis for price comparison, or in the rule’s jargony language, “an adequate cross-walk between hospitals for their items and services.”

Much to my chagrin, I soon discovered they don’t provide an adequate crosswalk even within one hospital.

My first inkling of the insuperable complexity came when I noticed that Sutter’s Alta Bates Summit Medical Center in Oakland listed the same outpatient procedure with the same CPT code three times, thousands of rows apart, with entirely different prices. CPT 64483 is the designated code for injection of anesthetics or steroids into a spinal nerve root with the use of imaging, which relieves pain in the lower back, legs and feet caused by sciatica or herniated discs. The spreadsheet showed a maximum negotiated price of $1,912 in row 12,718, $3,650.85 in row 19,014 and $5,475.80 in row 19,559 (let your eyes glaze over for just a few seconds, so you know what it feels like). The reason for the triple listing is tied to Medicare billing guidelines, Sutter later told me. I’ll spare you the details.

My head really began to hurt when I decided to double-check some of the prices I had pulled from the big spreadsheets against the same items on the shorter shoppables sheets. Kaiser’s prices were generally consistent across the two, but for Alta Bates, there were large discrepancies.

The highest negotiated price for removing a breast lesion, for example, was $6,156 on the big sheet and $23,069 on the shorter one. The difference seems largely attributable to the estimated cost of additional services, some rather nonspecific, that Sutter lists on the smaller sheet as accompaniments to the procedure: anesthesia, EKG/ECG, imaging, laboratory, perioperative, pharmacy and supplies.

But why not include them in both spreadsheets? And what do the two dramatically divergent prices actually encompass?

“How many bills they really represent and what they mean is difficult to interpret,” said Dr. Merrit Quarum, CEO of Portland, Oregon-based WellRithms, which helps employers negotiate fair prices with hospitals. “It depends on the timing, it depends on the context, which you don’t know.”

In some cases, Sutter said, its shoppables spreadsheets show charges not only for ancillary services typically rendered on the day of the procedure, but also for related procedures that may precede or follow it by days or weeks.

The listings for Kaiser’s ancillary services do not always match Sutter’s, which further clouds the comparison. The problematic fact of the matter is that hospitals performing the same procedures bundle their bills differently, use different medications, estimate varying amounts of time in the operating room, and utilize more or less advanced technology. And physician charges are not even included in the posted prices, at least in California.

All of which makes it almost impossible for mere mortals to anticipate the total cost of their medical procedures, let alone compare prices among hospitals. Even if they could, it might be of limited value, since independent imaging centers and surgery centers, which are increasingly common — and generally less expensive — aren’t required to report their prices.

The bottom line, I’m afraid, is that despite my efforts I don’t have anything particularly insightful to reveal about how Kaiser’s prices compare with Sutter’s. The prices I examined were as transparent to me as hieroglyphics, and I’m pretty sure that hospital executives — who unsuccessfully sued to stop implementation of the price transparency rule — are not losing any sleep over that fact.

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

Bernard J. Wolfson: bwolfson@kff.org, @bjwolfson

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How Not To Get “Hurt” Giving Birth: Medical Billing Tips for Parents

Maria Montecillo Leave a comment

The Cost of Giving Birth: What Expecting Parents Should Know About Medical Billing

Giving birth in America comes with a lot of costs, some disclosed and some not. It is possible to manage the cost of childbirth through informed, careful decision-making. The key is to plan ahead. The below article includes quotes by Medical Cost Advocate and appeared on Fatherly.com on August 16, 2019

By Adam Bulger – Fatherly.com

Giving birth

Moments after my daughter’s birth, I basically had to negotiate the cost of a timeshare.

My first job as a new dad was choosing a recovery room at a Manhattan hospital known for luxury accommodations. It was the dead of night. I was exhausted and unsure about our insurance coverage, so I opted for a lower-tier option. Months later, our insurance covered the room but, because of a billing error that took months to resolve, didn’t cover basic care.
Sorting out the cost of birth was confusing and stressful. But compared to other parents, my family had it pretty easy. Giving birth in America is an expensive, confusing process where parents often feel like they have no choices or negotiating power. But medical billing experts and maternity care advocates say it’s possible to manage the cost of childbirth through informed, careful decision-making.

In a 2013 national study of inpatient care costs, pregnancy and childbirth hospitalizations accounted for five of the 20 most expensive conditions for hospital stays covered by Medicaid and three of the 20 most expensive conditions for hospital stays covered by private insurance. The mean hospital stay expense is $18,000. All told, a standard birth could run you roughly $30,000. If a C-Section is required? It’s considerably more. But despite the price tag, births aren’t big money-makers for hospitals. Sean P. Lillis, founder and CEO of New York City–based medical billing services firm Billing Geeks, notes that the high cost of birth for parents doesn’t translate into enormous profits for hospitals.

Per Lillis, hospitals don’t make money off of obstetrics. Hospitals have to devote considerable time, resources, and staff for labor. Despite the overhead, private insurance pays hospitals according to fee-for-service schedules, meaning insurance pays more to hospitals for some types of patients, like the ones undergoing short stay surgical procedures requiring a battery of tests and procedures, than others, like the ones giving birth. “They can’t make their maximum reimbursement charge rate,” he says.

While the real action of having a kid happens in the delivery room, that’s not what you pay for. Most labor costs happen later, during the mom’s short hospital stay following birth.
“Four out of five of all dollars paid on behalf of the mother and the baby across that full episode from pregnancy through the postpartum and newborn period go into that relatively brief hospital window,” says Carol Sakala, Director of Childbirth Connection Programs at the National Partnership for Women & Families.

Some of the hospital costs, like medical tests for the baby and mother, can’t be avoided. Others you might be able to work around. Some hospitals reportedly impose fees for using their TVs; others can charge as much as $20 for an Ibuprofen. Packing an iPad and a bottle of Advil in your go-bag can defray some of those gotchas. But, honestly, saying no to these add-ons is chump change compared to what you can save by doing a little homework ahead of time.

How to Avoid the High Costs of Child Birth
Maria Montecillo, a healthcare insurance and billing advocate for the New Jersey medical billing advocacy firm Medical Cost Advocate, says parents should get in the weeds of their health plan as soon as they know they’re expecting. Knowing what health care providers are in your network makes a huge cost difference. And if your network’s too small, you may be lucky enough to be able to expand it. While it isn’t easy to time a pregnancy, the months leading up to your company’s health care enrollment period are an ideal time to make informed coverage changes.

“If you know you’re going to be pregnant this year, think about changing your insurance coverage,” Montecillo says. “You’ll pay a higher premium now but it’ll work out later.”
And when you’re getting close to the due date, taking your time can save a lot of money. Hospitals often try to slot births into a timetable that benefits the institution but may harm its patients, as there’s evidence early admission correlates with higher rates of labor induction and C-section births.
“The system is, for its convenience, pushing women into giving birth at weekday, daytime, non-holiday hours,” Sakala says. “A vast number of labor inductions, which add costs, could be avoided, a vast number of Caesarians, which add costs, could be avoided.”

Delayed admission to labor, where the mother doesn’t enter the delivery until they’re in active labor, is a simple way to reduce the cost of birth. Under delayed admission, the mother, ideally with the guidance of a midwife, doula, or other birthing professional, monitors the frequency and intensity of her contractions.

If the expectant mother has a hearty constitution or advanced skills in pain management, forgoing an epidural can avoid billing surprises.
“One of the places where people are getting into trouble with out-of-network providers is with the anesthesiologist,” Sakala says. “You didn’t choose that person, and the person who’s on call at that time could very well be out-of-network and those charges could be sky-high.”

It might be possible to skip the hospital — and its price tag — altogether. Sakala is a big proponent of birth centers, non-hospital labor facilities that offer natural births, without epidurals, inductions, or Caesarians or the high costs associated with those procedures. “They’re avoiding many things that are avoidable and pulling in beneficial practices that might be kind of low-tech, like being up and about, as opposed to staying in bed,” she says. “Or being in a tub or being in a shower. Those kinds of things can make a huge difference.”

The first month after the birth, parents have a small window of opportunity to shuffle around their insurance coverage. If the mother and father have separate insurance coverages, a baby’s birth is automatically billed under the mother’s insurance. They have 30 days to add the newborn to either the mother or father’s policy. Tracking the vagaries of insurance coverage can easily slip down the priorities list when you’re dealing with a newborn but ignoring it can court disaster.
“I once had a case where the parents ‘forgot’ to add the baby into their insurance plan, and they had to wait until open enrollment for the baby to be added,” Montecillo says. “As luck would have it, the baby developed complications and needed surgery. The insurance company stuck to their guns and refused coverage for the baby, as this was clearly stated on the policy and the parents were hit with a huge medical bill.”

When your insurance company’s bill for the birth arrives, don’t rush out to the post office with a check. Take your time and scrutinize the charges. Insurance coverage is complicated, even for insurance professionals. Mistakes happen. An insurer may have calculated a payment on the basis of an incorrect fee schedule for your plan or charged you for something that wasn’t performed.
“Look over the bill carefully,” Montecillo says. “It’s just like at a restaurant. You want to see that if you ordered chicken nuggets that they charged you for chicken nuggets.”

Spotting a costly error can be infuriating. Nonetheless, overt hostility is the wrong approach to the discovery. Montecillo says that everything is negotiable — she chiseled down a $60,000 triplet birth to a $1,300 final bill, for example — but only when the person on the phone wants to negotiate. And that means being not just polite but persuasive. “Start with sweetness but if you’re not getting anywhere, ask to talk to a manager,” she says.

And Montecillo speaks from experience. Before working on behalf of consumers, she spent 14 years as billing manager for a large private medical practice.
“I was on the other end of those calls and I know that I can make changes,” she says. “But if you’re nasty or you’re saying mean things about the doctor, I can say no.”

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New Proposal Aims to Address Rising Out-of-pocket Health Care Costs: Prospect for Bipartisanship?

Maria Montecillo Leave a comment

Republicans and Democrats have an opportunity to work together to come up with reforms to address the high cost of health care. A draft discussion was recently released addressing surprise billing and the rising cost of prescription drugs, two of the most common problems for patients. We are hoping that this draft bill will be passed soon to help reduce out-of-pocket health care costs for everyone.

New Proposal Aims to Address Rising Out-of-pocket Health Care Costs: Prospect for Bipartisanship?

by Kara Jones

 

Blog photo 061219

Republicans and Democrats have an opportunity to work together to come up with reforms to address the high cost of health care. There are some areas of agreement on this issue. The Senate Health, Education, Labor, and Pensions (HELP) Committee, led by Chairman Lamar Alexander (R-TN) and Ranking Member Patty Murray (D-WA) released a draft discussion of nearly three dozen specific proposals to reduce out-of-pocket health care costs and increase health care price transparency.

The five main parts of the draft bill, the Lower Health Care Costs Act of 2019, include:

1. Tackle surprise medical billing: The bill would make sure that patients are not held responsible for surprise medical bills received when they see an out-of-network doctor that they didn’t choose. The bill lists three different approaches that health care providers and insurance companies could take to resolve payment for these surprise bills.

2. Lower the price of prescription drugs: The bill would ensure that pharmaceutical companies don’t game the system to prevent new and lower-cost generic drugs from coming to market. It would also help generic drug and biosimilar companies to speed drug development and avoid patent infringement by providing a searchable patent database. These actions would get lifesaving drugs into the hands of patients more quickly.

3. Increase transparency in the health care market: The bill would set up a non-profit entity to create an all-payer claims database, which would house anonymous patient health care data that patients, states, and employers could use to better understand their health care costs. The bill would also ban certain anti-competitive hospital contracts, such as those that prevent insurers from sharing pricing information with patients.

4. Improve public health: The bill would authorize grants to address important public health issues such as increasing vaccination rates and reducing maternal mortality. It would also give states an evidence-based guide to develop programs to prevent obesity and other chronic health conditions.

5. Enhance health information technology: The bill would give patients full, electronic access to their own health care claims information and would incentivize health care systems to keep patients’ personal health information private and secure.

Health care reform is a polarizing issue between Republicans and Democrats, and with current gridlock in Congress, it is not possible for either party to pass its own comprehensive reform. However, rising health care costs continually rank in the top three issues that voters are most concerned about. This presents an opportunity for the two parties to come together and compromise on ways to reduce health care costs for all Americans.

Two areas where we are most likely to see movement in Congress are on surprise billing and prescription drug costs. Large surprise medical bills have become a growing problem for patients who unknowingly visit health care providers that are out-of-network. And as insurance deductibles continue to rise year after year, patients are feeling high prescription drug costs more acutely.

There have been numerous bills introduced to address these two issues, and both Republicans and Democrats agree that patients need relief. The Lower Health Care Costs Act of 2019 would directly address these issues, as well as the others listed above, in its aim to reduce out-of-pocket health care costs.

The Senate HELP committee is requesting input on the draft to be submitted to LowerHealthCareCosts@help.senate.gov.The committee plans to hold hearings on the legislation by the end of June and put the bill to a vote later this summer.

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Medical Cost Advocate was featured in a documentary by a French journalist

Maria Montecillo Leave a comment

A French journalist from CAPA TV (the equivalent of 60 Minutes in the US) came to our office and interviewed our CEO Derek Fitteron regarding our advocacy services. The interview was also about our client Stella who is featured on the previous blog. Watch how Stella was very stressed over the thousands of dollars in medical bills that she received when her triplets were born prematurely, and how her Advocate helped her in resolving these bills.

To watch it subtitled in English, go to settings➡️subtitles➡️auto translate➡️English.

You will see Stella, Stella’s advocate Maria, and Derek beginning at the 7:20 mark.

 

 

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This Could Be the Obamacare Outcome we’ve All Been Waiting For

Doug Leave a comment

This often-overlooked long-term goal of Obamacare may be finding the mark according to this latest study from the American Cancer Society.

The third open enrollment period for the Affordable Care Act, best known as Obamacare, has been ongoing for roughly five weeks now. And as seems to be the trend around this time of year, more questions than answers appear to be swirling around healthcare’s law of the land.

Big changes lead to an uncertain future

Obamacare is facing a number of changes in the 2016 calendar year, and, frankly, no one is certain yet how those changes might affect enrollment or patient mix for insurers.

For example, insurance premiums are rising at about their fastest rate in about a decade. The Great Recession held premium rate inflation in check for years, but the failure of more than half of Obamacare’s health cooperatives, coupled with many low-cost insurers coming to the realization that their rates were unsustainably low, are leading to big premium hikes in the upcoming year.

Data from the Washington Examiner showed that 231 insurers requested double-digit percentage premium price hikes in 2016 compared to just 121 in 2015. Furthermore, the magnitude of these hikes — 61 plans are looking for a minimum premium increase of 30% this year — is much higher than 2015. In short, there’s concern that higher premiums could reduce the affordability of the program for those who don’t qualify for a subsidy, leading to a higher uninsured rate.

Meanwhile, the employer mandate will be fully implemented on Jan. 1, 2016. The employer mandate will require that businesses with 50 or more full-time-equivalent employees (FTE’s) offer eligible health coverage to those FTE’s and their dependents under the age of 26, as well as provide financial assistance in instances where low-income FTE’s would be paying more than 9.5% of their modified adjusted gross income out of pocket toward their premium. If qualifying businesses fail to follow the rules, they could be looking at a $2,000 to $3,000 fine per employee.
The big question here is how businesses will respond. Will bigger companies step up and supply health insurance for their workers or will we see layoffs, hour cutbacks, or a move to private health exchanges? Obamacare’s big changes in 2016 are leading to a seemingly uncertain enrollment outlook in the near term.

Obamacare’s incredibly important goal that you probably overlooked

The easiest way to measure the success of Obamacare has always been by its overall enrollment totals. Obamacare was first and foremost designed to reduce the number of uninsured and to utilize the individual mandate and employer mandate to make that happen. The Centers for Disease Control and Prevention reported in Q1 2015 that just 9.2% of U.S. adults remained uninsured, including Medicare patients, which is the lowest figure on record. By this token, Obamacare would appear to be hitting its primary goal.

But there’s an even more important long-term goal that’s often lost on critics when discussing Obamacare’s success or failure — namely, the impact that preventative (and earlier) medical access could have on reducing long-term medical costs.
For insurers, Obamacare is a bit of a give and take. Insurers are enrolling more people than ever, and they’re also being required to accept members with pre-existing conditions. The result is that some insurers, such as the nation’s largest, UnitedHealth Group, are dealing with adverse selection and losing money on their individual marketplace plans because they’ve enrolled a large number of sicker individuals. Even though some of its large peers such asAnthem are healthfully profitable, the margins most insurers are generating on Obamacare plans (if they’re even profitable in the first place) are relatively small.

Now here’s the catch: In exchange for spending more money on their members up front, it’s possible that chronic and serious diseases that are the primary expense culprit for insurance companies can be caught before they become a serious issue. Thus, while health benefit providers may be spending more now than they would like to, their long-term outlook is also looking brighter presuming the current generation of members is now going to be healthier than the last generation given expanded access to medical care.

This could be the outcome we’ve been waiting for.

This last point sounds great on paper, but it’s difficult to prove that Obamacare is really making a dent in lowering long-term healthcare costs, especially since it’s only been the law of the land for about two years. All that consumers and critics can focus on at the moment are the rapidly rising premium prices.

However, a new study from the American Cancer society that was published online in the Journal of the American Medical Association late last month appears to show that there is a correlation between Obamacare’s expansion and a higher rate of cervical cancer diagnoses in select patients.

Researchers from the Department of Epidemiology at Emory University and from the ACS’ Department of Intramural Research analyzed a large database of cancer cases within the United States, separating cervical cancer diagnoses for women ages 21 to 25 in one group from cervical cancer diagnoses in women ages 26 to 34 in the other cohort. The reasoning behind this split? Persons under the age of 26 are still eligible to be covered under their parents’ health plan under Obamacare, and thus the expansion of this dependent clause should give researchers a reasonable correlation of how well Obamacare is affecting the rate of cervical cancer diagnoses.

After examining cervical cancer diagnosis rates for both cohorts before and after the implementation of Obamacare, researchers noted that there was a substantial increase in the number of cervical cancer diagnoses for women ages 21 to 25, whereas the age 26-34 cohort had a relatively consistent number of diagnoses before and after Obamacare’s implementation.

On the surface, a rising rate of cervical cancer diagnoses may not sound good at all. But, in a different context it could be just the news we’ve been hoping for. The key to beating cervical cancer is discovering it early, and presumably being able to stay on their parents’ health plans until age 26 helped the 21- to 25-year-old cohort gain this vital medical access. It’s possible that this early diagnoses not only saved lives, but for insurers that it kept them from shelling out big bucks in mid- to late-stage cancer treatments.

Keep in mind that this is just one example, and one example does not make a trend. However, it’s long been postulated that reducing the barriers to health insurance would lead to a higher medical utilization rate for consumers and a better chance of discovering potentially serious and chronic conditions at an earlier time, thus saving the patients’ lives and cutting insurers’ long-term medical expenses. It’s possible we could be witnessing the first signs of that.

Understandably, we’ll want to see additional studies emerge that examine disease diagnosis and treatment rates in a pre- and post-Obamacare setting so we can make a conclusive ruling as to whether or not Obamacare could actually lower long-term healthcare costs and improve long-term patient survival rates. The initial signs, though, are very encouraging.

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Finding Help for the High Costs of Cancer Care

Doug Leave a comment

This article from the Philadelphia Enquirer contains valuable information about the high cost of cancer care and the options people have in managing those costs.

The good news is more Americans are surviving cancer.

The bad news? We pay big bucks to stay free and clear of the disease.

Nearly 14.5 million American cancer survivors remain alive and well as of Jan. 1, 2014, according to the American Cancer Society, the National Cancer Institute, and the Centers for Disease Control and Prevention. By 2024, cancer survivors will number 19 million people.

So how much does it cost to stay cancer-free? Quite a lot, says Zhiyuan Zheng, Ph.D. and senior health services researcher with the American Cancer Society in Atlanta.

For American men, the three most prevalent types of cancer among survivors are prostate (43 percent), colorectal (9 percent), and melanoma (8 percent). Breast (41 percent), uterine (8 percent), and colon and rectum (8 percent) are most common among women who survive cancer.

Prostate, colorectal, and breast cancers account for about 30 percent of all cancer-related health-care costs. The survivors incur higher medical expenses, are at higher risk of secondary cancer, and require more tests and follow-up care.

Total cancer treatment costs in 2004 were $72 billion, about $120 billion in 2014, and will increase to $180 billion by 2024, Zheng adds.

How does that break down per person? In the first 12 months, breast cancer treatment costs roughly $20,000, colorectal cancer $30,000, and prostate $10,000.

Lost workdays add to the total annual economic burden per cancer survivor: $20,238 for colorectal, $14,202 for breast, and $9,278 for prostate, for those under age 64, the researchers found.

Fortunately, cancer patients can now turn to medical bill negotiators who bargain with medical providers.

“We have a number of cancer patients who’ve hired us. Plus we’re also seeing a higher success rate” among cancer patients, says Derek Fitteron, founder and CEO of Medical Cost Advocate in Wyckoff, N.J.

One customer was a family facing $125,000 in bills incurred in a year for treatment of a rare childhood cancer.

“We reviewed the bills for billing accuracy and found comparable pricing negotiating savings of more than $85,000 with several Pennsylvania facilities,” Fitteron said.

Resources Cancer maintains a list of organizations that help patients financially

The Cancer Financial Assistance Coalition is a group of national organizations that provide financial help.

The nonprofit CancerCare provides limited financial assistance to people affected by cancer. It also has a foundation to help fund copays, the CancerCare Patient Assistance Foundation

The HealthWell Foundation similarly provides financial assistance to cover copayments, premiums, and deductibles for certain medications and therapies.

Partnership for Prescription Assistance helps qualifying patients who lack prescription-drug coverage obtain the medications they need.

Needy Meds offers information on companies assisting those who can’t afford medication.

The Patient Access Network Foundation assists patients with out-of-pocket costs associated with their treatment.

Patient Services Inc. assists with insurance premiums and copayments for people with chronic diseases.

RxHope.com helps patients obtain free or low-cost prescription medications.

The Assist Fund provides financial support to chronically ill patients with high-cost medications.

The Patient Advocate Foundation provides education, legal counseling, and referrals for people with cancer who need assistance managing insurance, financial, debt crisis, and job-discrimination issues.

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Hospital Charges Surge for Common Ailments, Data Shows

admin

This excellent NY Times article is based on Medicare data on over 3,000 hospitals nationwide for what they charged in 2012. The data shows that the prices that hospitals charge is highly variable and has risen across the board. The article correctly points out that these increases in charges do not necessarily affect what Medicare pays because Medicare is so large that they tell hospitals what they are going to pay them independent of what they bill.

By JULIE CRESWELL, SHERI FINK and SARAH COHEN –  JUNE 2, 2014

Charges for some of the most common inpatient procedures surged at hospitals across the country in 2012 from a year earlier, some at more than four times the national rate of inflation, according to data released by Medicare officials on Monday.

While it has long been known that hospitals bill Medicare widely varying amounts — sometimes many multiples of what Medicare typically reimburses — for the same procedure, an analysis of the data by The New York Times shows how much the price of some procedures rose in just one year’s time.

Experts in the health care world differ over the meaning of hospital charges.

While hospitals say they are unimportant — Medicare beneficiaries and those covered by commercial insurance pay significantly less through negotiated payments for treatments — others say the list prices are meaningful to the uninsured, to private insurers that have to negotiate reimbursements with hospitals or to consumers with high-deductible plans.

“You’re seeing a lot more benefit packages out there with co-insurance amounts that require the holders to pay 20 percent of a lab test or 20 percent of an X-ray. Well, 20 percent of which price?” asked Glenn Melnick, a professor who holds a Blue Cross of California endowed chair at the University of Southern California. “Some hospitals will charge 20 percent of what Blue Cross Blue Shield will pay; others will play games.”
Data released by the federal government shows that hospitals across the country charge Medicare differing amounts for the same types of cases. The data includes bills submitted in 2012 by 3,300 hospitals nationwide for the 100 most commonly performed treatments and procedures like hip replacement, heart operations and gallbladder removal, among hospitals that reported at least 11 cases.

Charges for chest pain, for instance, rose 10 percent to an average of $18,505 in 2012, from $16,815 in 2011. Average hospital charges for digestive disorders climbed 8.5 percent to nearly $22,000, from $20,278 in 2011.

In 2012, hospitals charged more for every one of 98 common ailments that could be compared to the previous year. For all but seven, the increase in charges exceeded the nation’s 2 percent inflation rate for that year, according to The Times’s analysis.

Experts say the increase in the price of some of the most common procedures may be offsetting rising technology or drug costs, declines in the number of patients being admitted to hospitals and a leveling out of reimbursements from Medicare. Between 2011 and 2012, Medicare increased payment rates by only 1 percent for most inpatient stays.

The number of patients admitted for chest pain under Medicare’s fee-for-service plans plummeted more than 28,000, to 107,224 in 2012, and inpatients with digestive disorders decreased more than 29,000, to 217,514.

Over all, the number of Medicare patients discharged from hospitals for the comparable 98 most common diagnoses dropped from 7.5 million to 7.2 million. The total amount Medicare paid for their care also declined somewhat between 2011 and 2012, from $62.8 billion to $61.9 billion.
In an effort to reduce overall health care costs, hospitals have been encouraged to admit fewer patients for conditions like asthma, for example, in favor of less expensive outpatient care.

(more…)

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Rising Cost Tops Employees’ Health Care Worries

J Roberts


Employers are still concerned about the rising cost of healthcare. Will there be any end in sight?

By Stephen Miller

U.S. employees’ greatest concerns about health care are rising costs, canceled coverage and new taxes on medical benefits. Their employers are most concerned about the lack of federal guidance on what requirements must be communicated to employees, according to a December 2010 survey by HighRoads, a benefits administration service provider.

“There appears to be a healthy skepticism on the employer’s part about the content and timing of guidance from the federal government on how to administer and communicate future plan changes,” said Kim Buckey, practice lead at HighRoads. “While most employers increased their communications efforts during the fall 2010 open enrollment period to communicate changes required by health care reform, there are still doubts about how effective those communications were.”

Buckey advised, “There is clearly an opportunity to do some follow-up communications—based on the actual employee elections during open enrollment—or employee sensing (surveys or focus groups) midyear to determine whether employees truly understood the impact of the year’s plan changes.”

Employees’ Concerns

The biggest concerns HR professionals and benefits managers are hearing from employees about how health care reform affects them, HighRoads found, include:

• Increased cost of coverage (noted by 50 percent of respondents).

• Cancellation of benefits (13 percent).

• Government taxation of medical benefits (13 percent).

• Ability to add adult dependents (12 percent).

• No real concerns (12 percent).

Increased Communications

While 88 percent of employers reported that they had increased their employee communications to address health care reform, many still worried that the communications might not have been enough. The biggest communications concerns employers had around health care reform for the year ahead include:

• Lack of federal guidance on what the requirements are or how any changes in guidance during the year might change what has been communicated to employees (25 percent).

• The disconnect on cost and existing plans, because the law is predicated on being cost neutral to taxpayers and allowing employees to not lose the coverage they have (13 percent).

• Making sure that employees are told everything that is changing under their plans (13 percent).

• Employee understanding of changes and how the changes affect them (12 percent).

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AARP survey finds N.J. seniors are facing financial, health care hardships

J Roberts

A recent survey by AARP reveals that many NJ senior citizens are having a hard time meeting their financial obligations and getting adequate health coverage. Healthcare costs continue to rise and benefits are shrinking. The fear is real as more and more seniors find themselves working well into their golden years in order to support themselves. Read the below article and review the survey.

Peter Van Ness used to be the picture of financial health: perfect credit scores, quick to pay down his credit cards, never late on bills. During 50 years of work, he said, not once did he need help making ends meet.

But he could use some help now.

“I am being buried,” said Van Ness, 67, of West Milford, who still works but must pay for his bedridden mother’s medical expenses, has three kids in college and won’t be getting any retirement benefits from his company.

“I have real problems even trying to supply food for the family,” he said. “Whoever said the golden years are your best years — I laugh like hell.”

Van Ness was one of 400 New Jersey residents over age 50 polled for a survey to be released today by the AARP. Like him, many of the respondents said they’re having a hard time meeting their financial obligations and getting adequate health coverage. About two-thirds said they don’t have all the resources or information they need to stay healthy, and three in four said they worry about the levels of Social Security and Medicare benefits.

“It shouldn’t be surprising that there’s real palpable fear out there because seniors are suffering,” said Douglas Johnston, legislative director for AARP-NJ. He said the state’s utility costs, for example, have risen for the last five or six years while Social Security payments, a major source of income, have remained flat the last two years.

“I frankly don’t know how they do it,” he said. “The median amount Social Security recipients get per year is $10,400. How do you live on $10,400 anywhere, especially an expensive state like New Jersey?”

Harry Padden of Irvington, 58, is nearing retirement from his job as an inspector for the U.S. Department of Housing and Urban Development, but he fears his pension may be cut before he leaves and said he’s already paying more for health care.

“I’m squeaking through paying my bills,” he said. “I’ve considered moving to Georgia or Florida — there’s higher wages and it costs you less. My daughter has indicated that if I go, she’s going to follow.”

The survey also found 84 percent of residents would prefer to get long-term care at home or in an assisted-living facility, as opposed to a nursing home. Johnston said the state could save money by investing more in home-based care, which he said costs one-third of what nursing homes cost.

“It gives people what they want, we’ve never met a legislator or governor who doesn’t agree — and yet it never seems to happen,” he said.

The AARP survey also asked New Jerseyans over 50 what they most want to do in their retirement years. Forty-two percent said travel, 23 percent said they would focus on hobbies and interests, 8 percent mentioned their jobs or careers and 6 percent said they would devote themselves to their families.

Though he talks of moving, Padden said spending time with his family was a major reason he’s still in New Jersey.

“My grandson is in a basketball team, and I don’t really miss a game,” he said. “I’m driving over now.”

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Major Reforms in Student Insurance Proposed

J Roberts

Looks like there may be some hope for college students regarding insurance coverage.  In an area that has long been neglected, Congress has now introduced new regs to the Affordable Care Act which will require colleges and universities to provide health insurance coverage to students.

By Ria Patel

In quest to make lives of University students better, the Congress has decided to introduce new plans in the existing health care law, which will be in effect from the next year.

The reforms proposed, will be in favor of college students, who have estimated number of 3 million at present.

Till now, the area of student insurance was widely neglected, partly because of its uncertain and short validity duration.

But now after, bringing the student health insurance plans offered by colleges and universities to the same level as that of the 2010 federal Affordable Care Act by the U. S. Department of Health and Human Services, the need for further amendments is strongly felt.

The new reforms will ask colleges and universities to provide the health insurance to students, even if they are less than 18 years or have underlying medical conditions like diabetes or other discrepancies.

The law will also take care of benefits borne out of student plans. The schemes, which currently have very less boons, will observe a boost to minimum of $100,000 before September 2012 and more than $2 million after that.

The Universities will also be asked to maintain the coverage, in case the student is down with ill-health. No student will be punished if he forgets to give a proper account of its medical history.

Meanwhile, the Health and Human Services Department has sought public comments and views on proposed amendments till April 12.

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