medical advocates

This article provides insight into the many different types of health care resources and websites available to consumers regarding pricing and quality.

Bankrate.com

If you’re like most people, you’re taking more responsibility for and picking up more of the tab for your health care. A growing number of Web sites can assist your efforts by showing how the price and quality of care offered by different providers measures up.

1. Insurer sites

Many health insurers have member sites, says Carlton Doty, vice president and research director with Forrester Research Inc. While their capabilities vary, most include educational content as well as information on average prices for different procedures. If you’re insured, you’ll want to start your research here because the information should be most relevant to your situation, Doty says.

Aetna Navigator, the member site of Aetna Inc., for instance, lets members in more than 30 states compare prices charged by different health care providers. For example, the overall cost of a colonoscopy at one surgery center ran $1,200 to $1,800. The same procedure at a nearby hospital was $2,240 to $2,800.

The figures are based on two years of claims data, from which any extreme outliers have been removed, says Wayne Gowdy, senior product manager with Aetna. The site also offers information on the number of procedures performed at a hospital or clinic over a time period, as well as quality ratings. Aetna also offers a tool that lets members compare drug prices.

2. Government Web sites

A number of states, along with the federal government, host Web sites that provide price and/or quality information. For example, Wisconsin PricePoint lets residents of America’s Dairyland search more than 100 procedures at different hospitals, urgent care centers and emergency rooms. Use of the site is free.

For each facility and procedure, the site lists the range of prices charged, as well as the number of procedures completed, and the average and median length of stay. The figures are based on data the hospitals are required to provide to the government, says Joe Kachelski, PricePoint’s vice president. While he and his staff double-check numbers that look out of whack, they don’t eliminate outliers.

Again, the price differences can be significant. Case in point: Treating an ear infection at one urgent care center runs about $111. It’s $450 at the emergency room down the street.

3. Independent Web sites

A number of companies also operate sites. Healthgrades.com, for instance, assigns quality ratings of one, three or five stars to around 5,000 hospitals across the U.S., using data the hospitals submit to the federal or state governments.

To calculate the ratings, Healthgrades’ team adjusts the information to account for differences in patient population, says vice president Sarah Loughran. For example, one hospital may serve a largely elderly population, and age usually affects patient outcomes.

Then, Loughran and her staff will look at data on survival and complication rates, among other factors. Based on this, they’ll run the numbers to determine whether a particular hospital, given its patient population, performed as expected (three stars); better than expected (five stars); or worse than expected (one star). Most information is free. The Web site also provides information on physicians and nursing homes.

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.”

(more…)

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