medical billing advocate

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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Ultrasound at $59,490 Is Outrage in Aetna Claim Against Doctors

J Roberts

Here is recent news about doctors charging outrageous fees for some basic services. This is surely one of the reasons health care costs continues to rise. Consumers, please be sure to confirm what insurance your doctor accepts. If he or she is not in your plan’s network, inquire what the charge will be and find out what you may be responsible for in out-of-pocket costs. Medical Cost Advocate can assist you in negotiating your out-of-pocket costs. No one wants to be stuck with a $56,980 consultation fee.

by Peter Waldman

(Bloomberg) — Aetna Inc. is suing six New Jersey doctors over medical bills it calls “unconscionable,” including $56,980 for a bedside consultation and $59,490 for an ultrasound that typically costs $74.

The lawsuits could help determine what pricing limits insurers can impose on ”out-of-network” physicians who don’t have contracts with health plans that spell out how much a service or procedure can cost.

One defendant billed $30,000 for a Caesarean birth, and another raised his fee for seeing a critically ill patient in a hospital to $9,000 in 2008 from $500 the year before, the insurer alleges in the suits. The Caesarean price was more than 10 times the in-network amount Aetna quotes on its website.

“If these charges are accurate, consumers and purchasers should be outraged,” said David Lansky, president of the San Francisco-based Pacific Business Group on Health, a coalition of health-insurance buyers that includes Chevron Corp., Walt Disney Co. and General Electric Co.

Lawyers for the doctors declined to comment on specific charges in the suits, and said their clients did nothing wrong.

The insurance industry is grappling with how to respond to out-of-network hospital physicians who realize they have pricing muscle, according to Arthur Leibowitz, chief medical officer of Health Advocate Inc., a Plymouth Meeting, Pennsylvania, insurance adviser.

“These doctors can charge whatever they want,” Leibowitz said. “The challenge for the carriers is to come up with an agreeable, acceptable, unbiased judgment as to what a reasonable and customary reimbursement rate is.”

AMA Lawsuits

Aetna tried in 2007 to impose caps on some out-of-network payments, prompting doctor complaints to the New Jersey Department of Banking and Insurance. The agency sided with the doctors, fined the company $2.5 million, and ordered it to pay out-of-network practitioners enough so that patients wouldn’t be asked to pay balances other than co-pays.

In 2009, Aetna, UnitedHealth Group Inc., Cigna Corp. and WellPoint Inc. were accused by the New York attorney general of underpaying out-of-network physicians by manipulating a database used to calculate payments. They paid a total of $90 million in settlements without admitting wrongdoing. UnitedHealthcare agreed that year to pay $350 million to settle a lawsuit by the American Medical Association over the same issues. Similar AMA lawsuits against Aetna, Cigna and Wellpoint are pending.

Rare Glimpse

The Aetna lawsuits, filed in superior court in Camden, New Jersey, over the last eight months, allege the defendants violated New Jersey Board of Medical Examiners rules against excessive fees, and seek triple damages under state insurance- fraud laws against filing false or misleading claims.

The complaints provide a rare glimpse at the sums physicians earn from an insurer and the huge variations in what different doctors charge and receive for the same services.

Aetna reimbursed the defendants $8.3 million in 2009, up from $4.9 million in 2008, spokeswoman Cynthia Michener said, sometimes paying the full amount demanded and sometimes not. The insurer paid some of the large charges because of state regulations mandating timely payments and to prevent doctors from sending patients big bills, Michener said.

(more…)

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Medical Advocates Save Money on Medical Bills

admin

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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