medical bills

A Look at the Lives of American Nurses

Doug

Fantastic new book, film and website explores nurse’s critical role at the bedside working within the state of our current healthcare system. This film has received nationwide acclaim and is worth seeing.

By Nancy Szokan, Washington Post

Photographer and filmmaker Carolyn Jones created “The American Nurse” after publishing a coffee-table book on the subject two years ago, and the film builds on the same mix of powerful images with words of men and women whose lives are devoted to healing.

Over the film’s 78 minutes, viewers see Jason Short, an auto mechanic, describe how a bad motorcycle accident taught him what it was like to be helpless and in need of care; he is now a home health nurse in Appalachia. They follow Tonia Faust into her job at the Louisiana State Penitentiary: “People ask me how I can take care of people who have committed such horrific crimes,” she says.

“But when I’m at their bedside, I’m taking care of just another human being.”

The other nurses are a nun who runs a nursing home in Wisconsin, a labor and delivery nurse at Johns Hopkins Hospital in Baltimore and a former Army medic who rehabilitates wounded soldiers in San Diego.

After its premiere before an invited audience, the movie will be distributed nationwide through theaters and health-care centers. To see a trailer and a schedule of screenings go to: www.AmericanNurseProject.com.

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10 Ways to Save on Healthcare

Doug

As health care costs continue to increase, it is extremely important for consumers to scrutinize the charges they receive.  Medical bills are difficult to understand. In fact, 77% of Americans don’t understand health insurance or medical billing. It pays to have a advocate review your bills and negotiate with medical providers on your behalf.  Their experience, available data resources and relationship with providers will save you time and money. Below are 10 ways you can save on healthcare costs.

By Margarett Burnette, Bankrate.com

As health care consumers endure higher deductibles and reduced insurance benefits, it is becoming more important to understand and even negotiate prices before receiving medical treatment.

Dr. Kathryn Stewart, medical director of care management at Mount Sinai Hospital in Chicago, believes that patients can and should be more proactive about seeking the best prices for their services.

“Hospital costs are probably 40 (percent) to 50 percent of what their (list price) charges are,” she says. But when it comes to billing, “most hospitals are happy to break even or have a little bit of profit.”

This means there is plenty of room to negotiate and reduce your out-of-pocket expenses.

Cutting costs

Shop for hospital care as you would any other consumer service, but with more effort since costs can run really high. You can save yourself a bundle using these strategies.

10 ways to reduce your medical bills
 1. Ask your doctor to be your ally
If you’re shopping around for medical services, you probably have a primary physician who directed you to seek the service in the first place. “You have to get diagnosed by somebody,” says Stewart. “So let that person be your advocate.”
She advises patients to ask their doctors where the best hospitals are for the recommended procedures, which centers will work with patients to lower out-of-pocket costs, and to even ask for help communicating with that facility’s finance department.

“If the hospital where a physician admits is approached by that physician on behalf of the patient, I think (the patient) might get somewhere with the hospital. Let’s say I have a patient in my practice who has one of these really high-deductible (insurance) plans, and they need to have a hysterectomy. (I could) approach the finance department and say ‘I’ve got this patient, but they don’t have (enough) insurance and they can’t afford to pay full price, but they can afford to pay something. Can you work with them?'”

2. Compare costs by using the CPT code
Though your doctor might be willing to initiate a conversation with the hospital finance department, you can still expect to have several conversations with them on your own. Before calling, make sure you have the “current procedural terminology,” or CPT, code for the procedure you are seeking.
“CPT is the industry term for the ‘billing code.’ It’s a five-digit number that is used to bill the procedure,” says Jane Cooper, president and CEO of Patient Care, a health advocacy company based in Milwaukee. Cooper says that your physician or physician’s office can provide you with the code, and the number is the same across hospitals. With this code, you can call multiple medical centers to compare prices for the same procedure.

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The $2.7 Trillion Medical Bill

Doug

The fragmented health care market in the United States has driven up costs, putting deep economic strains on consumers and the country. The Affordable Care Act promises to help Americans become insured and obtain access to the system. What about reducing health care cost? Reducing the cost of care has been more elusive. In the mean time consumers need to find trusted partners to reduce medical bills.

Colonoscopies Explain Why U.S. Leads the World in Health Expenditures

 By ELISABETH ROSENTHAL, NY Times

 Deirdre Yapalater’s recent colonoscopy at a surgical center near her home here on Long Island went smoothly: she was whisked from pre-op to an operating room where a gastroenterologist, assisted by an anesthesiologist and a nurse, performed the routine cancer screening procedure in less than an hour. The test, which found nothing worrisome, racked up what is likely her most expensive medical bill of the year: $6,385. That is fairly typical: in Keene, N.H., Matt Meyer’s colonoscopy was billed at $7,563.56. Maggie Christ of Chappaqua, N.Y., received $9,142.84 in bills for the procedure. In Durham, N.C., the charges for Curtiss Devereux came to $19,438, which included a polyp removal. While their insurers negotiated down the price, the final tab for each test was more than $3,500. “Could that be right?” said Ms. Yapalater, stunned by charges on the statement on her dining room table. Although her insurer covered the procedure and she paid nothing, her health care costs still bite: Her premium payments jumped 10 percent last year, and rising co-payments and deductibles are straining the finances of her middle-class family, with its mission-style house in the suburbs and two S.U.V.’s parked outside. “You keep thinking it’s free,” she said. “We call it free, but of course it’s not.”

In many other developed countries, a basic colonoscopy costs just a few hundred dollars and certainly well under $1,000. That chasm in price helps explain why the United States is far and away the world leader in medical spending, even though numerous studies have concluded that Americans do not get better care. Whether directly from their wallets or through insurance policies, Americans pay more for almost every interaction with the medical system. They are typically prescribed more expensive procedures and tests than people in other countries, no matter if those nations operate a private or national health system. A list of drug, scan and procedure prices compiled by the International Federation of Health Plans, a global network of health insurers, found that the United States came out the most costly in all 21 categories — and often by a huge margin.

Americans pay, on average, about four times as much for a hip replacement as patients in Switzerland or France and more than three times as much for a Caesarean section as those in New Zealand or Britain. The average price for Nasonex, a common nasal spray for allergies, is $108 in the United States compared with $21 in Spain. The costs of hospital stays here are about triple those in other developed countries, even though they last no longer, according to a recent report by the Commonwealth Fund, a foundation that studies health policy.

 While the United States medical system is famous for drugs costing hundreds of thousands of dollars and heroic care at the end of life, it turns out that a more significant factor in the nation’s $2.7 trillion annual health care bill may not be the use of extraordinary services, but the high price tag of ordinary ones. “The U.S. just pays providers of health care much more for everything,” said Tom Sackville, chief executive of the health plans federation and a former British health minister.

Colonoscopies offer a compelling case study. They are the most expensive screening test that healthy Americans routinely undergo — and often cost more than childbirth or an appendectomy in most other developed countries. Their numbers have increased manyfold over the last 15 years, with data from the Centers for Disease Control and Prevention suggesting that more than 10 million people get them each year, adding up to more than $10 billion in annual costs. Largely an office procedure when widespread screening was first recommended, colonoscopies have moved into surgery centers — which were created as a step down from costly hospital care but are now often a lucrative step up from doctors’ examining rooms — where they are billed like a quasi operation. They are often prescribed and performed more frequently than medical guidelines recommend.

 The high price paid for colonoscopies mostly results not from top-notch patient care, according to interviews with health care experts and economists, but from business plans seeking to maximize revenue; haggling between hospitals and insurers that have no relation to the actual costs of performing the procedure; and lobbying, marketing and turf battles among specialists that increase patient fees.

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Affordable Care Act Rate Shock?

Doug

By Kathleen Phalen-Tomaselli,TheStreet.com

Come January 1 of next year, those with the lowest health insurance risk may be hit the hardest with premium increases as high as 40%. “The rules are changing,” says Robert Zirkelbach, vice president of strategic communications for the American Health Insurance Plans (AHIP) in Washington, D.C.

If you are young, healthy and qualify for non-group coverage, you could face rate hikes forcing you to reconsider how you spend your health care dollars. Here’s what’s happening: The Affordable Care Act, aka Obamacare, reaches maturity the first of the year. Designed to tackle the problem of insuring the nation’s estimated 48 million uninsured in addition to increasing benefits for such services maternity care and reproductive aid—all while lowering premium rates for older Americans. But the new provisions come with a price.

And because of new age rating band requirements tied to the ACA, the 18 to 44 age group’s premiums will increase while the over 57 group will decrease. Today, the ratio for age rating bands is 5:1, which means insurers can charge older individuals five times more than younger insureds. Come January 1, the band ratio reduces to 3:1. Take, for example, a 24-year-old who pays $1,200 annually for non-group coverage today could. He could see an overnight increase to $1,800, while a 60-year-old paying $6,000 today will pay $5,400 in 2014, according to the AHIP.
Nonetheless, in the report “Timely Analysis of Immediate Health Policy Issues” published last month by the Urban Institute Health Policy Center in Washington, D.C., lead author Linda J. Blumberg concludes that such predictions are over inflated. Citing government subsidies available to help defray such increases for those earning less than 400% of the federal poverty level, Blumberg says that subsidies will help this age group obtain expanded coverage. Even so, according to the report, “Premiums for 21-to 27-year-olds are $850 lower under (the)5:1 (age band rating) than under (the)3:1 rating.”

The problem with counting on subsidies to defray higher premiums is that, “40% will not be eligible for subsidies,” says Zirkelbach. He goes on to explain that 7.6 million of those in the non-group category in 2011 earned more than 400% of the federal poverty level.

According to an Oliver Wyman study, the cut-off for subsidies is closer to 250% of the federal poverty level—in other words, those earning less than $25,000. There will be no subsidies for individuals earning more than $50,000.

Along with tax subsidies, the ACA calls for the expansion of state Medicaid programs to help those with lower incomes. But, depending on where you live, this may not be an option. The Supreme Court recently ruled that states can decide on whether they will participate. At this point, many states remain undecided with some governors, like Gov. Tom Corbett(R-PA), saying they have no intention of expanding an already stretched program.

To further compound the issue of higher premiums, the health care reform law includes a new $100 billion sales tax on health insurance that will continue to drive up costs. AHIP predicts this increase may be as high as $300 per family.

The Congressional Budget office says the taxes will, “largely be passed through to consumers in the form of higher premiums.” A 2011 Oliver Wyman analysis estimates that this tax alone—not accounting for age rating bands or expanded coverage—will increase premiums over a ten-year period by $2,150 for individuals and an average of $5,080 for families.

Currently, federal and state governments are establishing health care exchanges—much like a one-stop health insurance supermarket—and individuals will be able to select plans starting October 1.

What are your options?

Pay the higher premiums that will also offer you more coverage. Opt-out of coverage and pay the federal uninsured penalty of about $95 in 2014. Or choose a catastrophic plan available for those up to age 27.

What does Zirkelbach hope for? A repeal of the health care tax and a phasing in of the age rating bands. Is there still time to hope? “It’s hard to say,” he says. “Maybe when taking a closer look at this they will re-visit these issues.”

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Insurers point finger at fees

J Roberts

Sarasota Herald-Tribune – Online

Attend any town hall meetings over healthcare lately? It should be no surprise that a hot topic of discussion is the outrageous and exorbitant medical charges by doctors and hospitals to patients. Make no mistake, doctors, hospitals and other healthcare professionals can charge any amount without any sound economic basis or rationale. On the flip side, while charges often border the absurd in terms of excessiveness, most healhcare providers are willing to negotiate.  Medical Cost Advocate can assist in reducing those charges and bringing them down to a fair and equitable level to save you money.

Maria Davis poses last month with sons Ryan and Jack, left, at home in Miller Place, N.Y. Ryan fell and received three stitches; she got a $6,000 bill. Insurers say a survey shows how medical fees are a significant part of the nation’s health care problem.NEW YORK TIMES / MAXINE HICKS

A patient in Illinois was charged $12,712 for cataract surgery. Medicare pays $675 for the same procedure. In California, a patient was charged $20,120 for a knee operation for which Medicare pays $584. And a New Jersey patient was charged $72,000 for a spinal fusion procedure that Medicare covers for $1,629.

The charges were cited in a survey sponsored by America’s Health Insurance Plans in which insurers were asked for some of the highest bills submitted to them in 2008. The group, which represents 1,300 health insurance companies, said it had no data on the frequency of such high fees, saying that to its knowledge no one had studied that question. But it said it did the survey in part to defend itself against efforts by the administration to portray certain industry practices as a major part of the nation’s health care problems.

The health insurers, saying they felt unfairly vilified, gave the report to The New York Times before posting it online today, explaining that they wanted to show that doctors’ fees are part of the health care problem.

The group said it had used Medicare payments for comparison because Medicare was so familiar and payments are, on average, about 80 percent of what private insurers pay.

“It’s the Wild, Wild West when it comes to prices of anything in the U.S. health care system, whether for a doctor visit or for hospital charges,” said Jonathan S. Skinner, a health economist at Dartmouth.

The situation is so irrational, said Uwe E. Reinhardt, an economist at Princeton, that it simply cannot go on.

“We will not emerge out of this decade with this lunacy,” Reinhardt said, adding, “You worry about credit card charges, you scream for consumer protection — why not scream for it here?”

But Dr. Robert M. Wah, a spokesman for the American Medical Association, says there is another side to the story — insurers’ low payments to doctors who enter into contracts with them and the doctors’ difficulties, in many cases, in getting paid at all. That is why, he said, doctors may simply abandon insurance plans. Then patients end up with extra fees because they have to go outside their networks.

Karen Ignagni, president and chief executive of America’s Health Insurance Plans, had a different view, saying “As we think about the health care debate, what’s been talked about is, What are the cost-sharing levels? What are the premium levels? How much do health plans pay? No politician has asked how much is being charged.”

Some of the legislation being considered by Congress would require insurers to increase their disclosure to patients of possible out-of-network costs. And President Barack Obama has proposed changing how Medicare sets its payments to doctors and hospitals. But there are no specific proposals to control prices for out-of-network medical services.

In the survey, patients were insured but saw doctors out of their networks of care providers. When patients go outside their networks, doctors have no obligation to accept the out-of-network fee from insurers as payment in full. Patients may then be accountable for the balance.

The survey looked at 10 companies that insure patients; the companies provided some of the highest bills from 2008.

State laws protecting patients from getting stuck with medical bills in excess of their normal deductibles or co-payments to providers in their insurance networks, vary widely, said Betsy M. Pelovitz, the group’s vice president for state policy. And, she said, the laws often offer little or no protection to patients who seek care outside their insurance networks.

No one intervened for Maria Davis when her son fell and hit his mouth on a floor. Davis, a respiratory therapist on Long Island, took 4-year-old Ryan to an emergency room. “He was bleeding a lot,” Davis said.

She said a doctor said he would put in a couple of stitches but seemed uncomfortable treating the agitated child. When he said he could call a plastic surgeon, Davis agreed. The surgeon, Dr. Gregory J. Diehl of Port Jefferson, “was very nice,” Davis said. He put in three stitches, and Davis assumed his bill would be fully covered by her insurer, United Healthcare. It was not. The bill was $6,000. The Davises paid their deductible of $350. After United Healthcare paid $2,024.80, Diehl reduced his bill by $2,100 and billed the Davises for the balance, $1,525.20.

He did not return calls to his office.

So far, the Davises have not paid the balance.

“I told them I thought it was an unreasonable amount,” said Jonathan Davis, Ryan’s father.

“We have gotten several letters, and they have gotten more than a little threatening,” Davis said.

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Health-Care Costs Rise for 2009

J Roberts

Washington Post – Online

Medical costs continue to rise for American’s, even those with Health Insurance. The latest report from the health care consulting firm Milliman puts the cost at $17,000 a year for a family of four. Consistent with trends, the prediction is that more employers will shift the cost onto employees leaving them to pay more.

Families of four may want to stash away roughly $17,000 this year to pay for the cost of health-care services, according to the recently-released Milliman Medical Index. Produced by a consulting firm that advises health-care plan sponsors and participants, the MMI serves as a measure of the average annual medical spending of typical American families covered by a PPO. This year’s $17,000 price tag reflects a 7.4 percent increase from 2008. The median family income in 2008 was around $67,000, and if that amount does not change significantly, then this year’s projected spending represents about 25 percent of a family’s income.


Health economist Jane Sarasohn-Kahn crunched the 2009 projected cost in her blog, Health Populi and concluded that a rise in outpatient costs triggered this year’s projected increase. Outpatient costs have risen 10 percent this year, according to the MMI. Unit cost, rather than utilization, has gone up. As Congress continues to debate health-care reform, Sarasohn-Kahn believes companies will be unable to help cover the rise in health-care costs. She projects in her blog that “employers who sponsor health insurance will lay more health cost burden onto insured employees as their subsidy declines and the worker’s subsidy increases.”

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Enlisting Help for a Lower Bill

J Roberts

A great article from The New York Times Online that talks about the many challenges people face when sick, underinsured or have no insurance.  Here is a list of steps and helpful points to better manage the medical bills.

 The New York Times

MEDICAL bills have a way of piling up — especially when you’re sick or underinsured. Just ask Kirk Kupka, 48, and his wife, Susie, 53.

Mr. Kupka has multiple sclerosis. The Kupkas, who live in Lindstrom, Minn., have an annual income of $45,000 — a combination of her salary as an office manager and his disability payments.

More than 20 percent of that income goes toward health care. Their annual insurance premiums total $5,400, and then there’s the $4,000 Mr. Kupka spends on drugs, doctor’s visits and lab fees before he fulfills his policy’s deductible.

In the three years since Mr. Kupka’s disability forced him to stop working as a mental health therapist, he has accumulated $12,000 in debt.

“It’s frustrating,” he says. “We earn too much to qualify for state and county assistance, but not enough to stay ahead of the bills. I’ve thought maybe my wife and I should get divorced. But not only is it against our faith, it turns out it wouldn’t help.”

Medical debt can lead to drastic measures, forcing people to raid their 401(k)s, tap into home equity lines and, in some cases, declare bankruptcy. Surveys by the Commonwealth Fund, a nonprofit health care research foundation, found that 41 percent of adults said they were struggling to pay their health care bills in 2007, up from 34 percent in 2005. That percentage is almost surely growing.

And as Mr. Kupka’s situation illustrates, it’s not just uninsured patients who rack up large bills. Nearly two-thirds of those with debt problems, according to Commonwealth, had health insurance.

But insurance covers less and less these days, as employers continue shifting more health care costs to their employees, and as consumers resort to lower-cost plans that come with high deductibles or less generous benefits.

“People who have been faithfully paying insurance premiums for years are coming in with medical bills they can’t pay,” said Gail Cunningham, a spokeswoman for the National Foundation for Credit Counseling, an umbrella group for services that help consumers cope with debt.

But if you’re having trouble paying your medical bills, you’re not helpless, either. There are ways to reduce, or at least more effectively manage, medical debt.

CONFRONT, DON’T IGNORE Procrastinating only leads to trouble. If your bills are turned over to a collection agency, the debt goes on your credit report and will remain there for lenders, and even potential employers, to see. You may have difficulty getting a loan and, if you do get one, you’ll be charged higher rates. So take action — even if that doesn’t mean writing any checks right away.

Proceed to Step 2:

SCRUTINIZE YOUR BILLS Look over your outstanding bills and make sure the listed services actually square with the care you received. Errors are common. If terms or procedures confuse you, call the hospital’s or doctor’s billing department and ask for an explanation.

If your insurer denied one or more of your claims, resubmit the bills, advises Mark Rukavina, executive director of the Access Project (www.accessproject.org), a nonprofit group in Boston that helps consumers cope with medical debt.

“If that doesn’t work, file a formal grievance or appeal with the insurer,” Mr. Rukavina said. “Even it that fails, most states allow insured patients the right to an external review by a certified third party, often a state agency. And patients should exercise this right.”

HIRE AN EXPERT Try first to negotiate with your providers for a discount or an extended payment plan. Explain that you simply can’t pay your bills in full right now, and you need some leeway.

If this tactic doesn’t work, or you don’t have the time or energy to haggle, consider hiring a billing specialist — a professional trained to spot errors who speaks the language that medical providers understand and respond to.

Some billing experts charge only if they save you money. Others may ask for a retainer up front. Make sure you clarify the terms at the outset.

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