Are You Being Treated by a Subcontracted Doctor?

September 26, 2012 by Leave a Comment

A recent story from Dayton, Ohio, caught our attention, where according to news reports, some patients remain responsible for emergency room charges when a hospital happens to ‘subcontract’  doctors who may not accept health insurance at all. This adds another layer to the oftentimes confusing in network vs. out of network debate. In many cases, especially in an emergency situation, patients who visit a local hospital or facility may experience unexpected costs after they are cared for by a doctor who may not be ‘in their network’, even if the facility itself is listed as an in network provider. There’s been a lot of discussion whether this, which may seem deceptive, especially to those without specialized knowledge in the medical billing and health insurance field, is fair. In fact, state officials, like in New York, are  looking to pass legislation which mandates better transparency for out of network charges. Taking the time to understand your health insurance plan and what defines a covered provider or facility can save you hundreds if not thousands of dollars in non-covered charges.

It seems providers tend to respond to these scenarios in two ways: Some indicate they will change their policies to include more transparency while others claim to be bound by federal laws that do not allow them to reveal to patients whether an on-call doctor or a physician on shift will accept their insurance or not.

We find the second argument to be completely unacceptable at face value. In fact, it’s reasonable that consumer advocates would expect state regulators to crack down on these well documented examples of seemingly unfair provisions in delivering medical services. It’s not outside the realm of possibility that a patient facing bankruptcy after a bill like this would have a basis for legal appeal, especially as new legislation is introduced and passed. It’s vitally important that you discuss your options and ask questions before treatment to minimize impact to your financial future. How prepared are you in the event of an emergency room visit?

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Beware of Balance Billing in Medical Bills

August 7, 2012 by Leave a Comment

Balance billing occurs when a healthcare provider bills a patient for some or the entire amount that should have been declared an insurance discount (contractual allowance). The fact that Prime Healthcare Services in California recently settled a suit for $1.2 million and discontinued the practice suggests that this is a problem. In fact, several states have statutes that prohibit balance billing.

How do you tell if you’ve been balanced billed? First, you have to determine if your treatment was performed by an in or out-of-network healthcare professional. Then, you have to check your EOB (Explanation of Benefits).

In- Network

Check an erroneous charge simply by seeing if the bill for the service exceeds the amount on the EOB. If it does, let your insurance company know and let them handle it.

Out-of-Network (OON)

There are two scenarios:

  • If you have an OON benefit, the OON deductible and co-insurance will apply first. The insurance company pays the balance above that like always. However, if the provider billed you for more than the deductible and co-insurance you may be the victim of a scam. Check the EOB. Did insurance pay the provider? If so, report it. It’s a scam and it is wrong.
  • If you do not have an OON benefit and accidentally got treated by the provider, tell them you want to be treated like an uninsured patient. A standard discount will be applied.

When in doubt, check with a medical bill advocate.

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Past Due Medical Bills: When Do I Have to Pay?

August 6, 2012 by 1 Comment

Have you received a medical or hospital bill with no clear due date? This can be because of how bills are laid out or because of design issues. Typically, a bill or patient statement will show medical debt as 30, 60, or 90 days past due, providing the kind of urgency that can make you drop a check in the mail. Bills may also be labeled “second notice” or “third notice” to show that the biller has already tried to contact you. But, all of that doesn’t always tell you what you need to know: how long you have to pay before the bill goes to collections. There are several reasons you may choose not to pay your medical debt right away including having a lot of bills or long-term debts to juggle. Prioritizing which ones to pay can take precedent to stay afloat. And, some billing statements require real, actionable steps while medical bills seem to be written in some strange, esoteric language.

Medical Debt Collection: Common Practices

Every medical provider has their own system for handling past due bills. Some are quicker than others to send a past due bill to collections. Many have different billing systems that represent debt in different ways. Some may be explicit about a due date, others will not. In some cases, when patients call, the medical office admits that they don’t even know the exact date when a bill will go to collections. That’s what motivates many experienced consumer advocates and others to recommend “playing it safe” and promptly paying all past due medical bills aged longer than 30 days, which is a common grace period for payments.

Some patients, though, will make active attempts to talk to providers. Those who pick up the phone can often get on payment plans that will make due dates and everything else much clearer, while allowing for deferred payment according to the patient’s finances. Some can even qualify for charity. In many cases, it’s this direct communication which can yield benefits for both parties: you know where you stand and your provider receives data on how and when you are likely to pay a particular bill. It’s a win-win, and that’s why when it comes to vague patient statements, the direct approach is often best. How do you promote open communication with your provider on past due medical bills?

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25 Million Americans Underinsured Including Middle and Upper Income Families

May 1, 2012 by Leave a Comment

As current government initiatives wrestle with the issue of millions of uninsured Americans facing potential medical bankruptcy, new studies are revealing that it’s not just the uninsured who are at risk. The issue of underinsured American individuals and families is becoming a major part of today’s healthcare conversation and alerting many more Americans to the dangers that they face, even if they have access to affordable health insurance policies.

Current statistics show a startling trend, where being underinsured is becoming a common way to fall into extreme medical debt and eventual bankruptcy or bad credit situations. Research by the Commonwealth Fund that appeared in recent industry journals shows that America’s underinsured community has doubled in the past four years to over 25 million people. While the highest number of underinsured Americans are in the income range below the poverty level, research shows that middle and upper income families are being affected in larger numbers each year. Research also shows that some individuals with what others would consider healthy annual incomes are still very likely to become underinsured in the immediate future.

In general, being underinsured has to do with the cost of one’s medical bills against that person’s annual income. Consumer advocates point to co-pays and high plan deductibles as being part of the equation that pushes an underinsured American toward bankruptcy, but many experts would say that the largest component of these kinds of situations are massive bills for complex medical procedures where a factor called co-insurance can leave a patient with many thousands of dollars in debt. If someone who is insured faces an extensive and very costly set of medical procedures related to a certain condition, he or she can end up paying 5%, 10%, 15% or more of the total medical bill. Although the insurer will pick up the major portion of the cost, even a small amount of the total bill is enough to bankrupt many patients, simply because the bills for these procedures can be so large. It’s not uncommon for medical bills, including separate facility and doctor charges, anesthesia charges, charges for related items and multiple doctor visits, and more, to total up above $100,000 in a given year. For the majority of Americans, this is completely unaffordable and will result in an inability to pay the entire debt. In these situations, the resulting debt must be managed down to workable levels, or the patient simply defaults, going through bankruptcy or suffering a destroyed credit rating.

Take the time to thoroughly review your medical bills and health plan coverage details to ensure accuracy of billing and insurance charges and payments. This step alone could save you thousands in out-of-pocket medical debt.

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Overused and Unnecessary Medical Procedures

April 28, 2012 by Leave a Comment

Nine physician specialty societies are each reporting a top five list of commonly used procedures that are often unnecessary. These societies represent 375,000 physicians across the country.

Some of the procedures cited include:

  • Brain scan after fainting (Without other relevant symptoms)
  • Antibiotics for sinusitis (While typically resolving itself in two weeks, 80% of patients are prescribed antibiotics. CT scans are also usually unnecessary.)
  • Admission and pre-operative chest X-rays (Routine X-rays are not needed.)
  • Colonoscopies (Not recommended but once a decade.)
  • Cardiac stress tests (They do not need to be part of a checkup for a healthy adult.)
  • Lower back pain (Unless another ailment is suspected, X-rays are not needed in the first six weeks.)

Unwarranted testing can lead to stress, over treatment, higher medical bills, and even unneeded invasive procedures.

In fact, the natural tendency to screen for heart disease prior to having any symptoms, like getting a stress test as a 50th birthday present, hasn’t “panned out,” according to a preventive cardiologist at Northwestern Memorial Hospital.

Study members suggested that patients and doctors have to thoroughly discuss any tests/procedures even if they are suggested by patients because they are not always needed.

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When is a Medical Bill Sent to a Collection Agency?

March 5, 2012 by Leave a Comment

A recent article in the Chicago Tribune’s March 4, 2012, issue “Small, Paid-off Medical Debt Can Mar Credit, Upend Financing for Unknowing Americans” highlighted how quickly a pristine credit can plummet when unexpected medical bill balances show up on credit reports including previously paid off medical debt. According to the Commonwealth Fund, 30 million Americans were contacted by collection agencies in 2010, an increase of over 25 percent from 2005. And, the Access Project, a research group funded by health care foundations and advocates of tougher laws on medical debt collectors, estimate that over 3 million Americans who have paid off their debt in full still have their balances appearing on their credit reports. Most of the collection actions are attributed to medical bills with the majority of outstanding balances under $250.00.

Medical bills are sent to collection agencies quicker than you think. In fact, it is common to receive a bill within a few days or so of your procedure or hospital stay and the clock starts ticking. So, what can you do to minimize your account from being turned over to a collection agency?

  • First and foremost, do NOT ignore your bill! If you haven’t already done so, immediately communicate with your medical provider informing them of your financial situation. Most providers will collaborate with you on options when they know you are actively working to resolve the balance.
  • Be persistent and polite.
  • Get everything in writing even agreeements; follow up in writing yourself. Did you know a provider may choose to turn your account over to a collection agency if you miss an agreed upon payment or they feel you aren’t paying the balance down fast enough? Thorough and organized recordkeeping is a must including names, dates, what was said, etc.
  • Submit written communication when disputing your bill or requesting a bill audit for errors. You may want to make good faith payments until the dispute is resolved. Again, get this in writing.
  • Regularly check your credit reports for incorrect listings such as disputed bills that were reported as unpaid accounts. Submit a letter of complaint to the credit bureaus explaining the dispute. The bureaus must review your complaint and correct their reports.

Medical debt can appear on your credit report for seven years, even if it was paid off or settled.

In June 2011, bill H.R. 2086: Medical Debt Responsibility Act of 2011 was introduced. Should this pass, it will provide relief for Americans by excluding “from consumer credit reports medical debt that has been in collection and has been fully paid or settled, and for other purposes”. To support this bill, contact your Congress member.

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