The need for patient advocates

November 24, 2009

I came across this post from charlotteobserver.com titled ‘Every patient needs and advocate’ and subtitled ‘In today’s medical maze, a trusted ally can help make sure you are getting the best care possible.’ With a title and subtitle like this I had to be interested.

The post details how a father was with his son dealing with life threatening injuries. The father became part of the patient’s team in ensuring he received the best care possible. The post also details many of the ways an advocate can assist a patient. There was one aspect the post missed; what happens when the patient is discharged from the facility and weeks later receives a bill.

Medical bills can be very confusing and difficult to understand. A recent study cites that 70% of Ohioans are concerned over their ability to manage their families medical bills.  INSNET provides medical bill review and negotiation services to ensure that the patient pays a fair price on their medical bills.


A glimpse into what government run healthcare will look like

November 10, 2009

The town I live in is running a program offering to vaccinate school aged children for the flu as well as H1N1. I’ve lived in this town over 17 years and am not sure why it is being done this year.

A letter came home from all the schools in September announcing this program, with the shots to be administered by a third party agency in the first week of October. The notice mentioned that this will just be the seasonal flu vaccine, and will not protect against H1N1. Shortly afterwards, we got another notice stating that due to a shortage, the schedule vaccinations will take place November 9 – 14.  Another notice came out stating that there will indeed be a H1N1 vaccine, but the seasonal flu vaccine will not be available. Furthermore, the H1N1 vaccine would not be a shot, but instead a nasal spray (much to the delight of my younger children. Finally, the first day of vaccinations and low and behold, the seasonal flu vaccine is available along with the H1N1, in both shot and nasal spray form.  Not only did they get the wrong information out to the families, but they had 3 chances to it correctly and still didn’t get it right. Do we want all of our healthcare run like this?

Due to the size of our town, the vaccines are to be administered based on your last name (A-F the first day, G-M the second etc.) Sound like rationing to anyone?

Additionally, the vaccines are to be administered between 2:00 and 7:00 at the high school. My daughter who attends the high school went to register for the vaccines immediately after school ended at 1:45. She got in line behind others, who were already in a line extending outside of the school. I know people who waited in excess of 2 hours for their children to be  vaccinated yesterday.

Furthermore, there is no fee to be paid at the time the vaccine is administered. It appears to be a free program, which many will indeed believe does not cost them anything. How much are taxes going to go up to run this program this year and into the future?

Our healthcare system is indeed in need of change, but I believe that the government should stay out of it.







Back in the saddle again

April 24, 2009

It sure has been a hectic past couple of weeks. Preparing taxes, kids on school vacation and securing additional negotiators has left precious little time for this blog. It then struck me that if I’m struggling with squeezing more items in my day than so must others.

Which got me thinking obviously about our negotiating service. I believe that anyone can negotiate their medical bills, just like anyone can negotiate what they pay for hotel rooms, airfare and new automobiles. The major stumbling block is most individuals do not know what a fair price is to offer their provider or what is fair to accept as a discount.

The founders of INSNET have been negotiating medical bills for over 20 years. We have the experience to not only know what a fair price to pay for services is, but also what dollar amount your provider has accepted from insurance in the past. With this information we base a settlement proposal and ensure you pay a fair price for your medical care.

I was recently reminded of an article our president Jack Gillis wrote for the Self Insurer years ago. The article references a Case Management Nurse who was looking for pricing information for a lymphadema pump. The homecare medical dealer was billing the insurance company $5,200.00. The Case Management Nurse  negotiated the price down to $2,300.00. Now most would say that the savings was fantastic. However, before she contacted the provider we informed her that the manufacturer had a suggested list price (not dealer cost) of $1,600.00 . In this case, the fanatastic negotiated settlement was a least a $700 overpayment. If a medical provider is able to negotiate a deal that great for themselves with a trained medical professional, just what kind of chance does the average citizen have?

How much time do you have to contact your medical provider with questions on your medical bill. The time you spend on hold can be an eternity. In fact I finally used my time well and wrote this post during my 14 minutes and 34 seconds I was on hold with a provider.


I feel your pain

March 27, 2009

I recently had an encounter with my daughters pediatrician office which showed a brief glimpse into the frustration many feel about our system of healthcare

About a year and a half ago my twelve year old daughter had her annual physical examination. My daughter’s pediatrician is a male and the office has a Physicians Assistant who is female. For several years my daughters have seen the PA for the exams, which is fine with my wife and I because the girls are more comfortable having a female examine them. During the physical the PA noticed something unusual about the curvature of my daughters spine. Her examination noted that the curve was a bit more pronounced then they would like to see at a child this age, she was concerned, but not overly so and figured it was something my daughter may grow out of. To be safe, she ordered x-rays at another facility and asked us to come back every 6 months for checkups.

In January I took my daughter to this checkup. The PA came into the room and we small talked for a minute or so and then she asked my daughter to stand up and bend forward at the waist so she could exam her. The PA used an instrument about the size of a ruler that had the middle hollowed out and ran it up and down my daughters spine. She did this twice and then showed me as well. This instrument is kind of like a level and apparently my daughters spine is now within the acceptable range of curvature, for which I am thankful. We were in the exam room less than 5 minutes, including the time small talking.

We left the office and a few weeks later I received a bill from the pediatrician. I have a high deductible plan, so I knew going in that I would be responsible for all costs involved in this exam. What shocked me was the statement from the pediatrician said that the exam was done by the attending pediatrician, not the PA. Common sense told me that a pediatrician should receive a higher reimbursement than a PA.  The statement also included CPT code 99212 and I was charged $77.00. Thankfully I know what the code means and it was the appropriate code, and the price for my geographic area was at about the 70th percentile, another words a fair price. My problem was with who gave the examination.

I contacted the billing company about this. The first person could not answer my question and offered to check with their supervisor and call me back. A few days later they called back and said they bill according to how my insurance company requires, which is to bill in the name of the attending pediatrician, even if he does not perform the exam. Furthermore, the biller stated that the code does not differentiate between the exam being done by a pediatrician or a PA. I was not satisified with this answer and asked to speak to the supervisor. Later that day they called and still did not give me an answer that satisfied me.

The pediatrician’s office is in network, which means the pediatrician agrees to write off a portion of the bill in exchange for increased volume from others who participate in this network. The statement I got from the pediatrician stated the billed charge was $77.00, which is fair, and the write off was $40.00, leaving me a balance of $37.00. I consider this a fair rate of reimbursement and have no problem paying this.

Our healthcare system is far from perfect and everyone needs to be alert about their bills. If you need assistance with a bill review or negotiation, contact INSNET.


We need to reform our attitudes before we can reform healthcare

March 18, 2009

Deloitte recently published a 2009 Survey of Health Care Consumers. Some of the findings are not surprising; 40% would grade the current healthcare system with a D or a F, a significant number of consumers have skipped care because they could not afford it, were not covered or thought the costs were too high and 53% believe employers should be required to provide health insurance for their employees.

The study also states that 7 in 10 say the would participate in a wellness program if they were given financial incentives such as reduced insurance premiums or monetary rewards. What is wrong with the 30% who would decline this offer? Everyone agrees the cost of health insurance is skyrocketing and needs to be controlled. The best way to lower the insurance premiums is to lower the bills the insurance must pay. Isn’t it easy to see if you are healthy, you will have less medical bills?  Participation in a wellness program will promote a healthy lifestyle and reduce healthcare costs. It just amazes me that 3 of 10 people surveyed have no interest in bettering their health, even if it puts money in their pocket. In this economy couldn’t we all use a little more in our wallet?