When not knowing can cost you money

Yesterday Insurance Negotiating Service, which negotiates out of network medical claims for insurance companies and TPA’s got a phone call from a gentleman wondering if we negotiate non healthcare claims. This seems like a strange question since INS has saved insurance companies millions of dollars since opening in 1985.

It turns out this gentleman was calling on behalf of a friend of his who had a fire at their home. The home is a duplex and the friend’s side of the home suffered major damage while the other side just had smoke damage. The gentleman, who found our site on Google, was calling to see if we could assist his friend deal with the insurance company adjuster as they had no idea what  to do.

The call was routed to me as I had experience as a property casualty insurance adjuster. I  informed the gentleman that this is not something that INS could help with, for among many reasons, the fire took place in a state I am not licensed in; but I was able to pass on some information. I informed the gentleman that their are Public Adjusters who do just what his friend needed, they represent the homeowner or insured deal with the insurance company adjuster, to ensure a fair settlement is made. I was able to assist the gentleman find 3 public adjusting companies in his area.

This got me thinking that if there are people out there who do not know that Public Adjusters can help them with property casualty claims, then there are people who do not know that patient advocates such as INSNET can help individuals save money on their medical bills. Just like the price of a new automobile, a hotel room or an airline ticket; medical bills are negotiable! Professionals like INSNET ensure that individuals pay a fair price on the medical bills.

How do these numbers add up to savings?

I recently came across this story that says that hospitals have agreed to give up $155 billion in future Medicare and Medicaid payments to help defray the costs of President Obamas healthcare plan. This piece of news was seen as the bright spot in the White House effort to reform healthcare. Digging deeper into the story I’m amazed how this can be seen as positive news for people interested in reducing healthcare costs.

About $50 billion of this projected $155 billion “savings” is expected to come from a reduction in payments made to hospitals that provide care to uninsured and low income patients. The effected hospitals say this will put a strain on these local communities. These reductions come from payments currently made by Medicare and Medicaid (Government).

The story goes on to detail that in exchange for giving up $155 billion in future payments, the hospitals have negotiated a deal should the Finance Committees’ (Government) legislation include a public health insurance plan. Under this agreement, the hospitals would receive reimbursement amounts in excess of what Medicare and Medicaid currently pay.

So hospitals have agreed  give up a lesser amount from Medicare and Medicaid (Government) in exchange for higher reimbursements under potential Finance Committee’s legislation(Government). How does this end up saving any money on healthcare expenses. Where does the average citizen realize any savings in this plan?

US Open Golf and medical bills?

The second major tournament in golf in this week, the United States Open. I don’t play as much golf as I used to thanks to the responsiblities of parenthood, but I always look forward to this tournament and its last day which takes place on Father’s Day.

The responsibilities of providing for my children and how I go about it prompted the following comparison between golf and patient advocacy. The object in most weekend players game and the US Open is to break par on the course. Similarly, as a Patient Advocate, I try to help my customers break ‘par’ by reducing the amount they must pay compared to billed charges on their medical bills.

In the game of golf, one of the best ways to succeed is to have the proper tools, whether it be properly fitted clubs or a high distance golf ball. On a professional level, a caddy you can trust and a dedicated swing coach are essential. Patient Advocate’s help individual through the maze of health care statements from medical providers and insurance companies. INSNET has the experience through over 20 years of negotiating medical bills to know a fair price to pay on a medical bill.

The golf courses at most US Open sites have penalizing rough with high grass just outside of the fairways. Have you tried to contact a medical provider and speak to someone about reducing your medical bill?  If so, then you know it is possible to spend the better part of an hour doing so if you do not know the right department to ask for or the correct words to say to speak to the person who actually has authority to reduce your bill. At INSNET our service is not rough at all, as a matter of fact it is easy and painless; if we don’t save you money on your medical bill you pay us nothing!

I hope all father’s have an enjoyable day this Sunday, and reflect on how they provide for their families. I also hope every father gets a chance to step onto a golf course with if not your own father, then your children.

Back in the saddle again

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

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

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?

Common errors in medical bills

No matter how technologically advanced medicine becomes, billing remains mostly a data entry job done by human beings, who as we all know are prone to make mistakes.  Most of the errors found in medical bills are a variety of a data entry mistake.   All medical bills are generated based on a complex system of codes. Each medical provider has in their computer system a billable amount per each code. Below are some examples of medical bill errors.

A routine visit to your physician, a visit which includes about 10 minutes of face time with your doctor is usually given a 99212. For this code your doctor may have a charge of $95.00. Code 99215 includes around 40 minute visit and the charge could be around $300.00. The only difference in the code is the last digit, with the 5 being just above the 2 on a keypad. A small error by a billing clerk could result in an overcharge of over $200.00.

If a patient is receiving medication, the drug is dispersed in number of units. A billing clerk could accidentally key in 20 units instead of the 2 units the patient actually received. The use of surgical and  recovery rooms in hospitals are billed out on a flat rate for a given amount of time, usually 30 minutes. If you exceed this amount of time in the room there is a separate code for additional minutes. In a previous post I referenced the extreme time a hospital was billing for the use of a recovery room, which was later found to be a clerical error.

Another common error is for supplies or services which a patient never used. We once reviewed  a bill for a patient which had 2 pacemakers. The patient thankfully only received one pacemaker, but the hospital must keep a second one in the operating room in case of malfunction. A hospital employee failed to inform the billing clerk that the unused pacemaker was put back into inventory, and the clerk subsequently added it to the patient’s bill.

Some years back we reviewed a pharmacy supply bill for an insurance company. The pharmacy was billing out $7,412 for supplies. The problem was the supply charge should have been $412.00, not $7,412.00, a simple keystroke error that could have cost the payer dearly had it not been caught.

I just recently heard of this error where a patient was billed for the birth of a baby that wasn’t hers.

Now we get into the area where I tread very lightly, however it is a major problem; fraud. Estimates say that over $60 billion is paid annually in fraudulent healthcare bills. Most of the medical providers I’ve dealt with throughout the years are honest individuals, but obviously there are some out there looking to make a quick dollar.  I like to see the better side of individuals, however in the pharmacy example above, when we questioned the company about the error they stated that the 7 should have been the $ sign. Last time I checked, the $ sign is above the 4 not the 7….

Another issue especially with hospital bills is unbundling.  This should really be its own entry, but in summary it is the practice of billing for items which should be included within a code. For example if a hospital charges for suture removal following a surgery, and the removal of the sutures are included in the global fee for the surgery than the hospital is billing twice.

As stated before, it is very important that you review your bill for accuracy, even if you have insurance. In the example of the doctor visit, your insurance doesn’t know how long your visit was, they only know a contracted amount to pay per code on a bill. If you need professional assistance, contact www.myinsnet.com.

Information is just the begining

The recent episode of the tv show 24 showed Jack Bauer discussing strategy with his one time boss, Bill Buchanan. Jack wanted Bill to interrogate a known terrorist planner. Before Bill would even discuss the matter he wanted to know “how good the intel was”, or how reliable was the information. Even though Jack reassured Bill the information was accurate, Bill decided it was not his personality or in his capabilites to do this task.

Many individuals who now have high deductible health plans are in the same position, they have access to good information, but lack the necessary skills to negotiate better prices for the healthcare.

Resources such as Healthcare Blue Book and Change Healthcare provide individuals with pricing information for medical procedures. Their information comes from what insurance company ppo contracts have reimbursed providers for these procedures. This information is valuable in assisting individuals to determine if they are being billed a fair price for their healthcare. In other words their ‘intel’ is good.

Many individuals become like Bill Buchanan (by the way I love the Bill character on the show) and realize they don’t have the courage to take the next step, which is to contact their medical provider and ask for a discount. Many also do have the courage, but lack the time to wait for an answer or response from the patient accounts department.

Thankfully individuals have medical bill negotiators like INSNET,LLC who  provide risk free bill review and negotiation of medical bills. INSNET was formed by Insurance Negotiating Service which has over 20 years experience negotiating medical claims for insurance companies. INSNET uses the ‘intel’ gathered from previous negotiations to determine a fair price for your medical bills.

There are many Jack Bauer type personalities who can and will negotiate their own medical bills and be very successful. If you are a Bill Buchanan type and wish to have professionals review and negotiate your medical bills, INSNET is here to help.

The Uninsured and Health Savings Accounts

The Congressional Budget Office recently announced that there are currently 45 million Americans without health insurance. They state that without changes to federal policy that the number will be 54 million by 2019. The actual number is up for debate, I know a number of people who elect not to pay the premiums for health insurance, and spend that money elsewhere, even though they have the means to pay.  Whatever the number is, there are a significant amount of people who cannot afford premiums for health insurance.

Many employers now offer high deductible health plans. These plans are unlike many HMO plans where a patient pays small co-pay amounts for doctor visits, hospitalizations and prescription drugs. With high deductible health plans, the patient is responsible for paying medical expenses from dollar 1. The cost savings for the employer and employee for this type of coverage is significant, and could save as much as 30%. If the employer has set up a Health Savings Account they can fund the savings realized from the lower premiums into the accounts for their employees to use.

Here’s an example: A small business with 50 full time employees offers an HMO health plan. The annual premium cost is $325,000, of which the employer pays 75% or $243,750, the employee pays the balance, which is taken out through payroll deductions. Under the HMO plan the patients pay:

$15 doctor office visit co-pay

$250 out patient hospital co-pay

$500 in patient hospital co-pay

$15/$25 prescription drug co-pay

To attempt to lower costs, the employer changes to a high deductible health plan and HSA for its employees. With the patient responsibility starting a dollar 1, the premiums are less expensive. The same 50 full time employees can be insured with a high deductible health plan for $235,000. This savings is in excess of 25%. The employer can use the premium savings and fund $1,500 into each employee’s HSA. Health insurance will pay for any expenses once the deductible has been met. Now that employees are paying for healthcare from funds in their own account, they are more likely to shop for a better price, making them better healthcare consumers.

Smart employers will supply their employees with tools to ensure they make smart decisions for themselves. Access to wellness programs, prescription drug discount programs, discount lab and screening centers and medical  bill negotiators all help patients reduce what they pay on their medical bills.

Finding health insurance for those who really are in need is a challenge. For those who simple choose to put their money elsewhere, high deductible health plans provide an opportunity for those to have some peace of mind that catastrophic medical bills will be paid for.

When a claim becomes a medical bill

On Sunday my family celebrated an anniversary that my oldest daughter and son would like to forget.  We were skating on a frozen pond and the kids started a game of hockey.  The kids are not great skaters and they did not have any other equipment other than hockey sticks and a puck. Shortly after the game started my son lifted the puck and hit my oldest daughter right on her helmetless forehead. I fortunately witnessed this accident and immediately went to my daughter’s aid. When I arrived blood was already gushing from her head.  I applied pressured and ice to the wound to stop the bleeding, which slowed but did not stop. We decided we needed to get her to the hospital.

My wife and I drove her to the emergency room where she was seen immediately by a triage nurse.  I was the lucky one left to start the paperwork process. Since I pay for health insurance, I presented my daughter’s health insurance card to the receptionist. My wife and daughter went to another exam room and were met by a doctor. The receptionist finished taking down and copying the insurance company information and showed me to the exam room.

The emergency room doctor’s examination led to a decision to suture the forehead with 4 stitches. The doctor did the stitching, prescribed some pain medication and told us the swelling should go down in a couple of days.  About 3 hours after we arrived at the hospital, we were all back home and my daughter was showing her siblings her wound. Thankfully the swelling did go down and the stitches were removed a few days later.  To this day my daughter has a barely recognizable scar, you would have to know where she got hit to see it.  The doctor and hospital did a wonderful job.  In an ideal world, all are happy and the case is closed.  However, the hospital is a business and needs to be paid for its services, which is why most people purchase health insurance, to offset unexpected medical costs.  Most do not understand the process involved in paying for the services.

Upon being discharged, the hospital sent a claim to my insurance company. About 15 days later, I received a letter from the hospital telling me that this claim had been sent to my insurance company for payment, and that the enclosed “is not a bill”. When my health insurance company receives a claim on behalf of an insured, there are many steps which must take place before payment is released. They must ensure that I or my dependents were covered at the time of the injury/illness, they must determine if there is coverage for my injury/illness under the terms of the policy, they must determine if my claim is from an in network or out of network provider, they must determine if I met my deductible and co-payment amounts. Once all of these steps have been completed, the process of paying the claim begins.

Assuming the deductible and co-payment have been met, the insurance company must pay the full amount. If the provider is in the network, the insurance company pays the claim based on the discounted rate. If the provider is out of network, they pay the amount billed, or attempt to lower the amount via negotiation. If the deductible or co-payment have not been met, the insurance pays only their portion of the claim. Either way, upon processing the claim, an Explanation of Benefits is sent to the insured.

The Explanation of Benefits details how the insurance company determined the amount they paid on the claim. If they did not pay the full amount, the medical provider can and will bill the patient for any patient responsibility (deductible and co-payment not yet met). This is when you get a second letter and billing invoice from the hospital telling you how much you owe. The claim has now become a medical bill.

When you receive this bill, you must compare it to the Explanation of Benefits for accuracy.  Upon receiving the hospital bill most people put the bill with their other bills to be paid, and pay it just like their electricity or cable television bill. These medical bills need to be reviewed closely to make sure there are no errors, and that you were not billed for services not rendered. Today, with deductibles averaging $1,000 and rising healthcare costs, individuals are responsible for paying more for their healthcare than ever before. Professional bill negotiators like INSNET, LLC are available for RISK FREE bill review and negotiation to help lower the amount you pay on medical bills.