Costly medical billing error

We recently reviewed a large hospital bill for a self funded company. The patient had a brain tumor and the bill was for a surgery to shrink it. The surgery  placed 8 implantable wafers  in the brain. The hospital bill for the implants alone was in excess of $93,000.00. Needless to say, this was a very complex procedure.

The hospital is part of the network the self funded company belongs to and thus the bill was submitted with a ppo contractual adjustment. The bill was submitted to us to determine if after the adjustment, was the hospital billing a fair rate (within Usual and Customary amounts).

Upon our review of this bill, we noticed that the cost for a box of 8 implantable wafers was $45,015.20.   We were able to determine the hospital cost for the box of 8 wafers to be $24,453.The hospital was billing the company over 1.8 times their cost for these wafers.

This bill was several pages long, and we also noticed 8 single line charges each for $6,044.56. Each single line item was for the generic name of the implantable wafer.  Based on the Operative Report and the manufacturer suggestions, 8 wafers were implanted in this surgery. The billing error was that the hospital simply charged for the box, and then mistakenly charged for each individual wafer.

On the implant charges of over $93,000, our client allowed about $37,000. Upon receipt of the check from the company, the hospital contacted the company via telephone and was looking for a fight; accusing our client of all sorts of things.  I can’t say I blame them, if they were expecting $93,000. Our client simply pointed out the double billing error. The hospital rep quickly reviewed the bill and according to our client became very quite and ended the coversation.

Not all billing errors are this large. This really is a simple error, it’s just compounded by the cost of each unit. Studies show that 8 in 10 medical bills contain errors. Our client hired us to help them. INSNET is available to provide risk free medical bill review and negotiation on any medical bill with a patient balance exceeding $200.00. Next time you get a medical bill in the mail, doesn’t it make sense to have it professionally reviewed?

A 35% discount is good isn’t it?

If you got an email, or saw a coupon advertising a product or service at a 35% discount, you would think the product or service must a good value at the reduced price. However, when dealing with healthcare, numbers can be very deceiving.

Studies show that 90% of all medical claims processed are done so ‘in network’, meaning that the provider of service is in the insured’s network. Going to an ‘in network’ provider is generally thought to be a  great way to save money on out of pocket medical expenses.

An insurance company or third party administrator must process hundreds of medical claims each day. Elaborate computer systems assist these organizations with this task. But in doing so, the human element is taken out of the equation. It is estimated that 95% of medical claims are ‘auto-adjudicated’ meaning a human does not review them. These computer systems have eliminated many mistakes, but when a human does not review bills, overpayments can occur.

For example, we recently reviewed a medical claim for a patient who underwent spinal surgery. This bill was from an insurance company and exceeded $240,000. the hospital was in the insured’s network, and a contractual adjustment of $84,549.33 ( a 35% discount) was in place. It is hard to find anyone who would not think that the $84,000 savings does not represent good value. This bill was not auto-adjudicated due to the dollar amount, and it is a good thing.

Part of the bill, over $159,000 of it, was for spinal implants used in the surgery. The insurance company requested and received invoices from the hospital as to how much they paid for the implants. The invoices totaled over $65,000.  If the claim was auto-adjudicated, the hospital would have received $103,350 (35% discount on the $159,000) for these implants, a mark up of 1.6 times invoice price. Additionally, invoice price, does not represent the actual amount the hospital paid for the implants. If there was a standard 20% discount offered, the hospital is receiving nearly 2 times acquisition cost for the implants, after a 35% discount was applied.

If I was paying this claim, I would question whether this is good value or not, how about you?

Searching for the best medical pricing

USA Today ran a story titled In a weak economy, patients search for best medical pricing. The story points out that people today need to make the most of their dollars, and are thus actively looking for the best price for their healthcare. This is a difference to years past, when most of healthcare expenses were paid by insurance companies, and the patient had very little to pay out of pocket. Deductibles are now higher, which means out of pocket expenses are greater.

The story continues to say that many insurance companies are now providing online tools to assist their insureds. However, after reading the comments to the post, and in my own experience, many of these sites are not user friendly, and fail to offer enough information.

Healthcare Blue Book and Out of Pocket.com are two websites which I have come across which provide a wealth of information. But just having information doesn’t always mean you can get the best price. For example, you had a MRI on your knee at a hospital and were billed $1,750. You consult an online resource and see that the recommended price to pay for a MRI of the knee is $850.00. Is this a $900.00 overcharge? There are many factors involved in determining if you are being billed a fair price.

When in doubt, you should consult the services of a patient advocate who is trained in reviewing medical bills and determining a fair price to pay. Visit www.myinsnet.com if you have any questions.

Savings (on medical bills)until Christmas and beyond

Black Friday and Cyber Monday have passed. Many have taken advantage of the great deals that retailers offer this holiday season. No doubt there will be other deals in the last remaining weeks of the season.

I was not one of the thousands who brave the cold temperatures and lack of sleep in search of the great bargains on Black Friday, I’m more of a Cyber Monday person, I like to take the easy way out. That is probably why I am in favor of an even easier way to save money this holiday season and throughout the whole year.

Most people do not know that medical bills, just like new cars, hotel rooms and airline tickets are negotiable.  INSNET helps individuals determine what a fair price is to pay on their medical bills. If you are being billed an unfair price, an INSNET representative will contact the medical provider and propose a negotiated settlement on your behalf.  INSNET will keep a percentage of the savings on your bill.

Isn’t it nice to know you can save money all year round, and not have to battle the crowds and lack of sleep on Black Friday?

Are you paying someone else’s medical bills?

I recently came across this story which says that unpaid medical bills will cost the State of Washington over $1 billion by 2011.  The State Insurance Commissioner goes on to say that many of those costs are passed on to those who have health insurance.

The Insurance Commissioner estimates that average family in Washington that has health insurance pays an extra $917 a year to cover the costs of unpaid medical bills. The Commissioner calls this a ‘hidden tax’

According to the 2009 Milliman Medical Cost Index, the average American family enrolled in a PPO health plan spends $2,820 a year in out of pocket medical expenses. This ‘hidden tax’ that unpaid medical bills cost is in excess of 32% of what a family pays in medical bills.

With the current lack of transparency in medical billing, it pays to hire a patient advocate who is specially trained to review and negotiate a savings on your medical bills. After all, you don’t want to pay someone else’s medical bills, do you?

The need for patient advocates

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.

Haggling with your Doctor

Forbes Magazine ran an article recently titled Cut your Doctor Bill. The article explains that with the rising cost of healthcare that people need to find out the costs associated with a medical procedure before they have it done. The problem is actually finding the cost beforehand.

If you are seen at a doctor or hospital and don’t know beforehand what the approximate cost will be, you are in for sticker shock once you receive your bill, especially if the medical provider is not part of your insurance network, or if you don’t have any insurance.

INSNET,LLC President Jack Gillis was interviewed for this story and shares some tips for those who feel confident enough to do their own negotiations. First he says you need to determine if the facility is authorized to give you a discount. If they are, your next question should be, who is authorized to give me a bigger discount? Not all medical providers are willing to reduce their fees, but with unpaid debt at record levels, many any re-thinking those policies.

If you would rather have a professional organization who has been negotiating medical bills with providers for over 20 years review and negotiate your medical bill, INSNET is available at www.myinsnet.com or by calling 877-MYINSNET (877-694-6763)

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.

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.

Health Savings Accounts and Health Reform

A recent study by OptumHealth concludes that 78% of HSA accountholders believe that HSA’s should be a part of any health care reform that may take place. The study states that 30% would have no health insurance if it were not for their health savings account.

This study may take some of the political sting out of the debate about HSA’s. Democrats contend that HSA’s are just a way for the rich to store and keep more of their money from Washington. The study shows that 70% of the respondents earn less than $75,000 per year.

America’s Health Insurance Plan recently reported that 8 million Americans are now insured through a health savings account. This figure is up from 6.1 million in 2008. The AHIP study reports that almost half of the accountholders have a median income of $50,000 per year.

A typical American household of four enrolled in a ppo plan spends $2,820 per year in out of pocket medical expenses according to the Milliman Medical Index. Many studies show the premiums for a high deductible health plan which must accompany a health savings account have much lower premium costs than ppo plans. With a HSA you can choose the deductible you want, or the premium you can afford.

Many are  concerned that with a high deductible plan you will pay more in out of pocket expenses. That’s where professional medical bill negotiators like INSNET help individuals. They provide risk free medical bill review and negotiation. They charge a percentage of the amount saved on your medical bill, with no fee if there is no savings.

There are certainly many facets involved in healthcare reform, but empowering individuals to attempt to control their own costs certainly makes sense to me.