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.

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.

7 Reasons why you need a Medical Bill Advocate

Healthcare costs continue to skyrocket. If you have health insurance, your deductible has increased; meaning you’re paying more out of your checkbook before your insurance does. In these rough economic times we need to save money any way we can.

People hire lawyers to help them with legal matters, accountants for their taxes and mechanics to change the oil in their cars.  Using these professionals saves us time and money.   Since you’re spending more of your own money on medical bills,  don’t you want to make every dollar count?

There are many more than seven reasons to seek out a medical bill advocate, but these should make you stop and think.

1. 8 out of 10 medical bills contain errors

2. Medical providers often balance bill consumers for money they don’t owe

3. 1 in 3 Americans has trouble paying their medical bills

4. In 2004 almost half of all Americans under age 65 spent more than $2,000 in medical expenses. This is the latest published rate, which has surely increased due to rising healthcare costs and deductibles

5. The healthcare industry, like others (automobile, hotel, airline) has different rates depending on who pays the bill

6 Lasest published data shows per person healthcare spending at $7,435.00 and in 10 years it is projected to almost double

7. Medical bills are difficult to read and understand.  Plus who has time to wait on hold calling the hospital, doctor or insurance company

INSNET, LLC has experienced, trained professionals who will negotiate a lower price with your medical provider or there is no fee, its RISK FREE.

Save money on prescription drugs

This post has nothing to do with SPAM email and Viagra.  It is about a way to save money on all prescription drugs, which happen to be the fastest growing of all healthcare expenses.  It is estimated that prescription drugs account for $.15 for every $1.00 spent on healthcare.

What do you do when you leave the doctors office with a prescription to be filled? Most people will simply stop off at the pharmacy which is on their way back home or back to work or wherever is most convenient.  Once inside the pharmacy, you give the pharmacist the prescription and they will ask for your insurance card.  If you have insurance and a prescription drug benefit, the pharmacist will take it and begin the process of filling your prescription.  Once it is filled (it always seems to take a long time doesn’t it) you pay your co-pay, your deductible amount or the full price depending on your insurance situation, and leave.

Supermarkets, department stores and retailers have all gotten into selling prescription drugs.  These establishments have realized that providing prescription drugs gets customers into their place of business.  As upcoming Black Friday shows, one of the best ways to get customers into your store is to offer discounts. In the case of some establishments, prescription drugs have become a loss leader.

Prescription drugs at a discount, how is that happening?  Www.yourrxcard.com is a free drug card program which provides discounts up to 70% on prescription drugs.  Simply go to this site, enter your first name, last name and email address.  You then print out a card and take it to one of their more than 54,000 pharmacies nationwide.  The website will show you all of the participating pharmacies in your town as well as the price they will sell the prescription for if you use the yourrxcard.  I have personally used this card and paid less using this card than I would have using the drug benefit portion of my health insurance.

This summer I needed a replacement Epipen.  The first thing I did was log onto the website for my prescription drug benefit of my personal health insurance. Using their pharmacy I would have paid $65.00. The next thing I did was log onto www.yourrxcard.com. I saw that there were several pharmacies in my town that would take the yourrxcard.  Next, I printed out a card from their website. Then I went to the same pharmacy as my insurance would have instructed me to use.  Using the yourrxcard I only paid $58.00.  I have a high deductible health insurance policy, so I was paying the full amount.  I realize $7.00 may not seem like that much, but it is more than a 10% discount off my own insurance plan and it didn’t cost me a dime to enroll.  When you’re paying the bills, shouldn’t you make every dollar count?

Entering the Blog World

I’ve started this blog for the same reason I helped created INSNET, LLC, which was to help people save money on their medical bills.

Since 1985 Insurance Negotiating Service has assisted insurance companies by negotiating medical claims.  INS has represented some of the largest insurance companies and we have saved our clients millions of dollars.

While we were reducing the amount our clients had to pay on claims, we noticed that the patients were not realizing any of the savings as a result of our negotiations.  With the rising cost of healthcare; and higher deductibles and copays, individuals are paying more than ever for their healthcare. We created INSNET to be the individual’s safety NET to avoid overpaying their medical bills.

When you get a medical bill you probably do one of two things, and they are both wrong!  Most people either ignore the bill or pay it.  If you ignore the bill, the account could be turned over to collections which could adversely affect your future credit worthiness.  Paying the billed charge is also wrong.  I came across the article in a recent issue of Business Week which will explain a practice called ‘balance billing’

The healthcare industry is similiar to the automobile, airline and hotel industries.  They each have different charges rates based on who is paying the bill.  Have you ever asked the person next to you on an airplane how much they paid for their ticket?  More often than not it is not what you paid for yours.  The healthcare industry is similiar and I’ll be sharing detailed examples with you in future posts.  Here’s a brief example: You could have adult identical twins examined in the same hospital for the same condition.  They are given the exact same treatment and discharged at the same time. Depending on what type of health insurance they each have, the hospital will collect different amounts from each twin.

As this blog progresses, I will go into further detail about hospital reimbursement rates, errors, over payments, appeals, advocacy, ppo’s and many other healthcare issues.