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.

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)

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.

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?

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.

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.

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 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.

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?

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.