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?

Cigna release a study showing that while medical costs continue to increase double digits annually, that costs for individuals enrolled in consumer driven health plans saw their costs decrease 26% over a four year period.

Critics of high deductible plans often state the reason cost decrease is due to the high out of pocket costs. They say that people are foregoing treatment because they cannot afford it. This study states that the level of preventative care, chronic diease management and evidence-based treatments were higher than those enrolled in PPO and HMO health plans.

The study further states that 18% of Americans are covered under a high deductible health plan. If this amount rose to 50% (it is increasing each year due to lower monthly premiums), the United States could achieve $350 billion dollars in savings over a 10 year time period.

High deductible health plans and Health Savings Accounts need to be in the forefront of discussions about health reform. More people can afford coverage (decreasing the number of uninsured), no taxes will be raised and medical costs will decrease. Isn’t that what reform should be about?

Our family computer was not working properly. I’m the tech guy in our household, so it was my responsibility to fix the problem. Not knowing the answer I Googled the symptoms and got many possible cures. The problem was, I couldn’t run any programs on the machine. It was time to call in the experts.

As you probably guessed, the machine had a virus, and due to the damage caused by the virus and also by the machine having a lot of dust, the best fix was to replace the hard drive. I was a little skeptical about this, the computer is almost 3 years old, and I know these are built to have increasing shorter shelf lives, but I listened to the technicians reason for repairing this machine instead of replacing with a brand new one. I decided to replace the hard drive, which cost me around $150.00. The machine now works great, better than before for sure.

What does this have to do with healthcare reform? Instead of a rash, overhaul of a fix (new computer), I opted for a small, less expensive repair. I would advocate three small repairs to the healthcare system. Less expensive high deductible health plans ,which makes consumers more accountable for the true cost of the healthcare, tort reform which will lower the award in malpractice lawsuits which increase insurance premiums which doctors pass the cost of on to patients, and thirdly, allow insurance companies to sell their products across state lines, the more competition involved, the lower the cost of monthly premiums will be. None of these repairs will increase taxes, and will help lower the cost of healthcare. I don’t think the same can be said for the current health bills.

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?

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.

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?

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?

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.

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)