Re: Medical-bill errors becoming more common
- From: mg <mgkelson@xxxxxxxxx>
- Date: Mon, 29 Oct 2007 21:24:26 -0700
When my wife died, years ago, the insurance company refused to pay
part of the hospital bill claiming a billing error. As I recall, it
took me about 6 months to get that straightened out and it turned out
that the hospital did, in fact, make a mistake.
Then I had another situation where I knew the insurance company would
pay but the provider kept insisting they wouldn't. Eventually, the
bill was turned over to a collector and I decided to quit arguing
about it since it was only about $300.00 and I paid. Months later, I
got a letter saying the insurance company had paid.
When my wife died I had 3 insurance policies (from my retirement, my
employer and her employer) and they still drug me through a living
hell. America either needs some radical change to the system or we
need to get a 4th insurance policy to insure that the other 3 pay.
On Oct 29, 2:27 pm, Harry Hope <riv...@xxxxxxxxxxxxx> wrote:
From The Associated Press, 10/29/07:http://www.msnbc.msn.com/id/21527433
Medical-bill errors becoming more common
8 out of 10 hospital statements have multiple mistakes, expert says
Gut Check America
WASHINGTON -
Don't assume that your complicated medical bill is correct.
Errors on bills for doctors, medical tests or hospitals can result in
overcharges that run from a few dollars to tens of thousands of
dollars.
Husband and wife Ron and Marilyn Hess, from Homer, Alaska, were left
facing a bill of about $10,000 from a hospital after Marilyn needed an
appendectomy.
The hospital bill was about $45,000, of which her insurer agreed to
pay $35,000.
After obtaining an itemized bill and with the help of a
medical-billing advocate, the couple uncovered procedures billed that
weren't performed.
And on her appendectomy and the second clean-up surgery, Marilyn was
charged separately for each item used rather than a set fee for a
surgical packet.
"We were outraged when we saw the itemized statement from the
hospital," Ron said.
Nora Johnson, director of education and hospital billing compliance
for Medical Billing Advocates of America, who advocated for Marilyn
Hess, estimates "eight out of every 10" hospital bills she scrutinizes
contain multiple errors.
And while bills from doctors' offices and labs tend to contain fewer
mistakes, consumers can still end up paying unnecessarily.
Watching for common errors
Six out of 10 Americans with health insurance said they are paying
more out of pocket for medical expenses, according to a recent survey
by the Employee Benefit Research Institute, or EBRI.
And the higher costs are hurting their household finances, with
one-third reporting difficulty paying for basic necessities.
"These results show the impact of rising health care costs is
widespread and growing," said EBRI President Dallas Salisbury.
Against this backdrop, it is more important than ever to assure you
aren't paying more than you owe for medical services.
You can take steps to protect your finances, but you need to be
mindful of deadlines.
It helps to watch for common types of errors.
For instance, Johnson says consumers with high-deductible health plans
can take a hit if their insurer fails to apply discounted group rates
- which insurers negotiate with health-care providers - to charges
incurred within the deductible.
Deductibles in these plans can run from a thousand dollars to more
than $10,000.
Other common blunders include medical-coding errors, mistakes in how
annual deductibles are applied and confusion over which providers are
in or out of network.
Fraudulent activity by some unscrupulous health care providers and
medical-identity theft are other bugaboos, experts say.
Deciphering medical bills isn't always easy.
Paula Fryland, manager of the national health care group at PNC
Financial Services Group Inc., says one in three Americans reported
having trouble understanding the explanation of health benefits in a
recent study the company conducted.
An explanation of benefits, or EOB, is the statement your insurer
sends you after you have received health-care services.
One in four consumers polled by PNC said they believe their insurer
had denied a legitimate claim, and, of those, one in five paid the
claim out of their own pocket (consumer advocates say the fear of
getting their credit damaged motivates many).
But persistence pays off:
More than half of consumers got their insurer to pay all or part of
the claim.
Reviewing your EOB before you get a bill is the best way to track your
medical expenses.
If your insurer offers you the ability to review your EOBs online,
sign up; if you can receive e-mail alerts, even better.
Susan Johnson, a senior consultant at Watson Wyatt Worldwide, advises
checking that the name, address, insurance group and identification
numbers are correct.
If they are inaccurate, it might mean that you have received someone
else's EOB by mistake, or, more worryingly, that someone is using your
health benefits without your consent.
Next, check the claim activity to ensure that the name of the health
care provider, services rendered and dates tally with your
recollection.
"Sometimes you can get billed for tests you didn't have," says
Johnson.
Often this is due to a clerical error;
however, multiple procedures for which you have no memory of receiving
and/or surprisingly high charges can signal insurance fraud.
Don't call on Monday
Mark Rucci, a senior vice president at Apex Management Group, a
division of Gallagher Benefit Services Inc., says consumers should
also track the contributions they have made toward their annual
deductible.
Alert your insurer if your EOB erroneously says you haven't met your
deductible.
Make sure to get credit for using an in-network health care provider.
HMO plans can hit you with the full cost of out-of-network treatment.
PPO plans require higher coinsurance payments out of network.
If you notice discrepancies in your EOB, call your insurer's toll-free
customer service line, advises Dr. Charles Cutler, Aetna Inc.'s chief
medical director.
You will find the numbers on your EOB, your insurance ID card or your
insurer's Web site.
Avoid calling on Mondays, as they are notoriously busy.
If all or part of a claim is denied, it is usually because the insurer
didn't receive all the information required or because it believes the
procedure isn't covered or medically necessary.
You can appeal such decisions over the phone, but it is best to do so
in writing, supply supporting evidence and keep copies of
correspondence.
Generally, your insurer has 30 days to reply (within days if it
involves urgent care).
Most insurers have a multilevel appeals process, and you may also be
entitled to an external review.
It is important to find out what your plan's rules - and deadlines -
are.
Hire an advocate
You might want to enlist the help of outside experts.
Your state insurance department or state health department can offer
guidance.
Consider hiring an advocate.
For example, unbeknownst to you, your insurer might decide your bypass
surgery wasn't medically necessary because, instead of entering the
code for "heart attack," which is what you had, an administrator
mistakenly entered the diagnosis code for "broken leg."
Typically, advocates charge an hourly fee (from $25 to $75) plus a
percentage of any savings.
You can find listings at billadvocates.com.
As for the Hess family, it took 18 months of lobbying, but the
hospital finally wrote off their bill.
______________________________________________
Harry
.
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- From: Harry Hope
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