How to handle medical bill problems

How to handle medical bill problems - latimes.com var trblib = window.i$; i$.pluginPath = '/hive/javascripts/plugins/'; jQuery = $; //rename $ function trblib.ns('trb').data = { contentId: '75238536', marketCode: 'lanews', section: '/business'}; registration.manager.config.initialize({ productCode: "lanews", brandingSiteName: "latimes.com", assetHostname: "http://www.latimes.com", registrationHostname: "https://latimes.signon.trb.com", useGigyaCommenting: "", metricsCookieName: "metrics_id", skipNewsletters: "0", navProfileUrl: "", navNewsletterUrl: "", modalCloseUrl: "",navigationContainerSelector: "#ssorNavHeader",originHost: "http://www.latimes.com" || "", navigationBackgroundColor: "#000000", navigationTextColor: "", skipNewsletters: "0", userName: registration.utils.cookies.getValue( "c_unm" ) || "", tugsUrl: "http://discussions.latimes.com/", signUpHandler: function(){ if ( "/membership/" ){ window.document.location.href = "/membership/"; } else if ( "" ){ window.document.location.href = ""; } else { registration.manager.showRegistrationDialog(); } }, signInHandler: function(){ if ( "" ){ window.document.location.href = ""; }else { registration.component.navigation.NavigationController.defaultNavigationParams.signInHandler(); } } }); jQuery( function(){ if ( "/membership/" ){ var eventManager = registration.manager.events.getEventManagerInstance(); registration.manager.config.setConfig( "signUpListener", "reg-signup-override" ); eventManager.addListener( "reg-signup-override", function(){ window.document.location.href = "/membership/"; }); } }); i$.ns('trb.data').dssOverrideLevelCode = ''; i$.require('http://www.tribdss.com/meter/latweb.js', function meteringServiceCallback() { trb.meteringService.modalCloseUrl = document.location.href.split('/').slice(0, 3).join('/') + '/about/site/registration/signin_registration.complete?'; trb.meteringService.init = function() {}; trb.meteringService.meter(null, null, function() { }); }); trblib.require('/hive/javascripts/loggingService.js', function loggingServiceCallback() { trb.loggingService({ sn: trb.data.section == '/' ? 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After his three-day inpatient stay with nonstop intravenous antibiotics, they were hit with $8,900 in charges."); gigya.socialize.showShareBarUI(showShareBarUI_params); }); Loren and Keith Yaskin faced $8,900 in hospital bills. Loren and Keith Yaskin were charged $8,900 after their son spent three days in a hospital. The couple ultimately hired an advocate to help sort through their billing questions. (Peter Kertz, For The Times / April 7, 2013)

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When Keith Yaskin and his wife, Loren, rushed their 2-year-old son to the hospital with a dangerous infection in his neck, they weren't thinking about how much his care would cost. After his three-day inpatient stay with nonstop intravenous antibiotics, they were hit with $8,900 in charges.

But the toughest lesson for the Scottsdale, Ariz., couple came a month or so later when they began to sort out the hospital bills. Their insurance policy had a $10,000 deductible. So they scrutinized every item, made some calls and had a few surprises.

When, for instance, they asked a medical group they had never heard of why it was charging them $839.25, they said they got no clear answers, just threats if they failed to pay.

After 21/2 months of calls and a complaint to their state attorney general, the Yaskins finally learned that a pediatrician affiliated with the group had treated their son in the hospital. The medical group eventually cut the bill in half.

None of this surprises Pat Palmer, the founder of Medical Billing Advocates of America. "We get feedback from consumers saying that providers are telling them 'We can't give you an itemized statement' or 'You should have asked for it before you left the hospital.'"

The idea is to discourage patients from asking for the details behind the charges, she said.

Experts offer a range of suggestions for dealing with medical billing problems.

Know your rights. Most states have laws saying that patients are entitled to an itemized medical bill that details what services and supplies are included in their charges.

"You can't be billed if they can't tell you what they are charging for," Palmer says.

Contact the billing department at either the hospital or medical group where you received services, she said. Let them know that you want an itemized bill, and tell them you are aware of your legal right to have it.

Also, a few states have laws limiting how much hospitals can charge patients who pay for care on their own. In 2006, California passed a law to prevent hospitals from collecting more money from uninsured patients than what Medicare or other public programs would pay for the same service.

"Once a patient contacts the hospital and shows evidence of their financial situation, state law requires us to offer a discount based on Medicare rates," says Jan Emerson-Shea, vice president of external affairs for the California Hospital Assn.

Get explanations in writing and take protests to the top. All communications with a provider should be in writing, experts say. Insist that your account be placed on hold until the dispute is resolved to avoid having the bill sent to collections.

If you meet with resistance, don't waste time by calling back the customer service line or billing department. Go straight to the top.

Address a certified letter to the chief executive or chief financial officer of the hospital or medical group explaining that you have tried to resolve billing issues but have hit a brick wall. "The CEO and CFO will take it very seriously," Palmer says.

Get help from your insurer. In the Yaskins' case, both the hospital and the medical group were in their insurer's network and had contracts to provide services at a negotiated discount.

"If you are in network — and this is one of the good reasons to stay in network — you can go to your insurer for help. It has a responsibility to some degree to what happens between you and a contracted physician," says Susan Pisano, spokeswoman for the trade group America's Health Insurance Plans.

Also, ask to make sure you're getting the rate your insurer has negotiated with in-network providers, says Lynn Quincy, senior health policy analyst for Consumers Union, the policy arm of Consumer Reports. Insurers often pass claims through without processing them at the reduced rate. Ask your insurer to re-process the claim if the discount wasn't applied.

Seek help and file complaints. If your bill is large or you're having a hard time making headway, patient advocates can help sort things out. For either a flat fee or a share of the money you save, organizations such as Medical Billing Advocates of America (www.billadvocates.com) and Health Proponent (www.healthproponent.com) can help you fight charges or lower your bill.

If you're being stonewalled by your healthcare provider, and your insurer hasn't helped, Quincy of Consumers Union suggests filing a complaint with your state's department of insurance. In California, patients with HMO coverage can file a complaint with the California Department of Managed Health Care by calling (888) 466-2219 or visiting healthhelp.ca.gov. Californians with PPO coverage should try the Department of Insurance at (800) 927-HELP (4357) or visit http://www.insurance.ca.gov. If your provider isn't contracted with your insurer, your state's attorney general's office is a place to turn for help.

The Yaskins ultimately enlisted the services of an advocate to help them sort through all their billing questions.

"We're raising a family and running a business, and this is like a second job," Keith Yaskin says. His conclusion: "Hospitals, medical groups and doctors' offices have much to learn about communicating with real people."

Zamosky writes about healthcare and health insurance.

business@latimes.com

Copyright © 2013, Los Angeles Times

printComments5 i$.require('http://cdn.gigya.com/js/socialize.js?apiKey=2_COh26GgfZDptreu0iQ9aknzT_Ig861qYxOHZVxizrZMTn81vygTB-ptN33wgCtrj', function() { var act = new gigya.socialize.UserAction(), showShareBarUI_params = { containerID: 'componentDiv_bottom', shareButtons: [{ provider:'Email'}, { provider:'Share'}, { provider:'twitter-tweet'}, { provider:'facebook-like', action:'like'}], userAction: act, moreEnabledProviders: 'facebook,email,pinterest,twitter,linkedin,tumblr,delicious,digg,blogger,google,stumbleupon,reddit' }; act.setTitle("How to handle medical bill problems"); act.setLinkBack("http://www.latimes.com/business/la-fi-healthcare-watch-20130407,0,2892820.story"); act.setDescription("When Keith Yaskin and his wife, Loren, rushed their 2-year-old son to the hospital with a dangerous infection in his neck, they weren't thinking about how much his care would cost. After his three-day inpatient stay with nonstop intravenous antibiotics, they were hit with $8,900 in charges."); gigya.socialize.showShareBarUI(showShareBarUI_params); });   Comments (5)Add / View comments | Discussion FAQ Keith14 at 11:50 AM April 07, 2013

Hi Tom. This is Keith. We recently hired the advocate and she is beginning the process of analyzing our situation. I will let the reporter know about the advocate's results. 

Netizen at 3:22 PM April 06, 2013

Even an ambulance ride to a Kaiser Permanente facility a few blocks away from my home costed almost two thousand dollars. Kaiser paid everything except my ambulance co-pay of $100 which still seemed high. The Emergency room co-pay was $100, and the hospitalization co-pay per day was $200. This seems astronomical, at least until I see what the uninsured are paying. At least with Kaiser, I wasn't ruined for life financially.

I wonder statistically how many uninsured people die of heart or stroke related incidents, after opening their first invoices from the hospital and ambulance company?

Tom M. at 2:11 PM April 06, 2013

So how much money did the Yaskins save by getting an advocate? Isn't that one of the most inportant parts of the story??

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State hires consumer group to help it review healthcare rates

State hires consumer group to help it review healthcare rates - latimes.com var trblib = window.i$; i$.pluginPath = '/hive/javascripts/plugins/'; jQuery = $; //rename $ function trblib.ns('trb').data = { contentId: '75174954', marketCode: 'lanews', section: '/business'}; registration.manager.config.initialize({ productCode: "lanews", brandingSiteName: "latimes.com", assetHostname: "http://www.latimes.com", registrationHostname: "https://latimes.signon.trb.com", useGigyaCommenting: "", metricsCookieName: "metrics_id", skipNewsletters: "0", navProfileUrl: "", navNewsletterUrl: "", modalCloseUrl: "",navigationContainerSelector: "#ssorNavHeader",originHost: "http://www.latimes.com" || "", navigationBackgroundColor: "#000000", navigationTextColor: "", skipNewsletters: "0", userName: registration.utils.cookies.getValue( "c_unm" ) || "", tugsUrl: "http://discussions.latimes.com/", signUpHandler: function(){ if ( "/membership/" ){ window.document.location.href = "/membership/"; } else if ( "" ){ window.document.location.href = ""; } else { registration.manager.showRegistrationDialog(); } }, signInHandler: function(){ if ( "" ){ window.document.location.href = ""; }else { registration.component.navigation.NavigationController.defaultNavigationParams.signInHandler(); } } }); jQuery( function(){ if ( "/membership/" ){ var eventManager = registration.manager.events.getEventManagerInstance(); registration.manager.config.setConfig( "signUpListener", "reg-signup-override" ); eventManager.addListener( "reg-signup-override", function(){ window.document.location.href = "/membership/"; }); } }); i$.ns('trb.data').dssOverrideLevelCode = ''; i$.require('http://www.tribdss.com/meter/latweb.js', function meteringServiceCallback() { trb.meteringService.modalCloseUrl = document.location.href.split('/').slice(0, 3).join('/') + '/about/site/registration/signin_registration.complete?'; trb.meteringService.init = function() {}; trb.meteringService.meter(null, null, function() { }); }); trblib.require('/hive/javascripts/loggingService.js', function loggingServiceCallback() { trb.loggingService({ sn: trb.data.section == '/' ? 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Also Insurers see way to dodge federal healthcare law next yearInsurers see way to dodge federal healthcare law next year Healthcare law could raise premiums 30% for some CaliforniansHealthcare law could raise premiums 30% for some Californians California issues annual ratings for health plans, physician groupsCalifornia issues annual ratings for health plans, physician groups Survey: U.S. medical costs top other developed nations' Survey: U.S. medical costs top other developed nations' By Chad Terhune, Los Angeles Times April 3, 2013

California Insurance Commissioner Dave Jones lashed out Tuesday at another double-digit rate hike for thousands of small businesses getting their health insurance from industry giant Anthem Blue Cross.

But this time Jones got some help from a surprising source. He has quietly tapped Consumer Watchdog, his political ally and the state's most outspoken industry critic, to help review health insurance rate increases under a one-year contract worth as much as $88,000.

The insurance industry expressed dismay that the state enlisted its longtime nemesis to help review rate increases, and some experts questioned whether it's necessary to further antagonize insurers at a time when state officials are trying to work closely with the industry to implement a massive healthcare expansion.

Public-policy experts also scoffed at the arrangement.

"Their very aggressive stance against insurance companies raises serious questions about a conflict of interest," said Jessica Levinson, a Loyola Law School professor and expert on government ethics. "You want an independent researcher."

Patrick Johnston, president of the insurance trade group California Assn. of Health Plans, said, "Any review of health plan rates should be conducted by independent, impartial consumer groups that do not have political conflicts of interest and financial motivations."

Consumer Watchdog was hired to supplement the state Insurance Department's own review of rates.

In its first report Tuesday, the Santa Monica group accused Anthem of padding its profits and overcharging small-business customers by about $17 million. Jones echoed that theme at a Sacramento news conference, but he didn't mention Consumer Watchdog's new role.

Jones criticized Anthem Blue Cross for raising rates on about 7,000 small businesses as much as 23% and said the company rejected his request for lower rates. Anthem said its average rate increase of nearly 11% for these 45,000 employees and their dependents was necessary to cover rising medical costs.

Later in an interview, Jones defended using grant money from the federal healthcare law to hire Consumer Watchdog.

"I think it's important to have the consumer perspective, but at the end of the day we make our own determination," Jones said. "This grant funding is a drop in the bucket compared to the hundreds of millions of dollars health insurers and HMOs have on their side. I think ordinary Californians know the deck is stacked against them."

Jamie Court, president of Consumer Watchdog, said the group's proven track record in challenging insurance company practices made it an ideal choice for the state. Consumer Watchdog says it has saved Californians $2.3 billion since 2003 by successfully disputing rate hikes for property and casualty insurance under Proposition 103, the 1988 ballot measure the group championed.

"We are the foremost expert on health insurance rates," Court said. "This grant allows us to pull back the curtain and show how the wizards at Anthem and other companies are manipulating Oz. We want to prove that rates are too high."

That approach by Consumer Watchdog troubled some observers.

"It's like asking one of the Dodgers to umpire a big game for the San Francisco Giants," said Dan Schnur, director of the Jesse M. Unruh Institute of Politics at USC. "Consumer Watchdog is a very well-respected organization, but the commissioner is clearly going out of his way to predetermine the outcome."

Consumer Watchdog has sparred with health insurers for years, often suing them on behalf of patients who felt they were improperly denied benefits. In the last year, Jones and Consumer Watchdog worked together to put an initiative on the November 2014 ballot that would give the insurance commissioner the authority to deny health insurance rate increases.

Under current law, Jones has only the power of the pulpit. He can publicly declare an increase unreasonable, but he has no power to stop the insurer from imposing it.

"Without reasonable controls on these rate hikes, families will be priced out of the health insurance market," Jones said.

In an effort to change the law, Jones has worked closely with Consumer Watchdog. Last spring, in a much publicized event, Jones joined Consumer Watchdog founder Harvey Rosenfield to drop off boxes of voter signatures at a local elections office to place the measure on the ballot.

The measure seeks to give the Insurance Department the same rate-setting authority over health insurance that it already holds over auto and property coverage. Insurers, medical providers and other business groups oppose the measure on the grounds it would create a costly new bureaucracy and that it doesn't address the underlying reasons for rising premiums.

Copyright © 2013, Los Angeles Times

1 2 next |   single page printComments9 i$.require('http://cdn.gigya.com/js/socialize.js?apiKey=2_COh26GgfZDptreu0iQ9aknzT_Ig861qYxOHZVxizrZMTn81vygTB-ptN33wgCtrj', function() { var act = new gigya.socialize.UserAction(), showShareBarUI_params = { containerID: 'componentDiv_bottom', shareButtons: [{ provider:'Email'}, { provider:'Share'}, { provider:'twitter-tweet'}, { provider:'facebook-like', action:'like'}], userAction: act, moreEnabledProviders: 'facebook,email,pinterest,twitter,linkedin,tumblr,delicious,digg,blogger,google,stumbleupon,reddit' }; act.setTitle("State hires consumer group to help it review healthcare rates "); act.setLinkBack("http://www.latimes.com/business/la-fi-0403-insurance-critic-hired-20130403,0,5476273.story"); act.setDescription("California Insurance Commissioner Dave Jones lashed out Tuesday at another double-digit rate hike for thousands of small businesses getting their health insurance from industry giant Anthem Blue Cross."); gigya.socialize.showShareBarUI(showShareBarUI_params); });   Comments (9)Add / View comments | Discussion FAQ Randy Horton1 at 4:00 AM April 05, 2013

Health insurance companies like Anthem Blue Cross are for high healthcare rates.  Consumer groups are against high healthcare rates.  It's a match made in heaven!

Adalberto Cervantes Rodriguez at 2:16 PM April 04, 2013

Might SOX laws and laws related be applied in the Companies using ERP more often?

The IRS does not have an email for quick reports about wrong implementations of ERP that are not considering American accounting and American models like the Activity Based Costing as it uses in American Corporates.

In the BRIC countries, the use of the of SOX laws and other American laws are not enforced, so even that they said they are using SOX, the reality it is that SOX is not applied in the same way like in the USA.

SOX basic principles are related to the rolls in the ERP, the user name and password of each consultant, super user, key users and other must be well defined using ABC technique and industrial engineering to define clearly the activities related to the roll in the ERP. But this basic situation in business is not done by the BRIC IT consultants, because they do not have idea of the legal implication of the wrong determination.

cato58 at 8:37 AM April 04, 2013

This sure feels like a kickback to me. I encourage the LATimes to continue to look into this arrangement.

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