When the Bill is Just Wrong

Health care bills have mistakes, sometimes lots of them.

The figure most often quoted is that up to 80% of medical bills have errors. I’ve looked for the original source of that statement without success, but I did find one medical bill review company, Medical Billing Advocates of America, who noted that in their practice 3 out of every 4 bills they review have errors. (Caveat: Theoretically only people who think they have a billing issue would be submitting their bills for review, so this may create a falsely high rate.)

Still, you probably look over your restaurant bill and ask the waiter about charges you see that don’t look right before you pay it, right? The same applies for medical bills – and even though you may not fully understand everything that was ordered for you, asking about what’s on the bill you don’t recognize before you pay it is just smart. read more

In or Out, Round About – Navigating Out of Network Providers

Stethoscope and hundreds of American dollars

Health insurance is complicated and healthcare costs a lot. If you’re not up for a complicated read, here’s the short version: Don’t use out of network providers if you can avoid it. If you think healthcare is expensive, out of network healthcare is very expensive! But if you want to dig a bit deeper, read on.

 

Maybe your doctor has recommended you see a certain specialist who’s not in your insurance network. Maybe you’re in an accident and the closest hospital isn’t in your insurance network. What then? read more

It costs how much??

Health care costs scrabble

Anymore, it seems for most of us every medical bill has a surprise when we first open the envelope!

How does a provider (doctor, hospital, laboratory, imaging center) decide how much healthcare costs? It’s a pretty closely guarded secret, and it’s not uniform across providers. But suffice it to say, it definitely requires some serious accounting that is largely invisible to consumers. Coined the “chargemaster” by Time author Stephen Brill, providers establish a base price for each and every service they provide. This is the price that they bill insurers and patients without insurance for services. It includes their overhead costs (staff, facilities, billing), and is essentially the base price for services. Understandably it’s higher for hospitals who have more significant overhead costs and lower for office based providers. Consider this “retail” pricing. read more

I’ll have some palliative care, please.

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Huh? Although medical care has certainly become incredibly specialized, whenever I’ve suggested that a client consider asking for a palliative care consult, the first response is “What’s that?” or a close second “I’m not dying, why would I want that??”

In our current environment in many cases palliative care and hospice are often provided as one service, and not the continuum of services from which palliative care as a stand alone is beginning to emerge.

The Association for the Advancement of Palliative Care defines it this way: “Palliative care, and the medical sub-specialty of palliative medicine, is specialized medical care for people living with serious illness. It focuses on providing relief from the symptoms and stress of a serious illness—whatever the diagnosis. The goal is to improve quality of life for both the patient and the family.” read more

Why Choosing a Hospice Provider Matters

wheelchair and aide

A headline in the business section of the Atlanta Journal several weeks ago caught my eye: “Atlanta hospice to pay $3 million.” That’s a lot of cash. The article went on.

“A Georgia hospice company has agreed to pay $3 million to resolve allegations it billed taxpayers for patients who were not terminally ill, the latest such settlement as federal officials target what they call a burgeoning number of abusive hospice schemes.” (italics mine)

There’s no question how important hospice care can be for someone to live their last days fully, surrounded by their loved ones and personal belongings, and supported with the physical, social, and spiritual services that underpin hospice care. read more

Patient-centered care – you may need a buddy!

Buddies

A friend of mine was undergoing an outpatient surgery a few weeks ago. Once in a gown, and her IV started (not a power position for us as patients, by the way!) her surgeon stopped in before heading to the OR to scrub. Having already talked with the anesthesiologist, my friend also shared her concern with her surgeon that she has had really severe nausea with codeine-based pain relievers after surgery (I mean really awful – I’ve been there!) with me nodding along vigorously and asked for different post-op medication. Her young-ish (to us, anyway!) surgeon was patient and gracious in responding that all narcotic pain relievers cause stomach upset and she would provide an anti-nausea medication to take along with the codeine-based drug she preferred to prescribe. Before my friend could share that that she’d had anti-nausea medication before and it wasn’t particularly effective, the surgeon exited stage left to prep for surgery. read more