Tuesday, September 13, 2016

Jan 26



Asked to pay your unmet Deductible now? 
Consider this...

In recent years, it has become common practice among medical providers to request the payment of your unmet deductible or out of pocket in advance, either for appointments early in the year, or before receiving services at a facility.

1. There are several reasons:

High deductibles and out of pocket liabilities (the amounts a patient must pay before an insurerpays medical costs in full) have become prevalent as ever larger costs are shifted to individuals and employees.


Changes mandated by the ACA ("Obamacare") profoundly affect the way medicine is to be practiced. Transforming this vast, complex and well-established system into a cost-effective, result-based model creates financial disruption. Uncertainty about the future of healthcare has created major anxiety, as many medical providers feel their livelihood and existence might be in jeopardy.

Reassessments of fee schedules by Medicare and commercial insurances, the downward federal budget allocation trend, rising operating costs and payment delays due to widespread technical system implementation issues have resulted in a shortage of income for many offices. Making do with less has become a daily game, finding new revenues an endless challenge.

2. The office point of view

Every billing department knows that, early in the year, patients pay off holiday credit card bills and taxes first. As an office cannot legally and ethically refuse to treat patients with open balances, getting advance payments guarantees a minimum income during those leaner months.

Some specialties such as oncology have suffered significant reductions in reimbursements in recent years. Smaller practices in particular don't receive the bulk discounts from suppliers, extended payment deadlines or preferential insurance contract rates that larger entities enjoy. While waiting for patients to pay their balances, many must rely on lines of credit or savings to make ends meet.

Every January brings new insurance plans, changes in regulations and a significant amount of new patients, especially since the ACA implementation. The addition of staff to absorb this workload causes increased labor costs.
An important ACA requirement is the mandated use of EHR (Electronic Health Records). Monetary incentives have been offered to medical providers to purchase new systems and upgrade their software. As they are based on payments made by Medicare in previous years, these incentives were negligible for those not catering to seniors.     
Costs surged too due to a major change last fall. The diagnosis-coding system was updated to a vastly expanded version; becoming fluent challenged staff and physicians and affecting all aspects of billing.  For at least one year, providers and insurers must use two different systems.

3. When to say no

If you have government issued coverage (Medicare, Medicaid, Tricare), do not pay in advance! CMS, the governing administrator, has ruled that a patient may not be asked for any upfront payment before a claim has been processed and the specific liability determined.

The only exception is the set office copay for Medicare Advantage or Tricare plans, due when services are rendered.
Patients covered under a commercial plan and only scheduled for a minor office visit or service, should wait until they receive a statement, as it is unlikely they will meet their deductible. If the office cannot financially survive without that early contribution, better management might be in order.

Explain that you have already met your responsibility, or charges for other prior services are in process, to stop these demands.    

4. In conclusion        

If you agree to pay, ask for a cost estimate and offer a lower amount.

Always confirm the refund policy. Will any overpayment be held until applied to another open balance or be refunded? How fast would this take? Will it be automatic or will you have to ask?

When in doubt, or if you need help getting the office to back off, contact your insurance company. This behavior is frown upon, and sometimes prohibited by contract. A phone representative will call and demand they stop.

©  [2016] Advimedpro.
©  [2016] Martine G. Brousse.
All rights reserved.

My objective is to offer you, the patient, concrete and beneficial information, useful tips, proven and efficient tools as well as trustworthy supportive advice as you deal with a system in the midst of sweeping adjustments, widespread misunderstandings and complex requirements.


AdvimedPro        (424) 999 4705 or (877) 658 9446       fax (424) 226 1330
                                           www.advimedpro.com           contact@advimedpro.com

Thursday, November 13, 2014

Healthcare: Patient Advocacy on your side




Patient Advocacy: Healthcare on your side

   by Martine G. Brousse
Healthcare Specialist, Patient Advocate, Certified Mediator
ADVIMEDPRO


Save on medical costs: 
 Alternative Options* 

As I negotiate down expensive facility bills for my clients, or fight insurance companies for higher reimbursements, I am often struck by the number of patients who thought the ER or the specialist's office were their only choices. Minor episodes end up costing thousands of dollars, when more affordable options were available.

Consider these options:

Please note this is given for informative purposes only, does not intend to provide or constitute medical care or advise. It neither endorses nor promotes any mentioned service or provider.

ALWAYS call 911 or go the Emergency Room if you are having a life-threatening emergency or if your health may be at serious risk by delaying care.

1. Urgent Care Centers

Staffed by MDs, they treat less severe emergencies that require immediate attention. Services include sutures, prescribing medications, chronic condition management, health evaluations, imaging, stabilization until your next doctor appointment and more.
Urgent care centers are found in many cities and neighborhoods. Appointments are not necessary.

2. Retail Health Clinics

Addressing minor concerns such as allergic reactions, minor infections, wound care and skin conditions, they are staffed with nurse practitioners licensed to prescribe medications and perform simple medical procedures. This is a good alternative to a doctor's visit for general and school health exams or for vaccinations.
Located in drugstore chains (i.e. CVS) or retail stores (i.e. Wal-Mart), they contract with most major insurers. Their services are fairly priced.

3. Nurse helpline

This free service, staffed by nurses 24/7, from your insurance can save you the cost of a doctor's visit. Find the number on your card or on the insurance website.
Call to determine if you need to go to the ER, to find the nearest "in network" urgent care, to ask what remedy is best for minor symptoms, to treat an illness or to get first aid steps that do not require the ER. These nurses can provide answers when the office is closed, help coordinate medical care if you are away from home, or order urgent prescription refills when your doctor is unavailable.

4.  Free or low cost clinics


Offering a variety of services, they should not be your first choice in case of an emergency. Administered by the County, privately run or belonging to teaching universities and hospitals (services are rendered by students under the supervision of fully-experienced doctors), waits can be long but prices worth a look.
Some specialize in a specific illness (HIV/AIDS clinics) or services (women's health clinics). Exams, prescriptions, tests and more are provided at significant savings.

5. Labs

Depending on the test, you may need to consult your Dr first. Many common tests can be obtained without a prescription, or at a lower cash cost than in the office, directly from these labs:
·           https://www.directlabs.com/

6. Chiropractors

If you have a minor sport injury or joint pain, or want to avoid surgery, consulting a chiropractor is a less costly option than an orthopedic MD. Specializing in bones, muscles and joints, they use more conservative, less drastic treatment methods (spinal manipulations, physical therapy, medical massages) to get you back in shape. They can order scans and limited labs. Expect to pay $ 50.00 to $ 100.00 per visit (including all modalities). This is often a covered insurance benefit.

7. Pharmacists

Ask the pharmacist at your local drugstore or pharmacy for a recommendation on what over the counter remedy is best for minor ailments, to check on possible negative interaction with current prescriptions, or advise on a minor allergic reaction.  Local and chain pharmacies also offer low cost flu shots, and other vaccinations.

8. Online  

An increase in the number of online MD visits has been observed, and is likely to continue this upward trend. Sites such as www.memd.me, www.interactivemd.com or the-online-doctor.com propose virtual encounters for set prices, and at convenient times for patients.

In Conclusion:

Remember to ask any healthcare provider or clinic you may consult if they are part of your insurance network. Choosing one who is contracted with your insurer will significantly lower your cost. You may need to send the bill directly to your insurer; getting a "superbill" (specialized medical bill) is essential. If you are self-pay, this receipt or statement will be useful come tax season.

Never jeopardize your health by denying yourself access to urgent or necessary medical care whenever necessary. Though more limited after the facts, solutions can still be found to help lower high medical bills.

* Previously seen on NerdWallet

©  [2016] Advimedpro.
©  [2016] Martine G. Brousse.
All rights reserved.

My objective is to offer you, the patient, concrete and beneficial information, useful tips, proven and efficient tools as well as trustworthy supportive advice as you deal with a system in the midst of sweeping adjustments, widespread misunderstandings and complex requirements



AdvimedPro        (424) 999 4705 or (877) 658 9446       fax (424) 226 1330
                                         www.advimedpro.com           contact@advimedpro.com

Monday, October 20, 2014

Patient Advocacy: Healthcare on your Side






Patient Advocacy: Healthcare on your side

   by Martine G. Brousse
Healthcare Specialist, Patient Advocate, Certified Mediator
ADVIMEDPRO

 

Medical Bills Management: a few tips*


I am often asked about how best to manage mounting medical bills while patients must face serious health issues, undergo treatment, keep their job and maintain their daily activities. Who has the energy, time and will to deal with financial paperwork?  How do you negotiate a bill or even know for sure that a statement is due?

While patient advocates specializing in billing issues can assist in this task, they can only do so based on the documentation they receive. Here are some tips that may make a difference for you and for them.

1. Be mindful of time limits

Patients usually have 30 days to make a payment on their account, or inform the office they contest a balance. Delaying may mean collection action (sometimes in as little as 60 days), or added interest. If more time is required, make a small payment to keep the account current and to show good faith. Make your call early for clarification purposes. If you disagree with a balance, indicate so in writing as soon as possible.

Insurance companies place time limits on filing a first grievance or second-degree appeal. Ninety days from the date on the Explanation of Benefit ("EOB") or the determination letter are the norm.

2. Communicate!

Report any arrangement, payment plan or settlement you have in place to your advocate to avoid misunderstanding and wasted efforts.

Always follow the policy guidelines about filing written appeals. You usually only have two: use them well!
A phone call asking for an explanation may count as strike one, even if you are unclear with the representative about your intention. Asking the adjuster to reprocess the claim "because the insurance did not pay enough" is a sure denial in the making. 

3. Play the matching game

Keeping accurate records will prove worthwhile when filing for medical expenses tax credits with the IRS or seeking reimbursement from your HSA account.

I recommend matching every bill with the corresponding insurance Explanation Of Benefit. Confirm the amounts billed to you are justified, and that every medical service has been submitted to your insurer for payment. Discrepancies, errors or issues should soon become apparent.

I recommend an Excel spreadsheet to keep track of statements, EOBs and amounts paid. Keeping it updated on a weekly or monthly basis costs little effort, with great reward. This is the way I keep track for my clients. You don't need to itemize every charge, but each date of service and provider should have an entry.

4. Details count

Small details make the difference between success and wasting time and $ on losing efforts. Winning an appeal may well depend on them.

Some examples: an error on the hospital's part caused you to have to stay longer; the provider was in network but canceled his contract with your insurance in middle of treatment; the patient signed a financial agreement while still under the influence of anesthesia or without an interpreter; the office sent your samples to an out of network lab because the Dr needed the results ASAP.
All of these are routine denials, yet each one can be the reason for winning your appeal. 

In conclusion:

Managing medical bills, establishing the best strategy and getting to the best outcome depend on basic matching and minimum organization skills. While hiring a billing advocate can mean peace of mind, not every patient can afford this service.
A small investment of time can save you money by recognizing errors and having them reversed.

Blindly paying every bill you receive, or sticking them on the growing pile until you can (or want to)  get to it are neither cost-efficient nor advisable.
  
* Previously published on NerdWallet

©  [2016] Advimedpro.
©  [2016] Martine G. Brousse.
All rights reserved.

My objective is to offer you, the patient, concrete and beneficial information, useful tips, proven and efficient tools as well as trustworthy supportive advice as you deal with a system in the midst of sweeping adjustments, widespread misunderstandings and complex requirements



AdvimedPro        (424) 999 4705 or (877) 658 9446       fax (424) 226 1330
                                         www.advimedpro.com           contact@advimedpro.com