Monday, December 16, 2013

Patient Advocacy: Healthcare on your Side

Patient Advocacy: Healthcare on your side

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

End-of-the-Year Insurance Checklist 

As 2016 marches on through joyful holiday traditions and end-of-the-year celebrations, we start focusing on new resolutions, exciting goals and fresh opportunities. But now also is the time to remember that an important aspect of everyday life must be reviewed and addressed before the last day of December. 

Healthcare and insurance matters have dominated the news for months. Have you reviewed and evaluated your position yet? Are you certain you'll have coverage in January? Familiar with the terms and cost of your policy? 
A little time spent on education and preparation will help reassure you, guide you to the best decisions, and possibly save you money.

Whether you will have new insurance coverage or keep your current one, here are a few things to consider now:

1. Use your policy wisely for the rest of this year
  • If you have already met your deductible and/or out-of-pocket liability, get as much out of your policy as you can. Now would be the time to schedule this last check-up, lab or scan. Even though getting an appointment will not be an easy task, it is not impossible. Accepting less desirable appointment time or spending a bit of time in a waiting room is worth a free service. 
  • Get your prescriptions refilled before the end of year: You might be able to get an up to 90-day supply if you use your health plan's preferred mail-in pharmacy, saving you having to pay a deductible for several weeks.
  • Adding to this year's medical expenses may be worthwhile when filing your tax return with the IRS. So go get those new glassesdental cleanings and physicals.

2. Check and recheck your insurance status
  • Did you receive a notice from your current insurer or employer regarding your policy? If not, are you sure? If yes, what are the implications? Being certain that your current policy will continue under its present terms, or becoming familiar with new terms of policy is essential to avoid bad surprises and costly repercussions later.
  • Contact your HR department, and/or your insurer for confirmation of the terms of your policy.  They may have changed even if your policy has not. 
  • The consequences of relying on the way things are without checking can be serious, including loss of insurance coverage and costly delays.

3. Talk with your current Physicians
  • Check with your current providers whether they will continue their contract with your insurer, or will be part of the new network you join in January. Ask for a referral if not.
  • If not, you must arrange for a transfer of care to a new physician now. Try and get an appointment with your new provider, even if you register as "self-pay" until you get a new insurance card and ID. Have the office send your complete records in a timely manner. Arrange for prescriptions to be refilled ahead of time or as a courtesy until the new physician takes over. 
  • Offices will be deluged by new and transferring patients in January; whatever you can get done now will save your sanity down the line. 

4. Check out the Marketplace

Even if you do not expect any change in your coverage, checking out your state or government marketplace is highly advisable. 
  • Your grandfathered individual policy (the only way it could be extended) is likely to have less coverage than those mandated under the ACA ("Obamacare"). For example, you may be responsible for the cost of preventive measures and services that insurers must now pay in full.  
  • Let go of restricted benefits, pre-existing conditions and limits now that they are banned in the new ACA policies. Why pay for restrictions when you could be paying the same for an extension of coverage? 
  • A new policy with a different insurer may give you access to a larger, better and/or less distant network than the one you currently have.
  • If you find you current HMO policy too restrictive, or an extensive and pricey PPO network unnecessary, switch to another plan better adapted to your needs. 

4. Split your family
  • Continuing to pay for your young adult dependents under a work policy is likely to be more expensive than enrolling them under their own policy, especially if they qualify for the emergency fund or premium assistance. Keeping them on your policy between 18 and 26 is not always the cheapest option. 
  • Your spouse may also be better off under an individual policy, especially with premium tax credits. 

5. Change can be $ good
  • Consider switching to a similar high-deductible policy if the new policy is listed as HSA-compatible and your present one does not. Funding your HSA can help you cover medical and dental costs while reducing your tax liability.
  • You may be able to afford a better policy, with a smaller yearly share-of-cost, for the same price as your present contribution.
  • Keeping your present policy will not give you an opportunity to receive premium assistance. Only new policies are eligible for this subsidy. Why would you give away free money if you qualify? 

Regardless of your circumstances, no one should be complacent or remain ignorant of the major changes that swept the country on 1/1/14. Every level of the healthcare system will be affected, willingly or not.

Even if your policy does not change, a re-evaluation of the situation is in order. Your doctor might drop out of your network. A prescription you routinely take may now be more expensive or require an authorization. A referral for a scan might require a change of provider. Making an appointment may now require weeks of waiting, or a longer drive. 

But even as time slips away and urgency mounts, it is still possible to deal with this issue now. It sure is highly recommended.

©  [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

Thursday, November 14, 2013

Patient Advocacy: Healthcare on your Side

Patient Advocacy: Healthcare on your side

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

Tips for Cash Patients (Part II)

As a continuation to last week's blog, here are more useful tips when negotiating for cash, or reduced fees with medical providers and facilities. 

1. Audit your billing (and medical) records

Chargemasters (the list of all procedures, labs, medications, supplies, visits performed during an office visit or hospital stay) should reflect your recollections, personal notes and medical records. They may however have errors that only a line by line audit will uncover. 

Some mistakes, especially on large facility bills, happen easily. Two separate users may record the same item; an item ordered by a physician is cancelled; a patient may refuse a sleep medication; an item is billed to the wrong patient; incorrect date of service and so on.

Some errors are obvious and should be rectified once common sense prevails: My 5-year old daughter was billed for a pelvic ultrasound in addition to the ear tube insertion that was performed. Really? A pregnant 5 year old? 

Once a physician has signed an order, it is prepared by the staff, whether a medication or a surgery. However, should you pay for it if it is not performed? 

Other errors, lapses, miscommunication may lead to an longer hospital stay, more medical care and services, or a more complicated case. 

A good example is a recent overseas client in the US for a visit. Rushed to the ER, it was deemed that an angioplasty was necessary but not immediately. The hospital staff, well aware that the patient did not speak any English, scheduled him for the procedure several days later, without waiting for a translator. The patient, anxious and not understanding what was being done to him, panicked. The procedure was cancelled. It was successfully performed two days later, after the translator explained it in details. This was clearly the hospital's fault, yet this patient was billed for the failed attempt as well as the two extra inpatient days.
Even though your life may not have been in danger, and malpractice is not an issue, you are being "punished" for circumstances out of your control and certainly not of your own fault. Who is financially responsible? 

Auditing your medical records may require the clinical and medical coding knowledge from a professional, especially a facility bill. 

2. Sharpen those negotiating skills:

   Don't take the first offer: Chances are, 50% can be taken right off the top before you start
talking. Unless you found a medical provider with a heart and some ethics (they do exist!)
who bases the cash chargemaster on a rate like Medicare + a low percentage, the advice is
to start low. 
•  Save interest by offering one full agreed-upon payment rather than monthly payments. First
you will save interest, second you may just get an additional percentage off for doing so. If
you use a credit card, and are being charged interest, why then get hit with more interest for
the same bill? Charge it all, clear your account with the provider and pay off Visa.  
   Make contact quickly: you do not want your account to be sent to Collection. Unpaid
account past 90 or 120 days make the billing department look inefficient at collecting the
debt, prompting them to sell your debt to an agency to get it off the books. Some accounts
are sent after 60 days, so don't delay!
   If you don't have it all, try and find the whole amount you agree to pay by asking family
members or friends for donations, fundraising, looking for financial assistance, cashing in
your life insurance, looking into borrowing from your 401(K), and more. 
   Offer a check rather than a credit card. If a provider can save on their credit card processing
fees, he/she might look more kindly on a discount. 
   If you must make monthly payments, offer to set up an automated payment through your
bank or credit card. That will save statement mailings and time, and reaffirms your good faith
and commitment to paying. 

3. Use apps like PokitDot: 
Free for iPhone, iPad, iPod Touch, soon for Android

            This app caters to those likely to pay cash for a medical or dental service and for all of us who care about pricing transparency.  Locate providers in your area, compare costs and services, review options, request quotes and negotiate a fair price directly with the office or facility.  
            Even if you have insurance, find out if an upcoming procedure or visit is cheaper as a self-pay patient than using your policy (especially if you have a high deductible). You might be surprised!

4. Hire a Patient Advocate

Patient Advocates come in different specialties and skill sets. Some, like myself, worked in
the medical billing field for years, Familiar with coding, records, statements, chargemasters
and common reimbursement rates, we can sort through itemized bills effectively and
Even though these services are not free, and not considered medical expenses, it is certain
that hiring a patient advocate will save you money, time and efforts, and lead to more fruitful
negotiations. Insider knowledge will make a difference.
A word of caution: all patient advocates are not skilled in negotiations and billing matters.
Question their skills and experience before signing any contract.
While charging a percentage of the savings is a common practice, charging up to a 30%
commission can be seen as unethical and somewhat greedy as patient advocates are, by
definition, people helpers. The higher the savings, the lower the commission rate should be. 

I recently negotiated a $ 275,000.00 hospital bill down to $ 40,000.00. Still a lot, but a 85%
reduction! The patient was only offered a 20% discount before I stepped in. Using my
experience and skills as a certified mediator, I was able to point out mistakes, miscodings,
discrepancies, duplicates, bundled and inclusive items, non-billable charges. I calculated
the usual reimbursement rates using proper coding methods and presented a complete
billing analysis for which the facility had no answer.

Like everyone else, your creditor is looking for a prompt payment that covers expenses and 

brings in some profits. After all, services were provided that should be paid for. Your
supermarket does not let you take that grocery bag home with nothing but the promise of a
later payment, so why should your doctor or hospital?  

People on the other side of the phone call have not made the rules, created the
chargemaster or prompted your need for services. Be kind and understanding as their ability
and authority to reduce your bill may be limited. If you cannot sign off on an agreement, ask
to speak with a supervisor, or someone with that authority. 

©  [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