Patient Advocacy: Healthcare on your Side

Patient Advocacy: Healthcare on your side

   by Martine G. Brousse, 

Healthcare Specialist, Patient Advocate, Certified Mediator

ADVIMEDPRO

Your Patient Right: 
                            Right to an Interpreter

One of the lesser known rights patients are now enjoying since the implementation of the ACA ("Obamacare") is the right to an interpreter. This is your right in a doctor's office, when in communication with your insurance, or when receiving medical services of any kind. 

Yet, patients confronted with the need for translation often find that this right is not fully enforced in many instances. Whether a foreign visitor, elderly parent or new immigrant without command of the English language, here are a few tips to getting the help you need.

1. Contact your insurance

When signing up for insurance, it is now customary that customers be asked and assigned a preferred language. Insurance companies are mandated to provide their subscribers with written and verbal translation services whenever appropriate or requested. While representatives fluent in Spanish might be more readily available than one speaking Hmong or German, every effort must be made to allow and encourage a proper and effective dialogue. 

Travel and foreign emergency insurances automatically provide translation support for their subscribers. 

When looking for a new doctor, call your insurer first. You can be referred to a provider both able to converse with you, and within your plan network, saving you $ in the process. Offices share their language capacity with insurers. 

2. Contact the staff

It is advisable to call the office before an appointment, and ask for an interpreter. This is probably where you will meet the most hurdles, as most offices do not have access to translators unless one of their staff member speaks your language. In such cases, advance notice will help lower the impact of this employee leaving her duties to assist you. 

Most practices will ask you to come with your own translator. Due to HIPAA regulations, and the need to protect your medical history and records, as well as cost, hiring an outside interpreter is unlikely on the office part. Hospitals are better able to provide such a service through a much larger staff pool.

3. Ask a friend or relative

Rather than wasting time and effort communicating with your doctor via sign language, consider bringing a friend or relative with you, especially in serious or complicated cases. For routine exams or basic visits (to a lab, for Xray), calling someone on the phone who can translate might be enough. 

4. Contact your State

In CA, the Office of the Patient Advocate offers a variety of tools, resources, brochures and information on the healthcare system in several languages. English, Spanish, Korean, Vietnamese, Russian, Farsi and Hmong are some of the options. Information may be downloaded directly, or requested by mail. This agency also offers assistance with filing complaints or reporting violations. 

Call them at 888-466-8900 or visit http://www.opa.ca.gov

Other states should offer similar services. Contact the insurance Commissioner's office for information. 

Giving up this right because of poor planning or unforeseen circumstances should not deter you from seeking medical care. In case of a true emergency, your local embassy or consulate may be able to help out, or refer you to a trustworthy translator for hire. 

Patient advocates may also be able to assist you. Many such as myself,  are fluent in other languages, and are familiar enough with the system to provide you with this service, and with ethical and trustworthy privacy. 

©  [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

Patient Advocacy: Healthcare on your Side

Patient Advocacy: Healthcare on your side

   by Martine G. Brousse, 

Healthcare Specialist, Patient Advocate, Certified Mediator

ADVIMEDPRO

The 411 on Patient Refunds*

As a billing manager for many years, and a patient advocate, the subject of overpaid accounts has come up all too often. If patients were truly aware of how much sits, not refunded to them, in the books of medical providers, they might gather pitchforks and descend onto offices to reclaim their money. 

This is a ugly yet common practice in the industry. While it has worked well for many providers, it is time to let the public in on the deal, and come clean with patients who are, after all, customers. Does the clerk at the supermarket, or at any other business, require your formal request to hand over your change? Does your credit card company not send you a statement indicating you have a credit balance? 

1. Why is it happening? 

Unlike any other business, insurance reimbursement will take a couple of weeks at best, months at worst. Paid charges may be appealed or disputed, payments recouped or claims denied or pended. Account balances remain fluid until fully settled, yet patients are usually billed after the first insurance notice. Even if the error or the fault for a denial lies with the medical provider, the patient will receive a statement of insurance non-payment. Threats of collection action will prompt your writing a check. 

The other major side to this sad story is "office policy". Though rarely advertised (and for cause!), many practices have a "refund on demand" rule. Don't ask? Don't get!

The administrative burden of processing refunds as soon as a positive balance is noted is often cited as the main excuse. While it is a valid reason, a good compromise would be "refund on demand for sums under $ 50.00 or $ 100.00", and automatic reimbursements for larger overpayments. 

2. Common reasons for credit balances:

• Premature payment: your claim had not reached final processing before you received a doctor's bill.
• Pre-Payments: the office demands your payment up front, to cover a deductible, or if out of network. 
• Double coverage: If you have two policies, especially primary, overpayments are more likely.
• Double payments: an assistance program may have made payment on a charge, or you may have paid the same bill twice. 
• Billing error: an erroneous adjustment may have been posted or an inaccuracy in the billing process may have occured. If you have a common name, expect such errors. 

3. What can you do?

Keeping track of your bills, insurance explanations of benefits ("EOB") and payments is crucial. Any statement not matching an EOB should be questioned, and a call placed for confirmation or clarification. 

Request a copy of your ledger, or itemized bill, at the end of each year, or after your last visit to a medical facility. Useful for tax purposes as well, it will allow you to scan for errors and check the balance. 

Get receipts for any payments, especially if paying cash. At the time of payment, indicate on it whether this is an advance on a future liability, partial payment or payment in full. 

Decline to make a payment in advance, even if you have not met your deductible or yearly liability. A contractual adjustment will reduce your bill, but it often is difficult to know how much before a claim is processed. If the facility is in network, they should not ask for any up front payment except for the set office co-pay.

At any suspicion or knowledge of an overpayment, contact the billing department and ask for a refund. While it is certainly unprofessional and deeply disrespectful of patients, expect to wait a while before a check is cut. Many offices are on top of billing patients but are reluctant, if not outright combative about  refunding them. 

Do not hesitate to contact the office manager or physician if you are given the run-around or further delay is unacceptable. A complaint to your insurer might be helpful too. 

In conclusion:

A French saying proclaims:" Good accounting makes for great friends". This goes for your medical providers and health practitioners. If you cannot trust the staff or the practices they follow, can you really trust the practitioner? 

If transparency and patient satisfaction are two important cornerstones of the ACA ("Obamacare") reforms, then surely this practice must be ended. 

* as 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

Patient Advocacy: Healthcare on your Side

Patient Advocacy: Healthcare on your side

   by Martine G. Brousse, 

Healthcare Specialist, Patient Advocate, Certified Mediator

ADVIMEDPRO

  Should you trust (and pay) statements  

                     from your medical providers? 

In my professional career, I have observed that patients tend to fall into two opposite categories. The "trusting" types always pay whatever amount is indicated, while the "questioning" ones rarely do so until a final or collection notice is sent to them.

The common excuses of the latter types are their lack of trust in the amount billed or their waiting for explanations (they usually do not request). The former trusts the billing staff as they do their doctor. 

Here are some guidelines to help you determine when to pay and when to wait.

1. Check your insurance policy

Each January, find out what amounts you can expect to ultimately be responsible for in the coming year. What is your yearly deductible (the sum you pay first before your insurer starts issuing payment)? What is your yearly out of pocket (your percentage of the cost before your insurer pays 100%). Do you have an office co-pay (set fee)?

Contact your insurance if the terms of your policy are unclear or confusing. 

2. Verify and compare

Every amount listed on your provider's statement (doctor, facility, imaging center, lab etc) should match your insurance Explanation of Benefit (EOB). You can also go online to check whether a claim has been paid, and what is your total liability. If the statement's balance matches the EOB's: you owe this amount.

A spreadsheet at the time of matching statements and EOBs is a great visual help for you, and for your tax person during tax season. 

3. If  you have not received an EOB

Further research may be required. 

Has the claim not been sent? More medical offices no longer handle claims, leaving it to patients to mail them. If you have been handed a claim form or an itemized bill, make sure to forward it to your insurance for processing. 

A first statement may just be a notification or description of services rendered. Confirm a claim has been processed before paying such a "notice".

Does the provider have your correct information? If you received a new card, forward a copy to the office: an identifying number or claim address may have changed. Charges may have been denied for the incorrect info.

4. If your EOB does not match

Is the claim pending by your insurance for additional information? The EOB will indicate what is needed. It could be required from you (info regarding another possible primary coverage, verification of a dependent status, or return of a health questionnaire or from your medical provider (address update, medical records). In this case, forward a copy of your EOB to the billing department and demand prompt handling. 

Consider calling the billing person, to verify contractual adjustments were correctly applied, or ask for justification. After all, mistakes happen. You may also contact your insurance for explanations. 

Is the provider "out of network", meaning not within the contractual network your policy covers? If this is the case, you will need to negotiate a settlement as you are liable for whatever amount is billed to you.

However, if services were rendered to you by an out-of-network provider at an in network facility or setting, especially if you had no choice, an appeal to your insurance should be fruitful. Your insurer, once informed you are being billed for the full amount, would likely propose a financial settlement or issue additional benefits to reduce, or cancel, your balance. 

5. What are your rights? 

In case of any conflicting or unclear paperwork, you are entitled, as a patient, to receive concrete explanations from your insurance carrier. You may also file an appeal, and ask for a review or reprocessing of any charge. Detailed steps and specific forms are available in your policy booklet or online.

As your creditor, the medical office has the burden to detail and explain any liability billed to you. Although many do not, by choice or lack of understanding or training on the part of their staff, do not give up. A call placed to an office manager or doctor will usually resolve such issues.

Filing complaint to the insurance company, a grievance to your state commissioner's office or medical board is next.

In conclusion:

While ignoring a bill from your medical provider is never a good idea, paying up without checking the amount billed to you is not recommendable either.

Your insurance should be your primary guide when determining if a bill is owed, and how much. Discussing charges with the billing department is a right to exercise whenever appropriate.

©  [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