# 10 Medical Paperwork & You

Had to chuckle, when I read this article. Many people that sign papers, of contractual nature, read a line or two , and then sign. They gotcha now. Well, I drive the people, asking me to " sign here ", nuts. I actually read the stupid fine print. I have actually " crossed out and initialed ", that which I had crossed out, from a given legal type document. Of course I receive the " Oh, you can't do that ", reply, "that is our standard form ". My reply, mostly has been " Yes, so what! " " Well you are not allowed to change the form ", they reply. So the verbal battle continues. Have gone through group heads, supervisors, managers, lawyers, and administrators. Did I win all my battles, no, not always to my full satisfaction, but mostly, I get what I want, and is what I can " honor ".
Everything is negotiable. Why sign that, which you cannot honor? One interesting episode went like this:
" We can't release her until the bill is paid in full".
" Bye ".
" Where are you going ".
" You said you can't release her until the bill is paid in full, I'm unable to pay the full bill".
" What about her! "
" Keep her until the bill is fully paid, bye ".
" Wait, lets talk this over ".
So read this article and you will see some of the things, I've done and battled over.
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Making Medical Paperwork Easier
Medical bills are incredibly complicated and expensive, even for those with health insurance. But here's what you may not know: Hospital bills aren't "unavoidable" in the same way as, say, taxes and death. The number at the bottom of the bill may not be the amount you have to pay at all. In fact, there are a number of things you can do to protect yourself from unfair medical charges, including working with a professional "medical billing advocate."
For information on this I called Nora Johnson, CCP (Certified Compliance Professional), a medical advocate with her own company, Med-X (Medical Expense Review & Recovery), and director of education and compliance for Medical Billing Advocates of America. Though most of these strategies relate to those with health insurance, which fortunately is still most of us, Johnson assured me that she has plenty of advice for both groups -- insured and uninsured.
BE SURE YOU GET WHAT YOU'RE INSURED FOR
Here's Johnson's first rule for those with health insurance: Know thy policy. It's boring as anything, she acknowledged, "so most people never bother to find out what their policy covers and -- often even more important -- what it doesn't." If you know in advance that a treatment or procedure you need is not covered, you can negotiate the price with the physician or facility beforehand, while you still have some room to do so. Most health care policies exempt emergency room doctors and procedures from needing to be "in network." But emergency coverage is policy-specific.
Another common trap for the insured is inadvertently going "out of network," she says. Say you are having gallbladder removal, which is typically an elective surgical procedure. You've chosen a surgeon covered by your plan and he's chosen a team, including the anesthesiologist and pathologist, all of whom you assume are on the plan as well. However, that's not necessarily true, says Johnson. Often radiologists, anesthesiologists and pathologists are out of network or even do not participate with any insurance companies. Always confirm by calling your insurance company (the published list of participating providers may not be up to date) before a procedure and confirm with the physician. If a provider is not covered, you have the right to one who is. Ask for the names of participating providers in your area and request in writing that the hospital use one of them. If the hospital refuses, tell them you will sign an agreement for the provider(s) they want to use on condition those providers will accept the out-of-network fee from your insurance company as payment in full. As further protection, Johnson suggests noting on the back of the hospital admissions form that you are responsible only for participating providers' billing. On the same form there will be an item that says you will pay all "usual and customary charges." Cross that out, she says, inserting the words that you are responsible only for "fair and reasonable" charges for anything your insurance does not cover.
WHAT'S "FAIR AND REASONABLE": DECIPHERING THE CHARGES
This brings us to a brief discussion of what hospitals charge. They say they charge all patients the same rates, says Johnson, which is basically true -- but what's also true is that not everyone has to pay the same fees. When negotiating for clients, she bases what they should pay on that same phrase mentioned above, "fair and reasonable," which is the reimbursement most commonly accepted by that hospital, usually from Medicare. Rule of thumb: The hospital's billed charge is the gross charge and it is more than the hospital accepts from most other payers for the same service, she says.
Further confusing matters, all medical billing is based on three coding systems -- ICD-9-CM, CPT and HCPCS -- used for reimbursement, and she estimates that about one-third of all billing errors result from incorrect coding, such as entering a code for a procedure you never had. While these codes aren't available to the public, you can and should request an itemized bill from your hospital, which includes explanations. Review it carefully, and if you're confused or see an error, ask for clarification from the hospital's billing office. Pay close attention to seemingly minor billing incidentals such as IV start kits (quoted cost, $57... real cost, 61 cents). Medicare does not allow independent charges for such incidentals, so it stands to reason that you should not have to pay them either. Reason: Supplies are calculated into the room/unit/procedure charge. Therefore they are duplicates when billed again for a separate dollar amount.
If there are mistakes in your bill, Johnson says you should address them immediately. If your insurance company refuses payment for something, figure out where it went wrong -- perhaps the statement was miscoded or the doctor's office filed incorrect information. Talk to both the insurance company and the doctor's office to learn if there is an error, and then correct it. Medical Billing Advocates of America say 90% of medical bills contain errors.
People with high deductible policies have one more consideration -- the hospital may charge its full (and inflated) fee up to that amount. Don't let them get away with that. Insist instead that fees against your deductible are the discounted rate (at least 35%) -- not the full -- charges.
EMERGENCY ROOMS CAN'T REQUIRE PAYMENT IN ADVANCE
Nearly all emergency rooms cannot, by law, withhold emergency medical treatment based on payment issues. The Emergency Medical Treatment and Active Labor Act requires all hospitals accepting Medicare to not withhold screening, stabilizing treatment or appropriate transfer of patients, regardless if patients are on Medicare or have no insurance or ability to pay. Some hospitals will attempt to get a credit card number up front in order to ensure payment. If this happens, warns Johnson, ask that they put the demand for payment prior to rendering treatment in writing, specifying whatever the amount or percentage they are requesting. Simply say "I won't pay unless you put it in writing." By asking for them to request payment in writing, you will find they quit bothering you for payment before service, since Federal law mandates that hospitals render emergency treatment that is medically necessary to save lives regardless of inability to pay. After that, if you feel you are being overcharged, you can get the official hospital policy about payment requirements in writing, which you can then take to an advocate for help in negotiating. Patients can also inquire about "charity care," says Johnson. All hospitals that participate with Medicare have to provide a certain amount of charity care to patients who qualify. Get the charity care forms from the hospital, fill them out, make copies and return them to the hospital.
WHEN TO CALL IN BACK-UP ASSISTANCE
If you have been unsuccessful at resolving your billing problems or feel that the fees charged are truly unreasonable, it may be time to call in a professional advocate to help. These professionally certified and trained specialists will advocate on behalf of individuals to combat unreasonable and/or outrageous medical fees. Although hiring an advocate to fight your battle might at first seem as though you are just adding another cost to already high expenses, in reality their training and negotiating savvy can actually reduce costs. The depth of their knowledge and experience working with complex medical billing enables advocates to negotiate fair fees for virtually everything including CAT scans and other imaging procedures, as well as hospital and doctor bills and fees. Johnson advises calling a medical billing advocate after you have reviewed an itemized bill yourself if you think it is not fair -- say, $6,000 for two stitches in the emergency room.
Advocate fees vary. Johnson says they charge by the hour or a percentage of the money saved. They aim to be "reasonable" and always negotiate up front to spare you yet more stomach-turning surprises. To find an advocate, you can go to the Medical Billing Advocates of America Web site http://link.dhn.bottomlinesecrets.com/h/D9G9/44FT/UP/LYS48, or call 540-387-5870.
Source(s): Nora Johnson, CCP (Certified Compliance Professional), medical advocate with her own company, Med-X, (Medical Expense Review & Recovery), in Caldwell, West Virginia, and director of education and compliance for Medical Billing Advocates of America, Salem, Virginia.
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# 9 Quality Service ! Sez Who ?

Well now, here is the situation. Have been through three computers, in recent years. So every new unit has a copy on of MS windows running. now go through all the hassle of updating the brand new unit ,with all the patches and SP1, SP2, etc, to update what is supposed to be a brand spanking new computer, running XP Home,So, I have in essence purchased another licensed copy of XP Home for each new computer, when I already had one. Am not aware if one can even buy a name brand computer new, but without an operating system. Used to be all units came with program disks and printed manuals. No more though. If and when a problem shows up, on a unit, whats the first thing you are told? Insert the program operating disks. Ha, can't be done. Why? There are no disks available. Well just use restore or copy the old drive to the new drive. Can't be done. Why? The original / old drive went kaput. Oh, then just use the install disks. What ! Are you even listening to me ? There are no available disks to use. Well then, send the unit in with the install disks. Do you have a problem listening to a conversation ? No, why? I just told you there are no disks, and none came with the unit. OK, just contact ( in this case ) Microsoft for another copy, we can't do anything for you. Microsoft ( in this case ) says each manufacturer, customizes the operating system for use on their computers, and we can't help you. Contact the computer manufacturer. Round and round we go. Call the store where you purchased the unit. They say "can't help you unless you have the install disks". Yes, but you sold me the unit five weeks ago. You can send the hard drive to a drive recovery company. How much does that cost? Anywhere between $ 100.00 to $ 200.00. You're kidding aren't you. Anyway, won't bore you with the " how and what ", of what then took place. Then there is the rebate ploy. Jump through all kinds of cut out that original, copy that number, copy this other number, send the original to each address. Huh! Come again. How can I send an original to three place , when there is only one original ! Well, just copy the original. But that's not an original then ! Well just try it. So in they go. Six to ten weeks later, comes the letter, rejected, due to no original documentation. On and on. Many discussions, if one can call it that. Then a few more weeks, give another call. There is no record of any transactions being processed. When did you , on and on. Ask for a supervisor, reexplain, suddenly there is a Oh here it is. So anyway the outcome here was worth about $ 300.00. So the added aggravation and persistence was worth it. While I'm in the compliant mode, another gripe is that as name brands that had high quality once, start becoming very poor quality, as companies are bought out. Now, as I understand it, groups will buy the once good brands copyrighted name only, and immediately drop the once famous quality of the item.In all fairness, I did on some dealings find some excellent customer service departments. Overall though, they are poorly managed. By the way, have you needed to contact a health insurance provider lately,about screwed up billing? Account number, name, address, city, state, last four digits of your social, date of birth, telephone number, and than how can I help you. Explain. Oh we don't handle that here, I'll transfer you to..... Than if your lucky, a voice asking again, yup you got it, Account number, name, address, city, state, last four digits of your social, date of birth, telephone number, and than how can I help you. This will happen every time you are transferred to another dept. Needless to say, and not mentioned, is the in between transfers, with the voice recordings, this call may be monitored for quality service, and your call is important to us, please stay on the line for the next available agent. Now comes the repeated, All agents are currently assisting other customers, please stay on the line. Over and over. Ah, a voice comes on, may I please have your .....................