Fighting Back Against Medical Overcharges
Posted by Advocate Aaron on April 26, 2009 · Leave a Comment
(Here are some tips that a Patient Advocate such as myself uses to help you save money)
It is a fact that the medical system is a mess and if you are uninsured or underinsured and do NOT know your rights or if you do NOT know what to look for chances are VERY high that you will become a VICTIM of the medical establishment. I know, I know, nobody including myself wants to believe that. (But, facts are a stubborn thing) It is now estimated that 90% of all hospital bills contain errors. (Not a misprint, 90%!!!!) So what are you supposed to do to protect yourself? (Follow my tips and tricks below and you could save thousands of dollars) The bad news is the medical establishment knows that you are unlikely to do any of this, which is why Patients Advocates have become VERY popular. I know, because I am one.
There are several strategies to lower your out-of-pocket costs:
First and foremost, if you have any sort of insurance make sure you are aware of exactly what your insurance does cover and any deductibles that must be met before coverage takes affect.(Obvious, but I needed to state it)
Prescriptions:
If you are not insured or not eligible for government assistance be sure to check with Partnership for Prescription Assistance, they provide free or low cost prescriptions. www.PPARx.org or 1-888-4PPA-NOW (1-888-477-2669). (Yes, it requires some paperwork on your part but you really can get FREE Prescriptions. I also recommend you ask your physician or local pharmacist for any coupons or refunds offered by pharmaceutical companies, you would be surprised at what is available just for asking. Also ask them about any local assistance programs that they are aware of in the area.)
It is very important that you COMMUNICATE openly and honestly with your doctor and let them know that you simply cannot afford expensive prescriptions. Most of the times he/she will have sample packs available, or will be able to prescribe generic or over-the-counter alternatives. If you are on any maintenance prescriptions inquire whether the dosage can be altered to make it more cost effective, or if it can be doubled and split to cut costs. Pill splitters are inexpensive, and you can purchase empty capsules at most apothecaries or formulary pharmacies. They may even split the capsules for you.
Doctor Bills:
Most insurance carriers pay physicians one-half to two-thirds of the billed amount, so if you are uninsured speak with your doctor personally and request a discounted rate. They will most often work with you. (If they won’t QUIT being loyal to a doctor that is NOT willing to offer you the same or better rates that he allows the greedy, self-serving “SYSTEM.”) Instead find a compassionate doctor who cares about YOU. If they request a follow-up visit see if it is possible that any fee may be waived, or at least discounted. And, if it is necessary, a follow up visit with a nurse so you won’t interrupt the doctor’s schedule and pay more. Notify your doctor that you will be paying out-of-pocket, and that you need to keep the costs down. Most respectable doctors will be happy to accommodate your request.
If any tests are suggested, make sure that you ask if they are necessary and what they will do. If you do have to have them request the paperwork so you can have it done at a lab. Or, you can request the physician waive the additional lab fees because you’re already being charged for a visit. And if you have to come in just to have blood work done you will be charged for a visit, a phlebotomist fee, and lab fees. If you go to a lab, you are charged a flat lab fee. (This is typical of MOST but NOT all situations)
If the tests are expensive (and you have insurance) be sure to check with your insurance to verify that they will be covered, or if a second opinion is necessary before payment will be made.
Hospital Bills:
This is one place most people are likely to be overcharged. There are several things you can do to prevent this. You just need to be diligent and observant and always enlist help to catch anything you may miss.
The first thing you want to do is request an itemized bill when you are checking in. They are required by law to provide this. Be sure to specify that you want an itemized list brought to your bed each evening. If they neglect to do this or deny your request, demand to speak with a Patient Advocate. They are there for you, and their job is to protect your rights. (Hospitals don’t like it, but think about it, who wants someone looking over their shoulder?) If you’re being truthful it should be NO BIG DEAL…RIGHT?
Secondly, ask if you will be charged for your final days visit. Hospitals charge a full day’s visit no matter what time you are admitted, and in return, they are not supposed to charge for the final day. But, unless you check your bill you will not know until either you are billed, or the insurance company declines to pay, and then you have to fight with them. Be sure to ask for a specific check out time also. Before the final day arrives let the doctor know that you want to be discharged by the check-out time. If he will not be on call inform him/her that either you want to be discharged the day before when he/she is on call, or, you want to see another doctor. If you still are not accommodated, let your Patient Advocate know that you will refuse to be billed because it is the doctor’s fault that you could not be discharged by the specified time.
The third thing you need to do is double check your itemized list and verify every item on it. If something isn’t clear ask a nurse for a specific description. Make sure you’re not billed for two doctor visits when you only saw a physician once. Verify that any non-essential item isn’t actually included in your room and board. Check operating room times against your charge for the anesthesiologist. Operating rooms are charged by the minute so if the charges are padded even a little it can be a substantial amount. And be sure to verify what exactly is included in operating room costs.
Finally, make sure that you have someone whom you can trust help keep track of all of the costs. Or, if you prefer have them take care of it for you. However, if any problems do arise that you feel are not adequately resolved there are people who will work on your behalf to resolve any issues. Generally speaking, these Patient Advocates will provide their services for a percentage of any savings they facilitate (NO savings, NO fees) or they will work for a flat rate. (Easy to budget for)
So, the question I get a lot. Advocate Aaron why do I need to pay a Patient Advocate? Can’t I just do it myself? The answer is simple. YES, you can do it yourself. If you get a DWI, you can also represent yourself. It is NOT recommended but you can. I only listed a few tips and tricks, the list is LONG.
I do think it is DUMB, UNFAIR, and RIDICULIOUS that you have to hire a Patient Advocate. The system should not be this messed up. The fact is the system is BAD and you DO need the help of a Patient Advocate.
Fighting for the uninsured and underinsured pregnant mom and their unborn babies,
