Hello, Frugs! Today, I have a Q&A with Cindy Holtzman, who is a medical billing advocate. After seeing Cindy on CNN, I wrote about her work, stopping shady health care waste. I just had to bring her to TheFrugalista.com to share her wisdom directly with us. We all know health care is not cheap. The way that she points out wasteful spending and looks out for the the little woman is just fabulous!
A medical billing advocate assists consumers with the huge amount of paperwork they receive after an illness or accident. They usually consist of licensed insurance agents, nurses, physicians, certified coding experts, medical billing specialists and more. The best advocate for you is the one with expertise with your particular issue; it does not matter what state they are located in! Go to the Medical Billing Advocates of America website for information: billadvocates.com.
2) What exactly do you do?
Many times the patient is too ill and cannot review the bills and insurance papers they are constantly receiving. Medical bills and insurance claims need to filed in a timely manner or they may go to collections. The patient really needs to concentrate on getting better instead of trying to understand the bills, which can cause a setback in their recovery. A medical bill advocate can take that load off their minds and organize all the papers, find what claims need to be filed (or re-filed), look for billing errors as well as buy some extra time for the patient to pay them. I’ve had a cancer patient say: “The surgery, chemo, radiation and loss of hair was not as bad as dealing with all the medical bills and insurance forms.” It is sad that it has to come to this point since billing errors occur more now than in the past (more claims and fewer personnel processing them). Advocates are used to receiving a batch of bills in a box and are experts in deciphering them and fighting any denied claims.
If the patient is uninsured, an advocate can go line by line on their itemized bill to find mistakes and have them removed and assist the patient with either financial aid/charity care, if the patient qualifies. Many consumers are unaware that there is assistance from a financial aid department in the hospital and that they may qualify for aid. If they cannot qualify for financial assistance, advocates try to negotiate with the self-pay department of the hospital. Most hospitals are “not for profit” (try to use them if possible) and they may offer anywhere from 25-60% off the bill. They do usually require the bill to be paid in full when it’s discounted. You also have nothing to lose by asking for a discount if you have a HSA/High Deductible insurance plan, they may work with you so that they get paid sooner.
3) What are some of the most outlandish expenses that patients have been charged?
-Hospital charged $1,004.50 for (1) toothbrush-A car accident patient-not allowed to use due to facial injuries.
-Emergency Room visit for dehydration billed for 41 I.V. Bags-only used one. Insurance paid entire amount, over $5,000 before we corrected the bill to $600.
-Circumcisions billed to twin baby girls
-One Tylenol for $140.00
-97 Pairs of gloves charged to a patient at $53.00 a pair, total cost $5,141.00
-Medicine cups for $10.00 each and “Oral Administrative Fee” of $6.25 for each pill a nurse gives you!
4) What should a patient do to make sure that he or she is being charged fairly?
Always request an itemized bill after coming home from any outpatient surgery or inpatient hospital stay. They normally will send you a one-page summary of charges clumped together, so you must ask for the detailed (itemized) bill. Otherwise you will never know if they charged you $1,004.50 for a toothbrush. Those items are usually listed on the one-page “summary” as “miscellaneous items” which can include many different services and supplies.
5) Are there any websites or books that consumers should read to help learn how to manage healthcare?
Many states have a web site that lists the costs of common procedures for all the hospitals in that particular state. A few excellent sites are:
Health Care Blue Book: www.healthcarebluebook.com , to go directly to their state by state listings of pricing comparison sites.
Georgia has a great site that is being updated currently:
Georgia Hospital Price Check http://www.gahospitalpricecheck.org/
This site can assist with medical and dental charges and much more money saving tips:
Fair Health Consumer http://fairhealthconsumer.org/
CNN’s Senior Medical Correspondent, Elizabeth Cohen, released a terrific book called “The Empowered Patient” which has many tips to save you money, get the correct diagnosis, appeal with your insurance company and still get the best medical care every time.
For those unable to qualify for health insurance due to pre-existing conditions, you now have help with the new Pre-Existing Condition Insurance Plan (www.PCIP.gov). You must be without insurance for 6 months and have a document showing you have been declined and you can enroll and have your pre-existing conditions covered-for a reasonable cost!
6) Why does the healthcare industry overcharge so much and why does it have so many errors?
I believe that some errors happen because there is too much paper and not enough electronic medical records being used. Also hospitals are all cutting down on their staff which can affect an increase in billing errors since there are more consumers needing medical care and less people processing all the paperwork.
There is no standardization of medical charges and reimbursements from insurance companies except with Medicare. Patients treated by their doctor, or in an outpatient surgery facility or an inpatient hospital stay have no idea of what any of it costs. You will get a bill and are expected to pay it all. You wouldn’t go to the grocery store, load up your cart and have no idea of what any of the items cost until you are at checkout. Even then you get an itemized bill of your purchases, you will never get an itemized bill from a hospital without requesting it, sometimes asking more than once. Don’t let them tell you they cannot give you a detailed description of your charges. Money is tight for all of us and you should only be paying for services received and at a “reasonable” price. Prior to any services, shop around if possible, and try to get the “Procedure Code” (called C.P.T. code-which consists of 5 digits) of what service you need and call around to several providers (in your network) and do your own price check. Also University hospitals may charge a little less.
7) Are there any specific questions that patients should ask their doctors? Insurance agency? Hospitals?
Always try to stay in network. If you need surgery, be sure the hospital and surgeon is in your network and also ask your insurer if you have those 2 providers in network, will they pay other providers like: Radiologists, Anesthesiologists, Pathologist as well as the Emergency Room doctor as in network as well even if they are not. (Some carriers do include other physicians and some don’t).
Be prepared to receive a separate Emergency Room Physician fee when you do to go the E.R. They usually are not included in the hospital bill and those doctors are not in any network most of the time. You can also negotiate for a discount with them.
When you purchase health insurance, the price is the same whether you are buying directly from the insurance company or with an insurance agent. It is crucial to have an agent that will be there to assist you in the future with any claim or premium billing problems. They receive commission, which pays them to help you, otherwise you may have to hire an Advocate. When purchasing individual insurance, I suggest asking your friends for a referral who they buy their insurance from. Excellent customer service is what I always give my clients and that is why I have the same members since 1991. I became an expert in this field because I believe great customer service is a key factor.
Cindy Holtzman has been a successful health insurance agent in Georgia since 1991 with years of experience appealing denied insurance claims. In 1998 she became the 5th member of the nationally known “Medical Billing Advocates of America,” which now has more than 60 expert advocates available nationwide. She’s been featured on CNN and in Smart Money Magazine, MORE Magazine, Black Enterprise Magazine and US News World Report.