Thursday, November 13, 2014

Healthcare: Patient Advocacy on your side


www.advimed.us    November 11, 2014  Issue 62
Patient Advocacy: Healthcare on your side

    a weekly blog by Martine Brousse, 
Healthcare Specialist, Patient Advocate, Certified Mediator
Founder, PRES.  AdviMed


Save on medical costs: Alternative Options* 

As I negotiate down expensive facility bills for my clients, or fight insurance companies for higher reimbursements, I am often struck by the number of patients, who thought the ER or the specialist's office were their only choices. Minor episodes end up costing thousands of dollars, when more affordable options were available.
Here are some of them:

Please note this is given for informative purposes only, does not intend to provide or constitute medical care or advise. It neither endorses nor promotes any mentioned service or provider.

ALWAYS call 911 or go the Emergency Room if you are having a life-threatening emergency or if your health may be at serious risk by delaying care.

1. Urgent Care Centers

Staffed by MDs, they treat less severe emergencies that require immediate attention. Services include sutures, prescribing medications, chronic condition management, health evaluations, imaging, stabilization until your next doctor appointment and more.
Urgent care centers are found in many cities and neighborhoods. Appointments are not necessary.

2. Retail Health Clinics

Addressing minor concerns such as allergic reactions, minor infections, wound care and skin conditions, they are staffed with nurse practitioners licensed to prescribe medications and perform simple medical procedures. This is a good alternative to a doctor's visit for general and school health exams or for vaccinations.
Located in drugstore chains (i.e. CVS) or retail stores (i.e. Wal-Mart), they contract with most major insurers. Their services are fairly priced.

3. Nurse helpline

This free service, staffed by nurses 24/7, from your insurance can save you the cost of a doctor's visit. Find the number on your card or on the website.
Call to determine if you need to go to the ER, to find the nearest "in network" urgent care, to ask what remedy is best for minor symptoms, to treat an illness or to get first aid steps that do not require urgent care. These nurses can provide answers when the office is closed, help coordinate medical care if you are away from home, or order urgent prescription refills when the doctor is unavailable.

4.  Free or low cost clinics


Offering a variety of services, they should not be your first choice in case of an emergency. Administered by the County, privately run or belonging to teaching universities and hospitals (services are rendered by students under the supervision of fully-experienced doctors), waits can be long but prices worth a look.
Some specialize in a specific illness (HIV/AIDS clinics) or services (women's health clinics). Exams, prescriptions, tests and more are provided at significant savings.

5. Labs

Depending on the test, you may need to consult your Dr first. Many common tests can be obtained without a prescription, or at a lower cash cost than in the office, directly from these labs:
·           https://www.directlabs.com/

6. Chiropractors

If you have a minor sport injury or joint pain, or want to avoid surgery, consulting a chiropractor is a less costly option than an orthopedic MD. Specializing in bones, muscles and joints, they use more conservative, less drastic treatment methods (spinal manipulations, physical therapy, medical massages) to get you back in shape. They can order scans and limited labs. Expect to pay $ 50.00 to $ 80.00 per visit (including all modalities). This is often a covered insurance benefit.

7. Pharmacists

Ask the pharmacist at your local drugstore or pharmacy for a recommendation on what over the counter remedy is best for minor ailments, to check on possible negative interaction with current prescriptions, or advise on a minor allergic reaction.  Local and chain pharmacies also offer low cost flu shots, and other vaccinations.

8. Online  

An increase in the number of online MD visits has been observed, and is likely to continue this upward trend. Sites such as www.memd.me, www.interactivemd.com or the-online-doctor.com propose virtual encounters for set prices, and at convenient times for patients.

In Conclusion:

Remember to ask any healthcare provider or clinic you may consult if they are part of your insurance network. Choosing one who is contracted with your insurer will significantly lower your liability. You may need to send the bill directly to your insurer; getting a "superbill" (specialized medical bill) is essential. If you are self-pay, this receipt or statement will be useful come tax season.

Never jeopardize your health by denying yourself access to urgent or necessary medical care whenever necessary. Though more limited after the facts, solutions can still be found to help lower high medical bills.

* Previously seen on NerdWallet

©  [2014] AdviMed.
©  [2014] 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


Quote of the week

"Quiet people have the loudest minds" S. Hawking


AdviMed        (424) 999 4705 or (877) 658 9446       fax (424) 226 1330
                                www.advimed.us            contact@advimed.us

Monday, October 27, 2014

Patient Advocacy: Healthcare on the Side


www.advimed.us    October 28, 2014  Issue 61
Patient Advocacy: Healthcare on your side

    a weekly blog by Martine Brousse, 
Healthcare Specialist, Patient Advocate, Certified Mediator
Founder, PRES.  AdviMed


  Billing Disputes: avoid costly mistakes*

It has become all too commonplace to receive overinflated, incomprehensible, erroneous, unexplained medical bills, sometimes from mystery providers. After all, if all bills were correct and justified, I, and other billing advocates would be checking job posts.

The usual reactions are discarding the statement as a mistake, placing it on the to-do list (or is it the never-to-do pile?), waiting for a miracle, appealing the insurance, getting upset at the phone representative or asking nicely for an explanation or a discount which may never come.

Before you give up, or worse before your account goes to collection, consider these steps.

1. Use your right to question

Medical providers are considered, under state and federal consumer laws, in the same category as other purveyors of services. It is your right to ask for justification and explanation of a statement, or proof services were rendered.

Just as you inquire about a charge on your credit card statement, or an item on the store receipt, so can you for medical bills.

2. Contest in writing

You should contest a balance or request clarification in writing. Address your complaint to the office manager, billing manager or physician. Knowing the name and contact information for the person in charge often translates into prompter responses and better outcomes.

Confirm with the billing department, preferably in writing, that your account is on hold and will not be reported to a collection agency until this grievance has been addressed, as per the Fair Debt Collection Practices Act.

Specific insurance appeal forms are usually required. These can be found on the website. 

Sending your documents certified mail, or via any way that can confirm its receipt, is best.


3. Share the news

If your grievance is with your insurance company, you must inform the interested parties of any delay in payment on your part. You may ask a representative to contact the billing department and request for your account to be placed on hold, as it is not done automatically. This step should be in addition to your written notice.

If a medical provider uses an outside billing service, both offices must be contacted. Communication between both parties is all too often infrequent. Avoid costly misunderstandings by mailing two letters.

4. Keep the account current

While the insurance works hard at finding ways to deny your appeal, or when waiting for the facility to mail you an itemized bill or review the charges, you must make small monthly payments to keep your account current. Sending a small monthly remittance shows good faith, confirms your acknowledgement of the outstanding balance, and buys you time.

Remember that it is much harder to get a bill reduced once it is in collection. Unless you have confirmation that your account has been placed on hold (and the date it expires), the countdown is on.

5. Give updates

Billing people love hearing from patients with unpaid balances (trust me, I know!). It reassures them that you are neither a deadbeat nor trying to pull a fast one. Regular updates will prompt more understanding and patience on their part.

6. Keep good notes

From the first call on, keep a log of calls made and received, the content of the discussion and subsequent results. Keep a copy of every written correspondence as well. Some providers are more eager to use the collection tool, and this evidence will work in your favor. Insurers keep notes one every call or letter you make, so should you.

This documentation may also come in handy if you are forced to go up the corporate ladder, need to escalate the issue or eventually file a grievance with a government agency.

In conclusion:

Delaying may end up costing you dearly. Other bills may wait without harmful consequences; medical statements should preferably be looked at promptly.

Timeliness may also become an issue if you decide to file an appeal with your insurance, as a deadline of 90 days is usually the norm. Check the website or your policy for more details.

Nobody likes to wait to get paid when the job is done, and your doctor or hospital are no different. Prompt, precise and courteous communications will be appreciated.

* Previously seen on NerdWallet

©  [2014] AdviMed.
©  [2014] 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


Quote of the week

"If you want to go fast, go alone. If you want to go far, go together" African proverb


AdviMed        (424) 999 4705 or (877) 658 9446       fax (424) 226 1330
                                www.advimed.us            contact@advimed.us