Emergency Room Patients Routinely Overcharged—Greatest Effect on the Uninsured

Emergency Room Patients Routinely Overcharged—Greatest Effect on the Uninsured

A Johns Hopkins study of billing records for more than 12,000 emergency room doctors across the country showed a wide variance in prices. On average, adult patients are charged 340% more than the Medicare rate (amounts Medicare pays each facility for like services, plus the deductible and co-insurance). These rates are lower than in-network health insurance rates—which generally are contracted at 1.6-2.0 times the Medicare allowable rate. The study covered a wide variety of services from CT scans to simple stiches for a small cut.

A very distressing finding of the study was that most hospitals charged minorities and patients that are uninsured substantially higher rates, than commercial insurance and Medicare allowable rates. These huge disparities in emergency room prices poses a serious problem to millions in the U.S.

Surveys of both emergency room physicians and general internal medicine physicians’ charges were analyzed. The resulting service bills’ markup ratios were staggering: Emergency Room doctors had an average markup of 4.4 times Medicare allowable-while the Internists’ charges averaged 2.1 times Medicare allowable; less than half. However, due to a ubiquitous lack of patient-friendly regulation and unfettered and unrestrained greed—some emergency room physicians charged between 1.0-12.6 times what Medicare allows. ($1000-$12,600). This “gap” cannot be attributed solely to the quality of hospital or doctor performance (given the variations within each institution).Besides, who is thinking of that in the ambulance? This disparity cannot be explained by equipment used(a CT machine is a CT machine).Thus, presumably more so than any other hospital department, emergency rooms were guilty for charging up to 12 times more than what Medicare paid for the same services. There is a clear bias, however, toward for-profit hospitals charging more than non-profits.

The population affected most greatly by these practices are more likely to be located in the Southeastern and Midwestern U.S., serving a population of African-Americans and Hispanics that are uninsured. These uninsured patients are often charged FULL CHARGEMASTER rates. It gets worse. Once receiving a bill for services calculated at 12 times Medicare allowable, the billing departments are often aggressive about collecting amounts 8-12 times higher than from most other patients.

Often, the uninsured will receive no discount on their bill. (Several hospitals first seek to have the patient apply for financial assistance—and, if qualified, may receive discounts through that route). Some hospitals are terribly rigid, setting up roadblocks to negotiating reductions to this medical debt. Billing personnel will not even identify their last names. Managers are difficult to identify-generally not listed on the website. A more transparent, interactive approach could go a long way to addressing this problem. Some have a very “quick trigger” as to when to send a patient to collections. The effect that medical debt-particularly debt inflated to 10.0 times the pricing at a comparable facility can have negative life-changing repercussions. The uninsured bear the brunt of such practices –although certainly not alone. Forty-three (43%) percent of the population has medical debt listed on their credit report. Medical debt is the largest driver of individual bankruptcies in the U.S.

 In 2003, the eighty (80) plus hospitals owned by Tenet was the subject of a lawsuit involving this precise topic—that was characterized as “Price-Gouging the Uninsured. To its credit, it softened its policy toward collections against those unable to pay; including discontinuing placing liens on the homes of such patients. Currently, it still offers automatic discounts for the uninsured in certain situations—with payment plans on discounted amounts (although its preference is to do so prior to the patient’s discharge).

The need for state and federal regulation to address hospital rates in order to protect patients becomes more pressing each day. If you have such an experience, write a letter to the hospital Administrator—copy its CEO and the state agency governing hospitals (despite that in some cases, it will not take jurisdiction of billing matters), call your congress person and senators(both state and Federal). Contact NPR and other news organizations. Silence will not result in change. Bringing this to the attention of those with decision-making authority might.

If you think you’ve been overcharged, or otherwise need help with your medical bills and health insurance matters– contact a Board Certified Patient Advocate at Human Health Advocates of Boca Raton, FL. WE ARE HERE TO HELP!

Biggest Flash Points In The Graham-Cassidy Health Care Bill

Biggest Flash Points In The Graham-Cassidy Health Care Bill

From www.npr.org: If Senate Republicans vote to repeal and replace the Affordable Care Act this week, it would affect the health care of pretty much every American.

Here’s a recap of four key flash points in the health overhaul debate with links to NPR coverage over the past six months, and our chart laying out how the Graham-Cassidy bill under consideration in the Senate addresses those issues compared with the Affordable Care Act.

Pre-existing conditions. One of the biggest issues in the repeal/replace debate has been coverage for pre-existing conditions, genetic risks and chronic illness. Before the Affordable Care Act, insurers could deny coverage to people with diseases like diabetes or charge them much higher premiums. The ACA requires insurers to cover pre-existing conditions without charging more. The GOP bills passed or proposed would give states the power to waive that requirement. People with disabilities or chronic diseases, people who have had cancer, and parents of children born with health problems like late-night host Jimmy Kimmel say that could make insurance unaffordable.

Medicaid. The federal/state insurance program provides health care for 20 percent of all Americans, including 40 percent of children, half of all births, 60 percent of nursing home expenses and 25 percent of mental health care. The Graham-Cassidy bill would transform the structure of Medicaid, giving states control over how they spend federal funds. The bill cuts Medicaid funding over time. States that expanded their Medicaid programs, including California and New York, would face the biggest cuts, while Texas and some states in the Deep South and West would fare better.

Essential Health Benefits. The Affordable Care Act requires that insurers cover 10 “essential health benefits,” including maternity care, mental health,Health Advocates hospitalization, prescription drugs, emergency care, and children’s health. The GOP proposals would let states opt out of those requirements, affecting insurance sold on the exchanges and employer-based coverage. But economists say that won’t lower health costs as much as the bills’ backers may hope, since the three biggest drivers of health costs are hospital care, doctor visits and prescription drugs — three things states may be most reluctant to cut.

Uncertainty And Market Instability. As far back as April, insurers were worried that they wouldn’t have enough time to set rates for 2018. That fear has only increased. Earlier this month, entrepreneurs said the lack of clarity is interfering with hiring. Enrollment on the federal exchanges opens Nov. 1, though the Trump administration has cut advertising for open enrollment by 90 percent. Some private insurers are stepping up to fill the gap.

The full article is available by clicking here: NPR

Who Wins, Who Loses With Senate Health Care Bill

Who Wins, Who Loses With Senate Health Care Bill

Would you like to have a clearer picture of the tremendous negative effects of the proposed  Republican Health Bill(“Better Care Reconciliation Act”)? Review the following chart and article from NPR for some clearly-presented information. There is nothing BETTER about this than the ACA! This provides LESS CARE than mandated by the ACA! This will cost patients MORE than under the ACA! This will cause more than 20,000,000 people to lose coverage! This is barbaric! Congress has no soul.

PLEASE—WRITE AND CALL YOUR Senators and tell them to VOTE NO!  It’s not too late.  It’s just plain wrong to take away insurance from tens of millions, reduce coverage, and raise costs—all so people that can afford great insurance can pay less taxes. Health care should be a right—available to all—regardless of economics or politics! SPEAK UP NOW! Later might be too late.

CLICK HERE for full NPR article.

This chart illustrates how the plans compare:

People under 26
AFFORDABLE CARE ACT (OBAMACARE)
HOUSE BILL: AMERICAN HEALTH CARE ACT
SENATE DRAFT: BETTER CARE RECONCILIATION ACT
Can get insurance through a parent’s plan or buy independently. Stays the same. Stays the same.
Adults under 65
AFFORDABLE CARE ACT (OBAMACARE)
HOUSE BILL: AMERICAN HEALTH CARE ACT
SENATE DRAFT: BETTER CARE RECONCILIATION ACT
Can buy insurance on health exchanges, with tax credits and subsidies if they meet income requirements up to 400 percent of poverty level. Cost of insurance is based on tobacco use and age, with the people nearing 65 paying no more than three times what the youngest pay. Premiums can’t cost more than 9.5 percent of income. Those with very low or no income qualify for Medicaid. Will see tax credits to pay premiums based on age, not income, and that max out at $4,000, much less than under the ACA. The oldest people under 65 can be charged five times more than the youngest, and maybe more depending on state rules. Medicaid cut after 2020. The CBO report says 22 million people would lose health insurance over the next 10 years, with people between 50-64 disproportionally impacted. The oldest people under 65 would pay five times more than younger people on the exchanges.Subsidies to help pay for insurance would be less and end at incomes of 350 percent of poverty level. Federal contributions to Medicaid start to decline in fiscal year 2020.
Low-income nursing home residents
AFFORDABLE CARE ACT (OBAMACARE)
HOUSE BILL: AMERICAN HEALTH CARE ACT
SENATE DRAFT: BETTER CARE RECONCILIATION ACT
Skilled nursing care covered by Medicare up to 100 days. Medicaid is available based on income. Skilled nursing care covered by Medicare up to 100 days. Medicaid services could be cut as states see federal funding decline. Skilled nursing care covered by Medicare up to 100 days per illness. Medicaid coverage for nursing home services could be cut as federal payments to states decline.
People with pre-existing medical conditions
AFFORDABLE CARE ACT (OBAMACARE)
HOUSE BILL: AMERICAN HEALTH CARE ACT
SENATE DRAFT: BETTER CARE RECONCILIATION ACT
Coverage cannot be denied or cost more. States can get permission to let insurers charge more for some pre-existing conditions and to exclude some people altogether. States would have access to federal money to help those with expensive policies or conditions. Insurance companies would be required to accept all applicants regardless of health status. But the draft bill lets states ask permission to reduce required coverage, also called “essential health benefits,” which would give insurers some discretion over what they offer in their plans. That could result in “substantial increases” in costs for people who want those services, according to the CBO. If a particular benefit is no longer classified as essential, insurers could impose annual and/or lifetime limits on what they spend on patients for that benefit. And caps on the annual out-of-pocket costs for patients would no longer apply.
People who go to Planned Parenthood
AFFORDABLE CARE ACT (OBAMACARE)
HOUSE BILL: AMERICAN HEALTH CARE ACT
SENATE DRAFT: BETTER CARE RECONCILIATION ACT
Federal programs reimburse for most Planned Parenthood services. A one-year block will be placed on federal reimbursementsfor care provided by Planned Parenthood. A one-year block will be placed on federal reimbursementsfor care provided by Planned Parenthood. The CBO estimates 15 percent of women would lose access to family planning care, increasing birth rates and Medicaid spending for childbirth and children’s insurance. But those increases would be offset by Planned Parenthood cuts.
People with disabilities
The majority of Medicaid dollars go to people with disabilities.
AFFORDABLE CARE ACT (OBAMACARE)
HOUSE BILL: AMERICAN HEALTH CARE ACT
SENATE DRAFT: BETTER CARE RECONCILIATION ACT
May qualify for Medicare and also Medicaid. Services covered by Medicaid could be cut as federal funding to states declines over time. Services covered by Medicaid could be cut as federal funding to states declines over time. The CBO report suggests that by 2026, Medicaid enrollment would fall by more than 15 million people.
People who use mental health services
AFFORDABLE CARE ACT (OBAMACARE)
HOUSE BILL: AMERICAN HEALTH CARE ACT
SENATE DRAFT: BETTER CARE RECONCILIATION ACT
Covered by all plans under essential health benefits. Could lose coverage in states that get waivers from covering essential health benefits. States could request waivers to opt out of requiring essential health benefits. If a state opted out of coverage for mental health care, the CBO says insurance that includes mental health care coverage could become “extremely expensive.”
Working poor on Medicaid
AFFORDABLE CARE ACT (OBAMACARE)
HOUSE BILL: AMERICAN HEALTH CARE ACT
SENATE DRAFT: BETTER CARE RECONCILIATION ACT
Thirty-one states and the District of Columbia offer expanded Medicaid coverage. Federal funding for Medicaid expansion phases out, potentially affecting millions of people who are currently enrolled under the expansion. Federal funding for Medicaid expansion phases out between 2021 and 2023. In addition, eight states would have a trigger clause — if the federal matching rate declines below the ACA-promised rates, the expansion goes away immediately in Arkansas, Illinois, Indiana, Michigan, Montana, New Hampshire, New Mexico, and Washington. Further reductions would start in 2025. In a separate provision, states could impose a work requirement on recipients. Most able-bodied adult Medicaid recipients already work.
The wealthy
AFFORDABLE CARE ACT (OBAMACARE)
HOUSE BILL: AMERICAN HEALTH CARE ACT
SENATE DRAFT: BETTER CARE RECONCILIATION ACT
Pay extra taxes to support ACA. The bill would repeal ACA taxes on corporations and cut taxes for the wealthy by about $592 billion. Similar to the House bill; would repeal ACA taxes on corporations and the wealthy that pay for insurance subsidies. That would add up to about $563 billion in tax cuts over 10 years, according to the CBO.
Navigating the Medical Billing Process

Navigating the Medical Billing Process

Kenneth Klein, manager of Human Health Advocates, was recently the featured guest on WLRN Public Radio’s popular Topical Currents show. There was an excellent discussion of many aspects of patient advocacy as it relates to medical billing and health insurers. Give a listen.

(3-7-2017) It’s a common assumption that if one has health insurance; the company routinely covers the bulk of medical charges.

Correct? The answer is only a “maybe.”

Today’s Topical Currents looks at the confusing aspects of navigating the medical billing process, with patient advocate Kenneth Klein, Founder/Manager of Human Health Advocates, LLC, in Boca Raton. He provides assistance to patients with medical bill and health insurance related concerns.

Click here to listen to the full interview.

www.humanhealthadvocates.com

CBS12 Investigates: Cash vs Insurance

CBS12 Investigates: Cash vs Insurance

There are times when it is less expensive to pay cash for medical procedures than submit claims having your doctor/medical provider seek payment from your health insurer.

Health Insurance AdvocateWEST PALM BEACH, Fla. (CBS12) — When you go to the doctor, do you ever think about not using your health insurance?
Some patients are now negotiating the price and paying in cash. They say cutting out insurance is like cutting out the middle man.
As a consumer, when you think about negotiating costs, you probably think about buying a car or a home – not negotiating with your doctor.
But, as we found out, paying out of your pocket instead of going through insurance could save you money.

PAID THE CASH PRICE
When James Tow needed to pay for a tonsillectomy, he knew it would be expensive. Instead of just handing over his insurance card and trusting that would be the best price, James asked the doctor’s office if they had a cash price. “If I go through insurance, I’m going to have to pay the insurance price,” said Tow. “Whereas if I do the cash price, I pay less.”

That’s right. For example, if he went through his insurance, the anesthesiologist would have charged $656. James’ insurance would only pay $136, leaving him with an out-of-pocket bill for $520. While just paying cash, the anesthesiologist would only charge $464. So, by paying cash and not going through his insurance, James saved $56.

PATIENT ADVOCATE
So why would the doctor’s price vary depending on whether or not a patient has insurance?
We took our question to patient advocate Kenneth Klein. He said one reason doctors charge more for insurance is that it costs them money to file the paperwork, and that can run as much as 20% more. “If they are presented with a situation where they can get cash up front and not do anything else, file any papers, that is great,” added Klein. Klein said there’s nothing in state law that requires you have to use your insurance. “In many situations, it may be disadvantageous to submit this through your insurance,” Klein explained. Although, paying cash isn’t a guarantee that you will always save money.
You will have to decide on a case by case basis. It can vary based on your level of insurance coverage, whether the provider is in or out-of-network and your deductible.

Klein said it pays to treat going to the doctor like any other consumer transaction, and ask, “How much is this going to cost?’ “You are not locked in, and one can always try to negotiate. The worst thing that can happen is the person on the other side says, ‘No’. You are no worse off than you were. In many cases, you may be surprised,” said Klein.

WHEN TO CONSIDER CASH
According to Klein, the best places to ask for a cash price are hospitals, imaging centers, sole practitioners, eye doctors, surgical centers and pharmacies.
James said he’s learned from this experience to always ask the doctor for both the cash price and the insurance price and to not assume using insurance is the financially prudent way to go.

“Just paying cash, it seems to me it’s far better,” said Tow. If you decide to negotiate a cash price, get it in writing with the full agreed upon price.
Also, ask for an itemized bill for your records. Klein suggests submitting that bill to your insurance. Some companies may apply it towards your deductible at a reduced rate.