A few healthcare tips…

As someone who works for a hospital, in a Department that works closely with insurance contract interpretion, I’ve seen a lot of behind the scenes sort of things that a lot of people don’t necessarily think about when thinking about their hospital and doctor bills – things that might be costing them a lot but that they are not aware of, costs both in healthcare being provided to them as well as monetary costs…

Here’s a few tips related to healthcare that you might want to keep in mind in the future when dealing with your insurance company, hospital, doctor, or any healthcare provider. I’ll probably post more tips in future postings as I think of new tidbits. I’ll try to keep this as specific as I can so that it’s useful information for the general public but as unspecific as I can so that I don’t get in trouble for HIPPA violations or get in trouble with my boss if anyone I work with ever stumbles across this in the future.

Reciepts…
Always ask for a receipt any time you pay a bill. Sometimes clerical errors can cause bills to continue to be sent to patients by a hospital after the bill is sent. Other times, it’s possible that the bills are being computer generated by a system that is automated, and it’s impossible to turn the system off if a bill comes in… In many cases, at some healthcare facilities, hospital bills DO get sent to patients after the bills are already paid, and in some cases, those bills will have a date on the top of them that indicates that they were produced AFTER the payment for the bill has already been paid by the patient. This usually happens because of the fact that many hospitals, doctor offices, and other healthcare providers outsource some or all of their billing, and/or rely on billing systems that are not able to always be 100% up-to-date. In some, rare cases, this could be considered fraud because the bills are being created after the claim in question is already paid, making it highly confusing to patients, who sometimes send in payments any time they receive a bill, resulting in overpayments.

Overpayments… and Small Dollar Writeoffs…

Many healthcare facilities, and some insurance companies as well, typically write off small dollar debits and credits below a certain amount. For instance some hospitals might write off debits and credits below a fifteen dollar amount, and some physician offices may write off debits or credits with values around five or ten dollars. The actual amount varies from place to place, and office to office. What is important to know about this is that this means that they are likely going to write off a certain amount of money up to a certain dollar amount if it is either OVER or underpaid. For underpayments, this can work to your benefit since it might mean that you are getting away with not paying your copay, etc.

However, As mentioned in the above paragraph on Receipts, that might mean that your overpayment on bills that you’ve already paid are being written off and you’ll never be refunded for the amount you overpaid on your bill if it’s an overpayment amount under the threshold that the facility in question is using to determine writeoffs. You would think that it would be unethical for healthcare facilities to keep your overpaid money, but they don’t think twice about it because they have deemed the amount below that threshold, whatever amount it’s set at, to be not worth their time since it’ll cost them more in paying their staff to refund you the money than the actual refund itself is worth. This can really add up over time, since some people may put off going to the doctor for many months, and then go and see several doctors in clinics in a hosptial all on one day – resulting in multiple bills for the same day…

For example… If a hospital has a 15.00 small dollar write off, and physicians at the same facility have a 5.00 writeoff policy that is similar… 15.00 overpayment could be being thrown away in a write off for one bill, and another 5 for the physician bill that’s for the same service… for a total write off of 20.00 overpayment for one clinics for one day… maybe one for diabetes, one for an eye exam, one for a follow up on something else, and a couple of others for various other problems… Lets imagine what could happen if you saw 5 clinics on the same day, and got an x-ray or mri too, both of which could result in additional bills… That could be 7 or more hospital clinic bills, and 7 or more physicial bills since the physicians and hospital send out different bills… You could have possibly overpaid 20×7 = $140.00 in total for just that one day… and never have a chance of getting it back since they consider it written off as a small dollar amount that they don’t want to mess with… Imagine how much money you could be loosing in something like this if you have ongoing problems such as chemo treatments, diabetes, or any other numerous health related issues that require ongoing visits?…

Make sure to ask what the small dollar write off policies at the facilities you deal with are. Also, be sure to always ask as many questions as you can think of related to your bill so that you know what is going on with your money.

Applying Overpayments…

Similar to the issues mentioned above, some facilities tend to move money around on various bills that a patient has where they see fit. In other words, if you overpay a bill one month, and you incur another bill the next month, some facilities will apply the payment up to the amount owed, move the overpayment and apply that overpayment amount to the next bill that still has a balance, resulting in a very messy accounting of where the money you paid was actually applied, and also making it very confusing to know if you have overpaid anything or still owe money on something. This typically happens if you pay a copay or coinsurnace payment to a healthcare provider at the time that the service was provided, and then later, after your insurance is billed, it’s discovered that the insurance paid your bill in full, and there was no actual balance you should have paid in the first place, or the insurance has left you with a copay, deductible, or coinsurance amount that is smaller than what you paid at the time of service. Make sure you know your benefits, and are kept updated with changes, and know exactly how much to pay when, if possible.

Discounts

Many healcare providers and insurance companies have negotiated contracts between one another so that the insurance company can pay a smaller amount than 100% of the charges billed by the healthcare facility, and the payment with that discount makes the payment considered to be “paid in full” by the healthcare facility. These managed care contracts can be very confusing, and often can be interpreted in a number of different ways by a number of different parties, depending on how the contracts themselves are worded. Many of these contracts also have new amendments, negotiations, etc made to them yearly, or on some sort of regular basis. Make sure to check all explanation of benefits that your insurance company sends you to make sure that you only paid the amount that you should have to the healcare provider. If you paid the amount that should have been discounted, request your money back.

Some facilities will work with uninsured people, or people that have out-of-network benefits at a particular facility that they go to (out of state provider that specializes in something that a place more local cannot handle, etc.). Similarly, some facilities are willing to negotiate with under-insured people, such as Amish communities, Church groups, people who have no health insurance that are willing to pay a certain percent of the bill immediately, etc. Make sure to ask as many questions as you can think of to both your insurance company and healthcare provider to make sure you are not overpaying on something that should have been discounted.

Medicare… and other Governement Programs can be very odd sometimes…

Did you know that Medicare pays a flat Diagnosis Related Grouper (DRG) rate on inpatient claims? They also pay something called an outlier in addition to that if the amount billed is high enough and falls in to certain conditions. What is very important to understand about this is that sometimes, the flat DRG payment rate is MORE than the amount that some healthcare providers charge. In other words, if a DRG rate is something like $1500.00, and the hospital is only charging $1200.00 for the bill, Medicare is paying the hospital $1500.00, and this is considered to be legal since Medicare paid the DRG rate. What is even more odd about this sort of thing is that even though the hospital is getting paid more than it’s billing, they can still legally hit you up for even more money in addition to this because you still legally owe your copay or deductible amount… In other words the hospital is getting paid more than it’s charging and you are still on the hook for more money than that. No wonder the folks in Washington are trying to reform Healthcare. Tricare (the insurance for our armed service men, and retirees) is set up very similar to Medicare. In addition some insurance companies use Medicare as a bases for establishing the amounts they pay… so in the past some commercial insurance companies have been known to pay hospitals more than the hospital charged for certain services, due to the fact that the insurance(s) in question were paying based on flat DRG rates, in contracts that did not have a “lesser of DRG Rate or total billed charges” clause in it – and patients still were getting billed copays in addition to this payment over the total billed charge amount… Ask as questions to both your insurance company and healthcare provider(s). Things can and are confusing sometimes…

Scanning money…

It is illegal for healthcare facilities, insurances, or anyone else to scan paper money at 100% of the original size of the money in question. Doing so is considered by the United States Government to be counterfitting. In the past, some healthcare providers have scanned dollar bills as proof of payment for some low dollar copays. If you ever see anyone scanning money, ask them why they are doing that, where they are saving it, and at what size they are saving it or printing it. Some newer software, such as Adobe Photoshop, will actually try to not save scanned money. It is legal to scan money, so long as certain rules are followed, so Adobe actually is going a few steps too far in completely stopping the scanning of money. http://www.ustreas.gov/usss/money_illustrations.shtml

more posts will likely come in the future about healthcare…

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