PHA Case Study – Unreasonable balance for a surgery bill

June 24, 2011

Situation 

Sharon had emergency surgery at an in-network facility, but was left with a large out-of-network balance on her bill because the on-call surgeon who performed the procedure was not in her plan’s network. Although the claim was already paid by her insurance company at the highest plan benefit level (90 percent of allowable). Sharon was still left with a $4,230 balance. Her Personal Health Advocate negotiated with the doctor to lower her payment to $2,000 and saved Sharon $2,230.

What The Healthcare Survival Guide Says

Step up and negotiate with your doctor or hospital to get a discount on your claims – 61 percent of patients who asked for a discount form their doctors got one (pg. 36). In some cases, hospitals offer a significant dollar or percentage discount if you pay cash (pg. 43). Keep track of the hospital care you receive; make a list of all your procedures, tests, medications and supplies. This will help you when you need to review your bills later. Double-check and question every charge. Overcharges such as being charged for the wrong number of days in the hospital are common (pg. 43).

For more in-depth advice on this topic, check out our blog post on negotiating with your doctor.

If you would like a free copy of The Healthcare Survival Guide: Cost-Saving Options for the Suddenly Unemployed and Anyone Else Who Wants to Save Money, you can download it at www.healthcaresurvivalguide.com.

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The Challenge of Obesity – Workplace Strategies

June 17, 2011

In addition to playing a role in the development of heart disease, diabetes, and other chronic conditions, the toll obesity takes often extends to employers, costing ~$13 billion in medical costs and lost productivity each year. Factors are well documented – imbalanced diets, a lack of exercise, and stress – all contribute to one of the most common health threats in America. Recent studies also suggest that sedentary jobs, where little to no movement is required, are to blame as well. (Story here.)

While the legitimacy of latter has been debated, it would only benefit you and your employees to implement carefully planned wellness strategies. In encouraging a healthier lifestyle, wellness programs can help to reduce disability, absenteeism & lost productivity. It is also obvious, but important, to note that these programs should be aimed at all employees – singling out overweight workers can be discriminatory and stigmatizing. However, the program should address the aforementioned factors that contribute to obesity – diet, physical activity, and stress.

Brought to you by Health Advocate, here is a short-version checklist for workplace strategies to take on the challenge of obesity.

Build a Wellness Team – Enlist employees to participate from each level of your organization. These individuals can serve as ambassadors to the program and increase employee buy-in.

Tailor Activities to Needs – Learn about what lifestyle changes employees need to make and gauge enthusiasm. Which programs would be the most interesting to your employees?

Set Realistic Goals – Emphasis should be placed more on participation than weight loss. However, 10% weight loss is considered to be a significant lifestyle change.

Develop a “Culture of Health” – Provide a variety of options to appeal to the most employees possible. Provide healthier options in the cafeteria and vending machines. Provide de-stressing activities as options, such as Yoga classes after work.

Partner up with the Community – Monitor community wellness events and make employees aware of them. Look for local initiatives, as government and public agencies offer wellness toolkits and grants.

Communicate Effectively – Encourage health through all available mediums – intranet, posters, newsletters, etc. Emphasize the value of health.

Reward Employees – Be creative! Use t-shirts, moderate cash awards, public praise, paid days off, etc. as rewards.

Celebrate Group Success – Celebrate with congratulatory announcements or with healthy-food parties.

Click here to check out our full checklist and many of our other whitepapers on how to manage costs by promoting a mentally and physically healthy work environment for employees.

To stay up-to-date on health news, wellness tips, and cost-saving healthcare advice, you can follow us @HealthSurvival and ”like” our Facebook page here.


PHA Case Study – Contending with Billing Errors During Recovery

June 17, 2011

Situation:

Patricia experienced a “bombardment” of incorrect bills related to the testing and hospital stays she underwent resulting from a brain tumor. Her Personal Health Advocate addressed the billing errors and also helped her find facilities for further testing and treatment covered by her health insurance plan. When she had a subsequent seizure and fractured her forehead in a fall, she was again bombarded with incorrect billing errors. The same Personal Health Advocate was able to help Patricia resubmit the appropriate paperwork and to have the bills corrected for payment. After the situation was settled, Patricia said, “On top of my brain tumor, I was faced with a bombardment of billing errors. They handled the paperwork with compassion and persistence. Thank you, thank you!”

What The Healthcare Survival Guide Says:

Keep a close watch on your medical bills. Compare them against the Explanation of Benefits statement received from your insurance company (pg. 41). To avoid other errors involving your care—such as mix-ups in diagnoses and medications – put together your own personal health record to record your medical history, past procedures, diagnoses, medications, allergies, etc. (pg. 53). It’s just one way, along with free or low-cost prevention measures like regular screenings (pgs. 54-55), to take charge of your health and reduce doctor visits and medications.

If you would like a free copy of The Healthcare Survival Guide: Cost-Saving Options for the Suddenly Unemployed and Anyone Else Who Wants to Save Money, you can download it at www.healthcaresurvivalguide.com.


PHA Case Study – Life-saving drug not covered

June 3, 2011

Situation:

Frank, a diabetic, had a costly mix-up in his insulin prescription. He expected the prescription to be the newer, penbased prefilled cartridge injection system, on which his physician instructed him during his office visit. However, the physician had not specified cartridges and the pharmacy benefit management service (PBM) sent Frank traditional, more costly insulin vials, which he unsuccessfully tried to exchange. The Personal Health Advocate provided documentation from the patient’s physician that he wanted pre-filled cartridges and the PBM agreed to the exchange, saving both Frank and his self-funded employer money.

 

What The Healthcare Survival Guide says:

It’s possible never to pay full price for your medications. Whenever possible, ask your doctor if you can substitute your brand-name medications for generics, which generally cost 20 to 80 percent less than their name-brand counterparts (pg. 47). Look for discounts—or free offers—for medications. Pharmaceutical companies offer a free trial of your medications through their websites (pg. 49).

If you would like a free copy of The Healthcare Survival Guide: Cost-Saving Options for the Suddenly Unemployed and Anyone Else Who Wants to Save Money, you can download it at www.healthcaresurvivalguide.com.