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.


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: Finding Senior Care

June 10, 2011

“You’ve given me peace of mind”

Karen needed assistance finding senior care for her mother. Her mother refused assistance outside of the home. Health Advocate worked with the local Office of Aging to locate weekly in-home care and a supplier of an emergency call-button device worn around the neck for immediately notifying police and other emergency personnel.


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.

 


PHA Case Study: Underinsured Patient Facing Foreclosure

May 13, 2011

Situation:

Edward, a part-time worker, had insurance coverage but not enough to cover several large hospital bills. Edward’s Personal Health Advocate informed him about “hardship/charity” assistance available through the hospital and helped him fill out the paperwork. As a result of this assistance, his inpatient hospital bills were cancelled. His PHA also negotiated with his physician to reduce Edward’s medical bills by 30 percent and worked with his insurance company to successfully reprocess and pay his past bills. Edward stated that without the PHA’s help, he faced bankruptcy and losing his home.

What The Healthcare Survival Guide says:

No matter what your income or health status, there are free or low-cost government and private options available. One example: free clinics for basic check-ups and screenings (pg. 17). Healthy individuals or those with a job on the horizon might consider a short-term mini-medical/limited benefit plan (pg. 31). The take-away: comparison-shop for what you need and read the fine print carefully. “Affordable” can mean exclusion of hospitalization, leaving you with big bills in a crisis. Look for drug coverage, limitations of doctor visits and other missing parts (pg. 26).

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.