Med­i­cal bills — some new de­vel­op­ments

The Reporter (Lansdale, PA) - - BUSINESS - Janet Col­li­ton

Years ago I re­mem­ber sit­ting with a rep­re­sen­ta­tive of a hos­pi­tal billing depart­ment try­ing to de­ter­mine the mean­ing of med­i­cal bills re­gard­ing a fam­ily mem­ber’s treat­ment. One as­pect that was es­pe­cially odd was that, for the same treat­ment, an infusion, the bill to us could be $200 or it could be $2,000. How could there be such a dif­fer­ence from one infusion to the next?

Af­ter wrestling with the billing state­ment and re­view­ing the de­tails, I fi­nally turned to the rep­re­sen­ta­tive and said in so many words “so am I cor­rect that the in­sur­ance com­pany de­cides what to pay and what­ever is left is left for us to han­dle?” Her an­swer, al­though I do not re­mem­ber the ex­act words, was along the lines of “that’s about it.” There were mi­nor dif­fer­ences. A blood test taken at one ap­point­ment was not taken at an­other. A TB test at one might not have been re­peated at an­other. It could have been “coded” dif­fer­ently from one visit to an­other or maybe the in­sur­ance cov­er­age changed in mov­ing into an­other year. How­ever, it was ba­si­cally the same pro­ce­dure.

Med­i­cal billing is still, to some ex­tent, a mys­tery to me al­though I work with fam­i­lies who have med­i­cal is­sues all the time and that in­cludes re­view­ing their ex­penses. I un­der­stand I am not alone. Since med­i­cal bills — in­clud­ing med­i­ca­tions, hos­pi­tal­iza­tions, physi­cians’ ap­point­ments, re­ha­bil­i­ta­tions, ther­a­pies and pro­ce­dures among other ex­penses are re­ported to be the No. 1 cause of bank­rupt­cies in Amer­ica, there re­ally needs to be some un­der­stand­able way to ex­plain dif­fer­ences and to as­sist peo­ple who are go­ing through prob­lems usu­ally not of their own mak­ing.

Two in­ter­est­ing re­cent de­vel­op­ments of note have come across my ta­ble, so to speak. One is the launch of a new ser­vice by Kaiser Health News that can be ac­cessed at https:// khn.org/send-us-your-med­i­cal-bills/. The other is a cam­paign “NBC Re­sponds: Eras­ing Med­i­cal Debt” launched in Philadel--

phia by our lo­cal Chan­nel 10 news but ap­par­ently na­tion­wide by NBC lo­cal sta­tions.

Kaiser Health News (which notes that it is not part of Kaiser Per­ma­nente which is a sep­a­rate med­i­cal provider) takes the ap­proach of a “Kaiser Health News’ Bill-of-the-Month Club.” It has promised to pub­lish, from the in­for­ma­tion pro­vided them by con­sumers a de­scrip­tion of an ou­tra­geous bill and the back­ground that led up to it.

NBC is tak­ing a very “hands on” ap­proach by giv­ing view­ers the op­por­tu­nity to con­trib­ute to an un­re­lated non-profit or­ga­ni­za­tion es­tab­lished only to re­duce med­i­cal debt. Re­gard­ing this or­ga­ni­za­tion and this cam­paign, this au­thor, by the way, notes I have no di­rect in­for­ma­tion re­gard­ing the or­ga­ni­za­tion or how this pro­gram works other than what is pub­lished on-line. There­fore, read­ers who are in­ter­ested ei­ther in ben­e­fit­ing or con­tribut­ing are in­vited to check it out them­selves en­tirely on their own with no com­ment from me. How­ever, the con­cept which is a char­i­ta­ble or­ga­ni­za­tion to as­sist in eras­ing med­i­cal debt, I have to ad­mit is in­trigu­ing.

First, as to Kaiser Health News, the ser­vice has had two “bills of the month” so far. The first was a $17,850 bill for a Texas stu­dent’s urine test. The ti­tle is “Pain Hits Af­ter Surgery When a Doc­tor’s Daugh­ter Is Stunned by $17,850 Urine Test,” https://khn.org/ news. El­iz­a­beth Morino, the ar­ti­cle re­ports, suf­fered from ex­treme back pain and was di­ag­nosed as need­ing surgery to re­move a disc. Later, she was asked to pro­vide a urine sam­ple. The lab tested for mul­ti­ple con­di­tions and drugs un­known to the pa­tient. The ar­ti­cle noted that, with opiod over­dose deaths ris­ing in the U.S., urine drug test­ing has ex­ploded.

El­iz­a­beth’s in­surer re­fused to pay any of the bill in­di­cat­ing the lab was out of net­work and not cov­ered. If the in­surer, Blue Cross and Blue Shield of Texas, had con­sid­ered it cov­ered the bill would have been $100.92. Her fa­ther paid $5,000 to set­tle the claim. The les­son to me was to make cer­tain to use an in-net­work provider. How­ever, that is not easy. Many times the pa­tient has no idea whether or­ga­ni­za­tions be­ing used are in­net­work.

The bill of the month for March was pre­scrip­tion of a top­i­cal med­i­ca­tion for toe­nail fun­gus that re­sulted in a $1,500 pre­scrip­tion bill.

To find out more about NBC10 Erase Med­i­cal Debt, check out www. nbcphiladel­phia.com and look for NBC 10 Helps To Erase Med­i­cal Debt.

Janet Col­li­ton, Esq. is a Cer­ti­fied El­der Law At­tor­ney and lim­its her prac­tice, to el­der law, re­tire­ment and estate plan­ning, Med­i­caid, Medi­care, life care, and spe­cial needs at 790 E. Mar­ket St., Suite 250, West Ch­ester, Pa., 19382, 610-436-6674, col­li­ton@ col­li­ton­law.com. She is a mem­ber of the Na­tional Academy of El­der Law At­tor­neys and, with Jef­frey Jones, CSA, co­founder of Life Tran­si­tion Ser­vices LLC, a ser­vice for fam­i­lies with long-term care needs.

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