Medical bills — some new developments
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.