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10 Ways to Avoid Medical Debt: By Maya JinwrightBY: Guest | Category: Health and Fitness | Post Date: 2009-11-24
Medical bills and health insurance are often tedious and difficult to understand. Healthcare reform is making its way through the Senate but healthcare costs are still rising. As a patient it is time to become your own patient advocate. Maya Jinwright of Washington, DC, a medical billing manager who has worked in hospitals and doctor's offices, haggles over fees for patients without insurance. Jinwright often negotiates with the hospital and physicians before patients begin treatment. She explains, -If a patient cannot afford to pay an insurance premium, they cannot afford to pay the uninsured treatment charges. Most providers will work with me.- In some cases the discount can be as large as 60 percent, which is in line with what a major insurance company would have paid. Use these ten tips to ensure you do not become a victim of medical debt. 1. Obtain health insurance Health insurance premiums are at an all time high. However, the amount that an elective surgery will cost out of pocket is much higher. -Patients often have no idea that medical expenses tend to be exorbitant,- says Tara Robertson, medical debt consultant at Full Cycle Medical Management a health care consultant firm. Insurance companies have the luxury of contract adjustments to reduce medical bills by as much as 70 percent. But, she says, the average uninsured patient does not get this discount. -It's just not something that most physicians or hospitals explain,- Robertson says. If your employer does not provide insurance or you are unable to afford the monthly premiums, you may be eligible for Medicaid. Generally seniors, disabled individuals, children and parent of dependent children are eligible for Medicaid if they have low incomes. Often patients with large medical bills can qualify for temporary Medicaid or medical bill assistance. 2. Choose the plan that is right for you There are several choices when it comes to health insurance; Indemnity, PPO, or HMO plan: With indemnity coverage, the beneficiary pays a portion of costs and the insurance company pays the rest. Most plans today are HMO (health maintenance organization) or PPO (preferred provider organization) managed care plans. With these plans, the beneficiary pays a co-payment for medical care visits and has an annual deductible for certain expenses. Be sure your preferred physicians are in the plan's network, or you might pay higher out of pocket expenses and co-payments. Beware of high-deductible plans. Beneficiaries carry a higher amount of financial risk in exchange for much lower monthly premiums. In short if you cannot afford to pay the deductible, this is probably not the right plan for you. To help choose a plan, calculate total monthly premiums for the year, plus total co-payments and out-of-pocket expenses for the family's health care visits and prescription medications. Then look at what one ER visit and one surgery (or whatever possibility might befall your family) would cost with each plan. Also consider the lifetime maximum -- a serious illness could exceed a $1 million or $2 million lifetime maximum. In addition, consider how often you see the doctor and if you have the need to see a provider outside of your local area. 3. Take advantage of a flexible savings account A flexible spending account (also known as an FSA) is a tax-benefited account that allows employees to be reimbursed for medical and dental expenses on a pre-tax basis. If your employer offers an FSA, calculate your anticipated annual expenditures to select an annual amount that will maximize your tax benefit. Then, track your expenses and keep organized records, this will ensure that you obtain reimbursement for your expenses. 4. Have a yearly physical Medical profits are not made on healthy individuals. Yearly check-ups, a healthy diet and exercise can stave off a number of health issues. Check your insurance carrier's website, most carriers offer wellness programs and free preventive care. Typical wellness programs provide patients a personalized health report. The programs often provide educational materials, weight-loss support groups, fitness classes, a smoking cessation program and personal counseling sessions. Patients who participate in these free programs are more likely to have lower health care costs, fewer sick days and be more satisfied individuals. Preventive medicine focuses on health issues that "drive a lot of costs and can lead to costly medical care like; obesity, smoking and stress. 5. Understand your health insurance plan, be informed Take the time to read your insurance policy. As a patient it is your responsibility to know what your insurance company will pay for before you receive a service, get tested or fill a prescription. Some services may have to be approved by your insurance company before your doctor or hospital can provide them. If you still have questions about your coverage, call your insurance company and ask a representative to explain it. Remember that your insurance company, not your doctor, makes decisions about what will be covered and what will not. 6. Make sure your insurance company has paid all bills correctly Once you have seen your physician allow 2-4 weeks for the insurance company to process the claim. It sometimes helps to follow-up with the billing person in your provider's office to make sure they have the correct insurance company and policy number on file. This simple oversight can cause claims to be denied unnecessarily. When the claim is processed your insurance company will send you a notice of payment called an explanation of benefits (often called an EOB). This notice shows what your insurance company paid, what your provider's office billed and what you are responsible to pay as the patient. If your insurance company did not pay an item contact them immediately for details and start the appeals process. Most claims submitted are not paid on the first try. Subsequently most appealed claims are paid. Contact your provider for assistance with the appeal or if you need medical records. 7. Be diligent with your insurance company and provider's office If you decide to submit an appeal, mail it via certified mail or keep the fax confirmation for your records. Allow 2-4 weeks before calling to check on the status of your appeal. Be sure to take note of the insurance representative's name, date and time of the call. Enlist the help of your provider's office. Most physicians have full time billing staff that can submit appeals. They can provide additional information and pointers. Sometimes your insurance carrier will request additional information from you or your provider. Complete the forms they send and return them immediately. If you have dependents in college you will need to show proof of enrollment every semester. If you have a primary insurance and a secondary insurance you are asked to complete coordination of benefit elections annually. 8. Pay your medical bills in a timely manner For most insured patients co-pays are paid as soon as you arrive at the doctor's office or hospital. Co-insurance and deductibles are calculated after the visit based on the services provided. Most providers bill on a 30, 60, 90 day schedule. Balances left unpaid after 90 days are often turned over to a collection agency. When this happens you may be subject to additional fees, late charges and even refusal of treatment. If you are unable to pay the amount that you owe request a payment plan. Ignoring the medical bill will not make it go away. 9. Do not be afraid to negotiate As your own patient advocate, be direct. Request to speak to the billing supervisor or manager in private. Then, be clear and confident. Say something like, -These bills are very expensive. Would you consider adjusting the patient responsibility to be more affordable?- Or -My insurance isn't covering much of the billed amount, so I am paying out of pocket for care. Is it possible to lower the price.- Discussing this matter with the billing staff is best, asking your physician is the wrong way to go. Physicians see hundreds of patients. Their focus is patient care not finance. Rest assured that any discounts are approved by the physician but asking your doctor to discount your bill in the middle of an office visit is not appropriate. Offering to pay the balance in full immediately in exchange for a discount usually works well. The office normally incurs fees if they have to send the account to a collection agency to recoup so providing you a discount is usually easier. Ask around to see if you qualify for any financial assistance programs. There are often medical foundations and even medical studies that your medical condition or expenses might qualify. In order to negotiate the best possible deal, do some research. Sites such as the Healthcare Blue Book, Vimo, and New Choice Health make research a piece of cake. With a 20 minute visit to these websites, you can find out how much local hospitals and doctors charge. In addition, you can see the types of discounts insurance companies receive. 10. Ask a professional for help if you are in over your head If the provider or facility will not give you a discount or you are overwhelmed by your medical bills, enlist the help of a professional. Full Cycle Medical Management has specialists who negotiate a reduction on your behalf. Typically the initial consultation is free and the company charges a fee based on the medical bills that you owe. In addition the company provides free one-on-one coaching, including how to complete and appeal, negotiating with your physician's office and/or hospital. There is even an online form that you can complete to have a consultant contact you. Reference Sites: fullcyclemedicalmanagement.com, healthcarebluebook.com, vimo.com, newchoicehealth.com 8ZGH7Z3E64D2 Article Source: http://www.saching.com About Author / Additional Info: Additional Articles: * Child labour is a crime. Underage working children in India. * The many advantages of Conference Calling * Play on Staffing process * The various benefits of attending college and pursuing higher education * Effective Marketing- Take a Walk in Your Customers' Shoes Does this article violate or infringe on your copyright ? 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