A few weeks ago, one of my clients called me, frustrated with a bill he had received for a stay in the hospital. He had been admitted for surgery, and while in the hospital had developed an infection: that had necessitated a longer stay. My client became depressed, and the hospitalist (the physician that was overseeing his care) had come to him and said that he felt a psychiatrist should see him, that it was “an integral part of his care” to recover from the surgery and infection. My client agreed to the visit from a psychiatrist.
When the insurance company received the entire bill for the hospital stay, they denied payment for all of the psychiatrist’s visits, saying that they had not been pre-authorized by the insurance company, so they would not be covered. The hospital then billed my client for the psychiatrist’s services.
My client called me, saying, “My doctor said I needed this; how could I possibly have known it needed to be pre-authorized? I was sick; he recommended a treatment and I agreed. How can they charge me for it?”
I could see immediately what had happened; this is a very common event when someone is in the hospital, and it frequently leads to an INITIAL denial by the insurance company. When I called the insurer, I said “you have this happen all the time: how can we get this reconsidered?” The insurer requested medical records to review. Once they were provided, the claim was paid.
Points to remember:
- Review all medical bills carefully; make sure you understand the charges.
- Team with the hospital billing department; they can assist with sending medical records.
- The first review of a claim frequently is a denial.
- Appeals are the rule of thumb: be prepared for two or more.
- Work patiently with everyone: you will get a better response if you are respectful but determined.
- If your bill is very complex, you might want to hire a medical coder to review it and make sure the coding was done correctly.
Healthcare Liaison, Inc. ® is pleased to announce another expansion of our services! We are delighted to announce the addition of our newest Affiliate, Healthcare Advocacy Partners (www.healthcareadvocacypartners.com) in Seattle, WA. Sima Kahn, MD, is a board certified obstetrician/gynecologist with licenses in both Washington State and California. She brings more than 25 years of expertise in both in-patient and out-patient services in women’s healthcare. Sima offers services that assist people in understanding complex medical situations and their treatment options as well as understanding how to make medical decisions about their healthcare. Sima completed the Healthcare Liaison, Inc. ® Credentialing Program in 2010 and is now a Certified Healthcare Advocate. Please look at her profile on our web page: www.healthcareliaison.com/affiliates.
At Healthcare Liaison we work with people of all ages, so some of our clients are very young (infants) and some are elderly. I had a call from an older client the other day. She was concerned because she lived far from two of her children, and close to one of them—but that adult child traveled a lot for work and also had a family of her own. My client wanted to know what she could put in place to help relieve all three of her children from worry about her.
As I listened to her talk, I realized again what a big part fear plays in the minds of people as they age. It does not seem to matter whether they are actually ill at this moment: the conversation is filled with “what if” thoughts and concerns. “What if my son is traveling when I’m sick? How will anyone know how to reach him? What if I need help at home and my daughter is too busy to do it herself? I live alone: what happens if I fall and end up in the hospital? “The initial concern about not being a burden was clear, but listening carefully I heard a strong subtext: “I’m scared and don’t know how I’ll manage.”
Too often I find that adult children take the overt questions quite literally, and try to problem solve, rather than listen to the underlying fears. The questions listed above are beautiful “openers” to a discussion about the kind of care the aging relative would like to have, where they would like to be cared for and how they envision their death. These are difficult discussion to have at any time, so adult children can welcome these subtle invitations to talk. IN ADDITION TO problem solving (by perhaps getting a “medic Alert” button or hiring help at home or someone to check in on a regular basis) consider this an invitation to discuss other topics:
Fears about their care
Setting up notification systems when they become ill
Giving up independence
Different living options
If you need assistance in having this discussion, we can help! Contact us to arrange a time to discuss your particular situation: email@example.com or 510-704-8476.
When we need medical attention, we generally have an immediate response: get help and get it quickly. While the co-pay for an emergency room visit is climbing steadily—even in HMOs, a fee can be more than $100—consumers frequently use the ER for non-emergency issues. To the public, any medical event, from a possible heart attack to a sprain means one thing: the local ER. People use the ER for colds, flu, fever, coughs and other symptoms as well as for suspected heart attack, stroke or a major trauma. Sometimes they must wait a long time to be seen.
Well, there is an app for that! Many hospitals now have created applications for download to a smart phone: these apps can tell you the wait time in their emergency room. This does not solve the problem of overuse of the ER (many times the treatment could be properly done in an Urgent Care Center at a lower cost to the consumer), but it does give the consumer the ability to choose which hospital to use.
Healthcare Liaison, Inc.® is pleased to announce expansion of our services! While our company is based in Berkeley, CA and also does business in Seattle, WA, we have just established our first Affiliate in Orange County, CA: Radany & Associates, Inc., Health Care Advocates of Orange County (www.ochealthadvocates.com). Maggie Radany, RN, President of Radany & Associates is a nurse with over 25 years experience in the field. She offers a range of services to help people understand their care options, insurance intricacies, billing issues and care coordination. Her goal is safe, effective, reimbursable care for her clients. She completed the Healthcare Liaison, Inc. Credentialing Program for Healthcare Advocates in 2010 and is now a Certified Healthcare Advocate. You can read more about her on our web page: www.healthcareliaison.com/affiliates. We are delighted to welcome her!