But the Doctor Said I Needed It

by Joanna Smith on Sep 29, 2010

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.

I”m Not a Patient: I’m a Consumer!

by Joanna Smith on Jun 22, 2010

I almost entitled this “Please Don’t Call Me a Patient” until I realized this is not something we ask politely for anymore:  this is the new world of the empowered consumer as a self’-made advocate!

In the “old world” of medicine, people seeking care were patients.  The origin of “patients” is from the Latin for  “to suffer or endure”.  Is that a relevant description for today?  Only partially.  Yes, people who are ill do suffer and endure, but they are also taking steps to learn about their options, talk with others in a similar situation and research centers of excellence and specialists.  They approach their providers with this information, and are collegial in their approach to their care:  they don’t ask a healthcare provider to tell them what to do:  they discuss options, risks and benefits and outcome data and then decide with their provider what options to take.  This is a very different way to approach healthcare.

So language needs to follow the shift:  rather than a “patient”, which conveys a static, “waiting-for-someone-to-tell-me-what-to-do” position, I think the title now is “consumer”. People look at healthcare as a product they can research and purchase.  These consumers have shifted away from the old model to the empowered healthcare model.  Patients no more, they are driving some of the most significant changes in healthcare delivery today.

23 and Me–and You

by Joanna Smith on Jun 11, 2010

In today’s newspaper was an item about “spit parties” where participants gather together to give saliva samples that can undergo genetic analysis.  There is a company in California that does this kind of testing–the company name is “23 and me”–and it’s moniker is “genetics just got personal”.  The company name, according to their web site, ” refers to the 23 pairs of chromosomes that make up each individual’s genome.  23andMe connects individuals to their unique, paired set of 23 chromosomes”.

What is particularly interesting is that  people are curious, and are willing to sped upwards of $399 to find out this information.

This is the world of new medicine: the information can be out there, for a price,and people are curious and would like the information.  So, if you were to appear at your doctor’s office with a genotype of your DNA, he or she might ask:  what can I do with this?  How will it currently help me keep you in good health? And that is the dilemma of healthcare today:  we can access very sophisticated information, but knowing how to apply it and where to go with it remain a challenge.

It’s one of the reasons healthcare advocates are so critical today:  helping the consumer know what to do with the information they acquire!

Early Registration closes October 15th….

by Joanna Smith on Oct 12, 2009

The newly formed National Association of Healthcare Advocacy Consultants has put together a wonderful First Annual Conference in Berkeley for next month, on November 14th and 15th.  Come hear these presenters:

Ann Tardy, Founder, LifeMoxie; Keynote Presenter: “The New World of Healthcare Advocacy — Creating It Together!”

Jeff Belkora
, PhD, Director of Decision Services and Assistant Professor of Surgery in the Institute for Health Policy Studies, U.C.S.F.: “Making Good Decisions in a Family Health Crisis”

Linda Garrett
, Partner, Risk Management Services: “Confidentiality and Privacy Law for Healthcare Advocates”

Gail Gazelle, MD, Assistant Clinical Professor of Medicine, Harvard Medical School: “Inside the Doctor’s Mind: What Every Advocate Needs to Know”

Maggie Radany, RN, Founder, Radany & Associates: “How to Solve Health Insurance Problems and Be a Hero to Your Clients!”

Dianne Savastano, Founder & President, Healthassist: “Bringing Bob Home: A Case Study in Patient Advocacy”

Elisabeth Schuler Russell, Founder & President, Patient Navigator LLC: “Inside the World of Pediatric Healthcare Advocacy”

Judith Stark, Principal, Judith Stark Consulting: “Harnessing the Power of Technology Solutions for Healthcare Warriors”.

To register, go to www.nahac.com.  Early registration (at the reduced rate of $150 for NAHAC members and $200 for non-members) ends October 15th.  After Oct. 15th the rates will be $200 for NAHAC members and $250 for non-members.

Understanding the Mysteries of Medicare

by Joanna Smith on Sep 2, 2009

Need help with Medicare?  It’s a complicated system to understand, especially when you’re first enrolling.  Join me in at a workshop in Portland, Oregon September 12th to learn and understand how it works.  The text of the flyer follows:
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National Association Formed

by Joanna Smith on Aug 10, 2009

I am very pleased to announce the formation of the National Association of Healthcare Advocacy Consultants (NAHAC, www.nahac.com), the organization, as it says on the web page, “dedicated to improving the consumer healthcare experience.”   Why NAHAC and why now? 
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Empowered Healthcare Conference May 16, 2009

by Joanna Smith on May 8, 2009

Joanna Smith, LCSW, MPH, the CEO of Healthcare Liaison, will be a panelist at the upcoming Empowered  Healthcare Conference, Saturday, May 16th at Mission Bay, San Francisco.  To find out more information and register for the conference, read the information at the Empowered Healthcare Conference web site.

Empowered Healthcare

Empowered Healthcare Conference