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Help With Medical Bills: Bill Review and Patient Advocacy

Updated on September 1, 2010

In my never-ending quest to educate people so they aren't discriminated against or taken advantage of simply because they don’t have medical insurance, I am going to discuss a few options available for people who need help with their medical bills by obtaining financial assistance through a patient advocacy group or obtaining a rate reduction through a hospital bill review company.

It seems that people are one medical catastrophe away from filing bankruptcy. According to a recent study, more than 60% of Americans filing bankruptcy have costly medical bills associated with their bankruptcy claim. Included in this number are people with insurance but are underinsured—people with high out-of-pocket costs or exclusions in medical coverage.

Many people utilize a credit card to pay for the costly medical bills, increasing their medical bills by paying high interest rates. Others refinance their homes or take out a second mortgage in an honest but not-so-smart attempt to pay for costs relating to the medical care received.

If you have had an outpatient surgery, I want to direct you to a hub I have written: Paying For Surgery: How to Negotiate Medical Payment. It will give you, the patient, the tools required to negotiate medical payment for all of your medical bills relating to your surgery. Also, if you have costly medical bills from being the victim of a violent crime (rape, assault, domestic violence, a drunk-driving accident, et. al.), you should refer to my hub: Financial Assistance for Victims of Violent Crime. For large medical bills like an inpatient claim, there is assistance—some of it is free and some of it you will have to pay for.

PATIENT ADVOCACY GROUPS:

There are non-profit organizations that assist people with all aspects of medical care. However, patients must qualify for this assistance by having either one or a combination of these circumstances: a covered, life-threatening and/or debilitating chronic illness (like cancer); financial hardship.

Patient advocacy groups offer case management services, acting as the liaison between you and your insurance company to ensure that you receive prompt, proper care without delay. They will offer this service for you with your employer as well, assisting you with job retention issues if you fear you may be let go due to a covered illness.

Also available is a co-pay relief program. There are 43 diagnoses covered for patients that financially qualify for assistance with co-pays and out-of-pocket expenses.

If you are suffering from cancer and are interested in obtaining access to emerging medical therapies (studies, clinical trials, etc.) patient advocacy groups will find this information for you.

Patient advocacy groups are involved in outreach programs for certain populations of the country. Patients that have difficulty gaining access to medical care due to race, religion, socioeconomic status, and/or senior citizens with disabilities might qualify for assistance from a patient advocacy group.

MEDICAL AND/OR HOSPITAL BILL REVIEW COMPANIES:

As I indicated above, for an outpatient surgery claim, you should first read Paying For Surgery: How to Negotiate Medical Payment. It might prevent you from having to hire a bill review company. Bill review companies can sometimes be costly, charging anywhere from a percentage of the total amount of the bills they review or a percentage of the charges that they were able to deduct. Deduct charges from a medical bill? Yes.

There are numerous reasons why a hospital bill might be subjected to deductions, but it requires that everything be audited—all medical records and charges, including a charge master. A charge master is a detailed itemization of every service that was charged in relation to a patient’s care—every injection and how many cc’s, every pill and what milligram, hospital gowns, gauze, band aids, etc.

Bill review companies are able to reduce hospital bills by identifying items that have been marked up by so much that it constitutes price-gouging. For example, charging $25.00 for a piece of gauze, increasing medication prices well-above what it would cost a patient to obtain the same medication from a pharmacy, etc.

Hospital bill review companies are also able to identify unnecessary charges like placing a patient in a higher level of care than what would normally be required. For example, ICU beds cost more than the normal med/surg beds. Bill review companies are able to examine the medical records to determine if you were kept in a room longer than necessary.

Bill review companies will identify duplicate charges and services not performed that have been charged for.

After performing an audit and reducing the bill to legitimate charges, the bill review company will negotiate a reasonable rate of reimbursement with the hospital, sometimes at a flat, per-day rate.

Bill review companies might be able to further reduce the amount you owe by helping you to fill out forms for hospital charity care.

HOSPTIAL CHARITY CARE AND BAD DEBT CASES:

Hospitals have charity care programs that every patient, underinsured and uninsured, should inquire about. DO NOT feel embarrassed about asking for this program. Many hospitals receive donations from people around the country that give to this charity specifically for people who are unable to pay for medical care. The people who are donating are doing so with you in mind.

Hospitals will often write off a remaining portion of a bill to bad debt. And though you might believe that this could be thought of as shirking your responsibility, keep in mind that bill review companies are able to reduce hospital bills by tens of thousands of dollars by identifying errors and over-priced items. They are able to further reduce a bill by negotiating a fair rate of payment based upon what an insurance company would pay for the same bill, because insurance companies never pay full price for an inpatient hospital stay. If you have paid a good portion of your bill, you may want to attempt to obtain a bad-debt write off for the remaining balance.

Hopefully, I have given you some information that will prompt you to either audit your medical bills or seek assistance to help lower your medical bills.

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    • Jillian Barclay profile image

      Jillian Barclay 

      8 years ago from California, USA

      Deni, This hub is one of my favorites! So much useful info, I will be reading it more than once!

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