Trench on 'surprise' medical charges

medical-billing

Lately, an article from the New York Times about surprise medical charges has been making the rounds on Facebook. Once again people are taking the article at face value without doing any further research. Luckily for you, I’m here to tell you the real deal as I call upon my 20+ years experience in the healthcare field. If you doubt my credentials they just happen to be that I worked for a major health insurance company for ten years and for the next 15 I’ve been working in various medical clerical positions mostly including medical billing.

The article seems to be mostly focused on one man’s plight when he received a rather astronomical bill for a surgery that he had. The charge was for an assistant surgeon who was out of his insurance’s network. The article gives the impression that there is no recourse even though there is.

First off this is a rare occurrence in my experience. If you going to have surgery in a hospital that is in your network and the primary surgeon is in your network then the odds are that the assistant surgeon will be in your network too. If the assistant surgeon is not in your network a majority of the time the insurance company is willing to make a deal with the doctor and most doctor’s offices are more than willing to work with the insurance company. The article also seems to give the impression that doctors will know ahead of time if they’ll need an assistant surgeon. Usually, an assistant surgeon is called in during the surgery when an anomaly or difficulty is discovered. Also if you read deep into the article you’ll find that the man’s insurance company did end up paying the assistant surgeon’s fee.

Here’s the one tip that everybody needs to keep in mind. Doctor’s do not know how billing procedures work. They are usually too involved in treating the patient to worry about each individual insurance policy covers. That’s what medical billers and coders are for and most of us bust our asses to get the most benefit from your insurance company.

Major employer charges vaping employees extra for health insurance

 

In my civilian life, when I’m employed, I work in the healthcare industry. I’ve worked in the clerical side of it for almost the past 30 years mainly in either claims processing or medical billing. You can read my musings on the healthcare industry here.

A few years ago I worked for a company that was contracted to assist UPS employees in signing up for their annual benefits. Not surprisingly UPS made their smoking employees pay more for health and life insurance. You had to have been quit for 18 months before being considered a non-smoker. What is surprising is that UPS is now making employees who vape or use e-cigs pay extra for their insurance.

This just leads me to believe that the real dependence on tobacco comes from corporations and governments who make their money off of people smoking. Not the tobacco companies mind you, but the healthcare industry. If no one gets sick from cigarettes in the U.S. how will any of these stakeholders get paid?

I’m not a conspiracy theorist but it’s not that much of a stretch of the imagination to believe that some higher-ups have a lot to lose if more people switch from smoking to vaping.

Are health insurance companies getting rid of customer service?

caduceus

The trend among health insurance companies used to be to outsource their customer service overseas. United Healthcare was the biggest proponent of this practice in my opinion.

Recently I received word through my job that a national carrier and a large east coast regional carrier are moving towards eliminating customer service reps altogether.

I work for a service that contacts insurance companies on behalf of doctors. Within the past few weeks, a major national carrier has made it where doctors, at least, can not speak with a live person and are being directed to the carrier’s website. I have no problem in using an insurance company’s website. I’ve been using them since as long as they’ve been around and they can be very helpful and a time saver.

However, there are plenty of times where the information you need is not on the website and you need to speak to a live person. For example on most websites, they only give you a general benefit breakdown. If your doctor needs to perform a specialty service the website probably won’t have that benefit.

Now granted, that’s an infrequent occurrence for most general practitioners. So what does this mean to you? I’m sure the insurance companies view this as a cost-cutting measure. Do you think that they’ll pass the savings on to you? Probably not. If anything, thanks to the Affordable Care Act, there will probably be an increase in premiums.

As long as the ACA stays in effect our healthcare industry in this country is doomed to crash.

Trench’s Annual Enrollment for Morons

benefits

So as I may have mentioned in my latest day job I work in what’s called a benefit center. Basically we help employees from certain companies enroll in their health and welfare benefits for the year. You may know this as annual enrollment. As with any occupation that deals with the general public we get our fair share of morons. So in order to get a few less morons asking me moronic questions I’ve created an FAQbM (Frequently Asked Questions by Morons) about annual enrollment.

Q, Can I add my girlfriend to my medical insurance?
A. No. Why? Because you’re a moron. The real reason is that only spouses and children can be added to your coverage. No girlfriends. No boyfriends. No baby mamas/daddies. No aunts. No parents. No 3rd cousins. No lizards and chickens.

Q. But same-sex domestic partners can be covered. How is that fair?
A. You’re right. It’s not fair. Morons like you can just go to Vegas or city hall and get married. Same sex couples have to go through hell to get coverage. They have to submit a crap ton of legal paperwork showing that they are committed couple and aren’t just in it for the benefits. Plus in my experience most committed same-sex couples stay together longer than most of you straight morons. Even if a gay employee likes to play the field they can’t just add their latest flavor of the week to their benefits whenever they feel like it. And let’s face it. The only reason you give a crap about same-sex domestic partners is because you’re a gay hating moron.

Q. My co-worker said…
A. Stop right there. Your co-worker is a dumbass. Don’t believe anything they tell you about your benefits. If you do listen to them that makes you an even bigger dumbass. If you want the actual information you can get it from 3 different places. The benefits center (me), the benefits manual, or your HR department. But even your HR department is suspect because technically they’re your co-workers too and that makes them possible dumbasses.

Q. I’m not good with computers.
A. Fuck you. You’re fine with computers. You’re just too damn lazy to enroll in your benefits online with the website that your company paid damn good money for to make it easier for you lazy bastards to enroll in your benefits. You have to be at least 50 before I’ll even begin to think that you’re not good with computers.

Q. I’m an overbearing mother who has no connection with the company but my adult son works for the company. Can I enroll him in his benefits for him?
A. Short answer, yes, Long answer, is your son some kind of moron or just a pussy? If he’s old enough to work a full-time job then he’s old enough to enroll in his own damn benefits. I have no respect for someone who is more than capable of calling in for their benefits but has their mommy do it instead. Get off the tit.

Q. How come I had to wait 45 minutes on hold before I got a representative?
A. Because you’re a moron who waited until the last-minute to enroll in your benefits and you called at the exact same time as all the other last-minute morons. Most companies give you anywhere from 2 weeks to a month to enroll in your benefits. Unless you were in a coma for all that time don’t bitch about holding you procrastinating bastard.

Q. Can you explain the differences between all my different benefit options?
A. Yes I can, but I’m not going to. Not only does your company have an elaborate website that describes all your benefits in great detail but you can also request a hard copy as well. Try doing some research first you moron. I don’t have time to hold your hand all damn day.

Q. I didn’t get (insert name of document here) that everyone else got about their benefits.
A. Yes you did but you’re too much of a freakin’ moron to actually read your mail and you probably threw it out.

Remember kids, no matter what you’re told there are stupid questions.

Mass. Healthcare Plan

Mass. Legislature Approves Sweeping Health Insurance Bill:

A lot of people are crowing about how great Massachusetts’ new healthcare bill. Personally, I think it sucks and I’ll tell you why…

The measure does not call for new taxes but would require businesses that do not offer insurance to pay a $295 annual fee per employee.

Which businesses would just pass on to the consumer resulting in higher prices and a higher cost of living.

The plan hinges in part on two key sections: the $295-per-employee business assessment and a so-called “individual mandate,” requiring every citizen who can afford it to obtain health insurance or face increasing tax penalties.

So they’ll be forcing people to get health insurance. Whatever happened to freedom of choice?

The state’s poorest ? single adults making $9,500 or less a year ? will have access to health coverage with no premiums or deductibles.

Those living at up to 300 percent of the federal poverty level, or about $48,000 for a family of three, will be able to get health coverage on a sliding scale, also with no deductibles.

Great, let’s give people more reason not to work.

Individuals deemed able but unwilling to purchase health care could face fines of more than $1,000 a year by the state if they don’t get insurance.

There’s that whole pesky freedom issue again.

Mark my words, if this plan passes it will fail and it will fail miserably. It will be as bloated and corrupt as Ted Kennedy.

Trench’s Health Insurance Tips: Pre-Existing Condition

Today we’re going to discuss pre-existing conditions and how all health insurance companies are run by soulless scum sucking bastards who deserve to rot in hell.

A pre-existing condition is defined as a recurring condition that you were treated for or diagnosed with 6 months prior to receiving health insurance coverage. That could be anything. It could be something manageable like diabetes or something life threatening like AIDS or cancer. If you did not have continuous health insurance coverage at that time the insurance companies will not pay for any treatment related to the condition for 12 months.

Think about that for a second. You could have cancer and the insurance company would not pay for treatment for a year. A lot of people can’t afford to pay for that kind of treatment so they might just forego getting treated until the waiting period is up.

The insurance company is basically hoping that you’ll die before the waiting period expires. What’s worse is the law allows it. In North Carolina and other states, it’s REQUIRED. Why isn’t this practice considered discriminatory? Why isn’t this a violation of the Americans with Disabilities Act? How many people have died because of this? Which lawmakers and politicians have blood on their hands?

And please feel free to post your pre-existing condition horror stories here. Let’s get the word out about this horrific practice.

Trench’s Health Insurance Tips: Diagnosis Coding

Today’s healthcare pet peeve du jour is diagnoses and the coding of your medical claim.

A lot of our patients come in just for a routine check-up, a cancer screening, or they have a family history of some disease. In all 3 of those cases, an office visit or procedure are considered “routine” because an actual disease has yet to be treated and no other complaints have been presented. In some of those cases, health insurance companies do not cover routine services. So let’s take a look a little hypothetical situation shall we?

The patient comes to see the doctor for a cancer screening.

The doctor uses the diagnosis code on the claim for cancer screening.

Insurance company denies the claim because they do not cover routine procedures.

The patient gets a statement from the insurance company saying they are not paying for the visit.

Patient calls the insurance company to ask them why they didn’t pay.

This part is important so pay attention…The insurance company tells patient that they do not cover routine procedures but if your doctor had coded it as non-routine then it would have been covered.

What the patient hears is “Your doctor coded it wrong.”

The patient then calls me and wastes my time telling me that the doctor coded the claim wrong and it needs to be recoded.

Here’s where I bust the myth.

The doctor did not code it wrong. In 99% of all cases, the doctor coded it correctly with the information provided from the patient.

With the information that we have received from the patient, we can not recode the diagnosis as anything else in order to get the claim paid. That is known as INSURANCE FRAUD. I am not willing to go to jail just so you can get out of paying your bill. Health insurance is not an absolute. No matter how good your coverage is you will eventually have to pay out-of-pocket. It’s inevitable.

Do yourself and me a favor. Every year you get a booklet from your employer that goes into great detail about your health insurance coverage. READ IT! LEARN IT! LIVE IT! And stop bothering me with your assclownic questions.

Trench’s Health Insurance Tips: Deductibles

Here’s a little health insurance tip from me to you. It will make my life easier and make you look like less of an assclown.

Say your health insurance policy has a $500 deductible. And say that you have a condition that requires you to see multiple practices (i.e. primary care, specialist, and hospital). This would require you to file 3 claims to your insurance company. Now say the hospital asked you to pay your $500 deductible up front and you do. The claims from all 3 practices get filed to the insurance company. However, the insurance company gets the specialist’s office’s claim first and takes out the $500 deductible from that claim leaving you with a $500 balance at the specialist’s office. What’s that you say? You shouldn’t have a specialist’s bill because you already paid your deductible to the hospital? Well, let me be the first to say YOU STUPID ASSCLOWN!!!! Run up to the nearest wall and slam your head into it for being so stupid. Let it be known now, forever and throughout perpetuity that the insurance companies not only don’t know who you paid your deductible to, they don’t really care either. The insurance company will take out your deductible from whatever claim they receive first.

Now that I’ve made you smarter here’s what you can do if you paid one practice up front and the insurance company took out your deductible from a different claim. If you paid up front to one practice and the deductible was applied to another, you should have a credit at the practice you paid up front. DO NOT call the insurance company about it. DO NOT call the practice that is billing you for the deductible. Neither of those places can do anything about it. DO call the practice or facility that you have a credit with. They are not going to call you. After you pay a practice up front it becomes your responsibility to get any credit back. Also, the practice that you have a balance with is not going to wait around for you to collect your credit. They will keep billing you and possibly send you to collections unless they receive payment. They are well within their rights to do so.

Any questions? I didn’t think so.