Patient Advocate Services

 

Reviewing and Auditing of Your Medical Bill


Nearly 80 percent of all bills that come from a medical procedure have a mistake of some kind. Is there an error with your medical bills?


There are various reasons that there might be a mistake. Aspects such as overcharging, repeating charges and duplicated costs, wrong encoding, mistypes on the computer, services cancelled, code unbundling and missing authorizations as well as pre-certifications are some of the reasons that you might be overcharged. The unfortunate aspect of medical bills that have errors, is that most people have no idea. Whether it is from not taking a close look, not understanding the information read or not getting the entire picture because the provider isn’t sharing all of the information, the medical consumer needs to be diligent to make sure they are not being charged too much.


The Centers of Disease Control and Prevention estimates that almost twenty percent of the United States population, or 54 million people, are not able to pay for their medical bills as of 2012.


In fact, as estimated by the Commonwealth Fund, a consumer advocate agency out of New York City, in 2014, it is believed that one in five adults (equaling 41 million people) were forced to discuss their payment options with a collection agency. Of those 41 million people, an estimated 7 million were dealing with collections on an erroneous bill.


Negotiating the Provider Fee


With the entire population of the United States receiving health insurance and having more ability to receive healthcare, there are many people that are facing issues such as high deductibles and costly co-insurances. In addition, many businesses are having to reduce benefits for employees, making people pay for more services, additionally increasing costs. But, providers, on the other hand are in a great position, with a large number of patients coming their way with new health plans.


If you are facing a health issue and are in need of a diagnostic test or surgery, it is vital for your financial wellbeing that you take the time to discuss with your doctor the plan of attack for payment so that you are both on the same page, helping you to avoid getting a shocking bill down the road. Although the 10 Minimum Essential Benefits of the Affordable Care specifies that health insurance meet their mandate, there are loopholes that consumers need to be aware of. Issues such as procedures that are denied, reimbursements not going through or sky-high deductible can stifle even the best health intentions.


Health or patient advocates can help with this potentially costly aspect to health care. Their services help you negotiate the Fair and Reasonable Pricing Rules that are applicable to all health and wellness procedures found in the healthcare world. Take the time now to learn the exact costs of your upcoming procedure. Waiting to understand the fees until after the procedure can lead to costly issues down the road.


Issues do come into play for consumers when uninsured or underinsured and wanting to lower costs with physicians. To make certain that health advocates can help you to the best of their ability, it is important to make sure that you are covered correctly prior to going in for a medical procedure. Additionally, if you are able to pay your bill outright at the time of the procedure most doctors and wellness institutions will provide significant reductions in costs or payment plans that make paying the debt easier. This is their specialty. They are able to negotiate on your behalf payment plans or loan possibilities that can help you pay your medical bills while satisfying the doctor’s office, making it possible to get the medical help you need.


Denials & Appeals within the Insurance World


• Are you aware that a mere one in 10,000 denials of insurance are fought by patients and doctors?

• Are you aware that of all insurance claims, only 33% are processed in the correct manner?

• Are you aware that the 45,000 pages of Medicare regulations is the basis of healthcare pricing and billing standards?

• Are you aware that a third of every dollar spent in healthcare pays for abuse, fraud and errors within the medical system?


The fact of the matter is, denials of medical insurance stems from codes that aren’t covered, from services that are determined not needed, costs that are considered not covered or because of being out the network. The truth is, most insurance holders are under the belief that their needs are being covered by their health insurance, when in reality this is far from the case. This results in utter confusion for the consumer that leads to not trusting the medical system, health insurance providers, not to mention, most people don’t have the time or energy necessary to fight the bills that they didn’t think they were going to receive.


As your acting health advocate, they are on your side. They will take the time to find out your exact needs and create a plan with your health provider to make certain that erroneous insurance costs and bills are taken care of, that you receive the procedure that you need and that the claims are handled in a correct and speedy manner.


One aspect of the Affordable Care Act is that there are more Americans involved in our healthcare system, creating an even larger need for awareness of errors associated with the new health plans that are available. They are ready to explain in detail exactly what you need to know so that you are covered by the best insurance plan that fits your situation, and how the benefits affect you so that when the time comes for a needed procedure you know all you need to know.


Managing Disease, Diagnosis Research & Coordinating Care


When it comes to preventing and managing chronic diseases, it is important to realize that there are steps in place laid out by the medical field that helps a person manage or cease all together the advancement of illness and disease. This is a place that health or patient advocates are experts. They are here to assist you in approaching chronic illness in a way that brings together all the resources needed so that you feel empowered and ready to tackle sickness, knowing that you are supported.


These health advocates are available to personally assist you and your family in scheduling appointments needed with your healthcare provider. They are also able to decipher prescriptions, allergies that may be connected with the prescriptions as well as information such as surgeries, past health issues and systematic problems that will make certain that you avoid facing a cut off of services from your provider.


Some of the other services that these health advocates provide include accompanying you or your loved to a doctor’s appointment or hospital, hospital visitations and discharge follow up. They may also help with doing medical research on your diagnosis, finding the right doctor or healthcare providers, pain management, medication management and coordinating your care with all providers.


Coordinating Assisted Living


Another place that health advocates are able to assist you and your loved ones is in the evaluation of optimum living situations when assistance is needed. They are able to support you in finding a way that you or your loved one may stay at home when ill by implementing and coordinating access to the home, function-ability within the home and adapting the home to your needs so that independence remains.


If the situation occurs where you need to move a loved one out of the home and into a living situation that offers more of a 24 hour support, they are there to help make the transition as graceful and positive as possible. From assisting in finding a realtor and an attorney, from finding the best assisted living home to helping with memory or skilled care as well as financial resources, they are there to help. Their vast knowledge and networking base connects you with the best possible outcome for your loved one, making the transition as economically feasible with the least stress possible.


Researching Nursing Homes


Moving into a nursing home can be a devastating and depressing part of the advancement in the aging process. But it doesn’t have to be the case. If the time comes when it best for a loved one to move into a nursing home, sometimes the decision can be very hard to make. Issues such as memory loss, lack of mobility, prescription administration or transitioning back to a home environment after a hospital stay can all be situations in which a nursing home may actually add life and vibrancy to a person’s life. What is important is that you, your family and your loved one are provided with all of the necessary information to make certain the best decision for a location is made.


Issues such as finding the best and most cost-effective nursing home as well as discussing the situation with your loved one are all heavy burdens to bear. Health advocates are there to help you. Let them take that daunting task off of your shoulders, helping you with finding the best nursing home situation for your family. They are able to research the optimum choices for your particular family member, giving you options and helping you decipher what is the best choice for your loved one.


As advocates for you, they will take the time to meet with you to discuss your specific needs and wants to create a plan of action. With that plan of action, they will then research, study, visit, and interview multiple nursing homes that are in your geographical location. They will also look at the quality of the nursing homes, the staff to patient ratio, monthly price for living as well as any government reports associated with the establishments. They will then provide you with a detailed report of their findings.


These health advocates are also able to provide support with Medicaid benefits.


Assistance and Aid


When it comes to the healthcare reform, there are many benefits that showed themselves with various programs and new choices, but it is hard to know your options and if you are qualified for the benefits. Not only have Medicaid rules, both federal and state, changed, but so has the aspects of disability eligibility. For the layman it is almost impossible to keep up.


Take for example prescription drugs and drug therapies. There is a vast number of new products available to the consumer as well as clinical trials that can be highly beneficial for the consumer. For instance, the FDA mandates that research and trials be created for all new drugs. These studies offer a chance for patients to be a part of the study while at the same time receiving the care for free. As advocates for your health, they are abreast of the ever-changing therapy and prescription scene, helping you to know what may be beneficial for your situation.


Another aspect of healthcare that has a large number of new options is the VA, although it is not always an easy labyrinth to decipher. Not only are there many people applying for assistance, making the wait long and cumbersome, but additionally if there is a mistake on a sent in application, the patient is required to start again from scratch, losing all of the hard work done and wasting time. Also, to receive assistance from the Aid and Attendance program there is specific criteria that must be met. They are there to help you figure out the best path to assistance.


Not only can health advocates help you in figuring out which program is best suited to you, but they can make certain that all forms are filled out correctly and sent in a timely manner.


Health Plan Evaluation


With the United States healthcare reform there are a variety of changes and new ways of going about things. This opens up new possibilities for you. For example, the Affordable Care Act must contain ten different categories for health care for both individuals and small groups:


1. Ambulance Services

2. Pediatric Services

3. Hospitalization

4. Newborn and Maternity Care

5. Preventive and Wellness Services and Chronic Disease Management

6. Prescription Services

7. Rehabilitative Services and Equipment

8. Laboratory Services

9. Emergency services

10. Mental, Behavioral Health Treatment as well as Substance Abuse Treatment


When it comes to creating a beneficial plan for you and your family, health insurance is only one aspect. Take into consideration that aspects such as a living will, power of attorney and healthcare surrogate are all parts to a plan that will leave your family in a better position if you are in a position of incapacitation.


• Are you knowledgeable about all of the options available to you for health insurance?

• Are you aware of which health plan matches your lifestyle right now as well as in the future?

• Do you know if you have too much insurance or not enough?

• Are you knowledgeable on the aspect of long-term insurance and whether or not this is something that you need?


Health advocates have a vast array of accessibility into the world of healthcare and health insurance. Their large knowledge base will make certain that you are set up with the most cost effective and beneficial plan for your life and your living situation.


Disability & Medicaid Eligibility


The Medicaid Program in the United States is the third largest aspect of health insurance, after employer insurance and Medicare. Medicaid, acting as the biggest federal program for helping the public, Medicaid offers both medical and medically related solutions for families and individuals in need of low cost services. For example, Medicaid offers assistance to thousands of poor families, women, children, elderly and disabled people.


Unfortunately, the application process for these programs is lengthy and tedious. In addition to eligibility mandates, history checks, Medicare and Medicaid dual-eligibility issues, cost sharing, children and elderly needs, waivers, nursing home situations, and situations with disabilities, there are many aspects that need to be looked at when applying. In this confusing world of Medicaid, there is nothing like having someone that knows the ropes on your side. Health advocates are able to make certain that all paperwork is completely compliant from beginning to end.


Another aspect that must be considered is long-term disability. The Social Security Administration reports that a 20-year-old employee has a 30% chance of becoming disabled before retirement age. This fact is a reminder that we all need to take into consideration the possibility that it could be a reality for many of us.


For example, most people aren’t aware that both the Social Security Disability Insurance Program, or SSDI, as well as the Supplemental Security Income Program, or SSI, are the two service available to those facing long-term disability. It is a complicated matter knowing which one a person is eligible for. In fact, it is estimated that nearly 70% of initial claims are denied, and the appeal is denied at a rate of nearly 90%. Thus, it is vital that you have someone on your side fighting for your rights. Health advocates are there to help you.


Home Health Care Research


In the case of injury or illness, there is also the option of home health care services. This form of care is less costly, more convenient and usually as positive as a stay in a skilled nursing facility or hospital. In a home health care situation needs such as wound care for pressure sores or surgical cuts, caregiver education, intravenous therapy, nutrition help, needle injections, and keeping a close watch on unstable health conditions are parts to the care. Home health care is a way that a patient can have the luxury of their own surroundings while being taken care of by qualified care giver. This often speeds up recovery, aiding in becoming independent as quickly as possible.


Health advocates are able to assist you in creating the best at-home healing situation for you. From assisting with Medicare and Medicare Supplement Insurance to deciphering which agency will best suit your needs, knowledgeable health advocates are able to assist you in home health care so that you are healing quickly and with ease, and at the same time minimizing the confusion so that you do not have to worry about the details.


Health and Wellness Coaching


A health and wellness coach aims at helping their clients to look into themselves for motivation that will help them to restore and maintain their health and wellness. This way they are important in prevention of disease, curing disease and the maintenance of good health


Other areas where health and wellness coaches play a role in their clients life is helping them to see the link between wellness and healing. When the two are integrated, they result in a more fulfilled and healthy life. This can further help the client see that they are not helpless against chronic illnesses like diabetes, heart diseases and even debilitating conditions like obesity.