Thursday, February 18, 2016

The One Thing You Must Insist Upon After Your Crash...Or Risk Ruining Your Credit

I've seen this scenario OVER AND OVER again from car accident clients who call me in complete frustration months after their crash.

Client--let's call her Jenny--is involved in crash not her fault.  Jenny visits the local hospital for treatment. She explains to the hospital intake person (you know, the poor soul who has to ask for your insurance information while you're spasming in pain, bleeding, or have that bone sticking out of your leg) that she has health insurance and provides "nice intake lady" with a copy of  her insurance card.

Frequently, one of two things eventually happen after her insurance information is given. Either Jenny is told "since this is an auto accident, we will be billing the at fault party's insurance," OR the hospital takes her information and simply refuses to bill jenny's health insurance.

And then months go by. The hospital bill is lingering. Nothing has been paid. The at fault insurance company who promised to "work with" Jenny tells her that "we have to wait until you finish treatment" or "we can't pay anything until we review your records" or "we'll just offer you one lump sum as a settlement and you can pay your hospital bills out of your settlement."

Now Jenny is getting hounded by bill collectors hired by the hospital--which usually prompts a call to me.

What is going on here and why is Jenny being turned over to collections when she has health insurance and there is other insurance galore to pay her bills???

When the hospital sniffs that this is an auto accident claim and someone other than the patient may be at fault, it simply refuses to bill the patient's health insurance. But why?

Two words: hospital greed.

It's real simple: health insurance may pay well less than 50% of the patient's hospital bill. For example, if your ER bill is $5,000, the hospital may receive $1000 or even less from the patient's health insurance company as payment in full.  This is because insurance companies negotiate these discounts with hospitals who agree to be in their insurance network.

Because insurance reimbursement rates are so low, some hospitals are telling patients that the hospital "could not bill health insurance because it was an auto accident," or  told the patient that their health insurance "did not cover auto accidents."

Both of these statements are deceptive. First, virtually every health insurance plan will cover auto accident related expenses. Second, hospitals CAN bill health insurance. They just don't WANT to.

Reality: if there is a better and more lucrative source for the hospital's payment (such as the at fault driver's insurance company), the patient's health insurance is often viewed like a Spam casserole in the buffet line, and ignored.

Now, in a perfect world, this would not be a problem if the at fault driver's insurance company stepped up to the plate and simply paid the bill. But they almost NEVER do that. See excuses listed above...

The mistake that car accident victims make when they go it alone is not insisting that the hospital bill their health insurance, or simply turning the bills directly over to their health insurance company for payment to the hospital.  Chances are, the health insurer will pay the bill if the patient insists upon it.

The takeaway? If the hospital bill has not been paid within a month or so, contact your health insurance company and insist that it pay the bill.

Otherwise, the bill will linger, and here's the irony: your credit rating may get dinged despite the fact that you have health insurance, all because your local hospital (who is in your health insurance network), wanted to step out of that network to be paid a few more bucks.  

It's no wonder people call me after getting sucked into this unnecessary vortex.

Tuesday, February 2, 2016

Why A Hospital Was Fined $86,000 For Leaving A Towel Inside A Patient's Abdomen

Here's the story. A patient was admitted to a California hospital to have his bladder and prostate removed.

After three months and 43 pounds shed, this poor soul was re-admitted and underwent a CT Scan, which showed a large mass. I'm sure he thought this mass was possibly cancer.

Well, it wasn't cancer. Upon surgically opening his abdominal cavity, the surgical team discovered a different kind of mass: a large blue towel. It gets worse; the towel was intended for surgeons and the team to wipes their hands with only.

Oops. The hospital had no explanation for why the towel ever got inserted in the patient's belly, because it was not the kind of towel or sponge that was supposed to be used in the body cavity.

But here's the most interesting part: the only reason this story has seen the light of day is because California requires mandatory reporting of medical mistakes that can cause serious injury or death. But for this law, most likely the hospital would require the patient to sign a confidential settlement if he sued the hospital for malpractice.
Case closed, and the public never learns about something awful like this happening at its local, "trusted" hospital.

States like Ohio need to pass mandatory reporting requirements of medical errors, mistakes, and mishaps. Hospital care is big business, and hospitals often compete, and even sue each other, over market share.

Their public relations and messaging machines are colossal, and they are quick to tout their latest achievements and ratings. That's fine.

But the flip side of that coin is that the public should know when preventable errors like this one occur. Otherwise, we never get to peer behind the curtain, or in this case the surgical curtain.

If there's no transparency for hospital errors, it's like logging onto an online ratings site where negative reviews are not allowed.