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Bette Grey, BA, RRT, CPFT

Clinic Founder CCVIM Clinic

Hi,

If I could run by some folks these two questions: Can a hospital bill a deceased guarantor's child for outstanding bills once the child is 18?Or do the bills remain as part of the estate?

Steven Okey Was the hospital bill for the deceased guarantor's treatment or the child's treatment? It's a bit unclear from your question. 

In either case, the answer is no. A debt incurred by the guarantor becomes a debt of the estate after the guarantor dies. And a child is not personally liable for a deceased parent's debts.

If a child has medical treatment before the age of 18 and the child's parent incurs bills for the treatment, the child does not become personally liable upon reaching 18. A child under the age of 18 lacks the capacity to contract. 

Hope this helps.

Bette Grey, BA, RRT, CPFT Hi Steven-Child had a procedure as a minor,parent was guarantor. Thanks for confirming what I thought. Bad enough the family has a lot of grief and then the hospital system sends the child to collections after there was a prorata estate settlement. Amazing how this game is played at the hands of innocent people who don't know know how to navigate.

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Claudia Kim Nichols Was patient on Medicaid?

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David Moll

Pharmacist/Entrepreneur/Telemedicine Consultant

Telemedicine: The Wave of the Healthcare Future Is Here!

What do you all feel about it? Microsoft and Virgin principals have spent billions of dollars to set up the industry....with the shortage of doctors and the increase in patient volume to see a finite number of providers of which is too small to handle the increase....

MDPlus is a subscription based telemedicine service that offers licensed physician access in an immediate timely fashion, 1-3 hours, as opposed to average wait time on appointment basis is 3-4 weeks currently; this time will only get worse as more people sign on to coverage with Obamacare.

There are 850 licensed certified physicians in all 50 states that stand by 24/7 and take calls through the MD Plus system. Those calls are initially answered by RNs who will ask questions (eg triage), and then have the MD call the patient back in a timely fashion.

These MDs can opt to call in prescriptions to same state pharmacies. They will not prescribe DEA controlled substances as part of this service. 70% of all ailments can be cared for by phone, chronic or acute. The service started in 2006, currently has 4 MILLION subscribers, and retention is 97%. Plans start at 19.95/month which allows for physician calls and ensuing activities along with a prescription discount card that can save up to 75% on prescriptions (almost like an insurance plan). However, THIS IS NOT INSURANCE. From the standpoint of costs, it may as well be 'insurance'. 

I asked a lot of hard questions as a pharmacist of 24 years before getting involved. The gentlemen that I spoke with had 35 years of pharmacy industry experience and actually told me the questions I was asking were excellent ones that should be asked.

Please email me at rxdgmrx@ or call me at either 503-760-4725 or 971-563-5911. I too am looking at advocacy, and am sure to utilize/recommend this service for my future clients.

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Claudia Kim Nichols One glitch is that each time an operating system is updated, often the devices go off-line, and lose all data. Applies to insulin pumps and sensor of blood glucose levels.

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David Moll MD Plus does not get involved in clinical monitoring aspects of medical devices and telemedicine. So for us, this is a non-sequitur.

Rosalie Weatherhead I don't think you should advertise here, though without direct disclosure. My opinion only. There are many great advances in medicine and technology, all of which deserve notice.

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Rick Pugach

Personal Health Advocate, Health Navigaid, LLC

Double deductible dips

A new black hole for my potential clients may be emerging in the brave new world of high deductible health plans, with more providers trying to collect patient deductibles at the time of or before the provision of services. I want to know how much provider billing offices can find out about a patient’s health plan coverage before delivering services.

Hypothetical situation - Jack has stage 4 kidney cancer and regularly visits his neighborhood hospital for procedures between visits to his medical oncologist. Any of these encounters would produce sufficient allowable charges from his network providers to absorb the entirety of his $1,000 annual in-network deductible.

After Jack’s deductible counter reset to $0 at the beginning of 2015 and he exited the hospital following a two day stay, Jack revisits his medical oncologist and his told he needs to pay his entire $1,000 deductible before receiving services. Why? Because before providing services, the oncology office called Jack’s health plan and was told (1) that Jack has a $1,000 annual deductible; and (2) according to their claims information, no claims have been applied yet to his deductible. So Jack, believing he has no choice in the matter, pays the requested $1,000 to his oncology office.

You can guess the rest – the hospital bill hits his health plan the next day (before the oncology office claim is submitted!) and the entire $1,000 deductible gets applied to the allowable charges. Short term result: Jack is out $2,000 instead of $1,000 because his oncology office was successful in working the system and cutting in to the front of the line. And now Jack is forced to play the provider refund game, which usually is not much fun.

In the experience of any of you who work in or understand provider billing, how much will health plans actually tell providers about a patient’s coverage – is it limited to disclosure of out of pocket maximums or will the plans actually try to disclose their best guess as to remaining member responsibility?

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Martine Brousse It is against the terms of a contract between a provider and an insurer to ask for a deductible before a claim has been submitted. All the patient needs to do is refuse to pay, contact the insurance and the provider will get a call to stop the practice. It is certainly illegal to do so for Medicare patients.

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Martine Brousse I wrote a blog on the subject last year. Change 2013 into 2104 and 2014 into 2015, and the advice remains current.



Rick Pugach Appreciate the discussion. Doubt we would have read

this () or this () 10 years ago, but collection tactics of many providers are more aggressive today.

Again, my question is how much will health plans actually tell providers about a patient’s coverage – is it limited to disclosure of out of pocket maximums or will the plans actually try to disclose their best guess as to remaining member responsibility?

Terri, how did the surgeon’s office and the surgery center know your deductible balance due was $205?

Cindi Gatton It's been a few years since I worked for an insurance company, but their systems are generally real time, at least in terms of claims that have been submitted and processed. So when you (or a provider) speak with customer service and they tell you the remaining deductible you owe (particularly important if you have a coinsurance vs. copay type plan), they are giving you information that is as accurate as they have it in that moment. But they don't have a crystal ball to know where you've been seen and when other providers will be submitting claims, so it's been my experience that the situation you describe can and does happen. It's not malicious on the insurer's part, though. They can only report what they have.

Back in the day when I had a high deductible, co-insurance plan, I found in the first quarter providers sometimes requested the co-insurance portion of my charges at the time of the visit. I typically refused, citing that unless they could show me the adjustments for that particular insurance contract I would be overpaying them and preferred to wait until the claim had been submitted and adjudicated at their contracted rates. At the same time though, I understand provider concerns as deductibles have been creeping up. An awful lot of patients aren't prepared financially to meet their deductibles, and high cost of medical services in the US aside, it isn't a provider's responsibility to fund that interest free over time.

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Terri Seibert 

Rick,

Because my surgery was elective, the surgeon was in touch with my insurance company for a pre-certification based on the procedure codes they intended to submit. The surgeon was out of network, but the surgery center was in network. I was also in touch with my insurance company to be sure the codes that were being submitted were "medically necessary" codes, since this was for removal of a cyst above my eyebrow...not cosmetic.

No one really knows what I do, so the drama began after the surgery when the wrong procedure codes were submitted for services, ballooning the changes to $18,000 ( 55 minutes under local anesthesia), I have since rectified the problem, however, as far as my insurance company is concerned...they think I have paid the doctor the $16,000.00 difference...it is a crazy world, and why we need advocates.

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David Moll Some of the points brought up perked my interest. High deductibles also means that patients may be hesistant to visit a doctor for whatever reason. Now, there is telemedicine. I now represent MD PLUS, a telemedicine company that has been in business since 2006 with 4 million members and 97% retention rate.

Briefly, the patient has a problem, say shortness of breath due to asthma (chronic) at 11pm. Its New Years eve, and regular doctor not available, urgent care closed, and oncall doctor hasnt returned the call for several hours. A call to MD PLUS is triaged by an RN and she has the MD callback asap, usually within an hour or so. He/she can then turn around and call in prescriptions (say in this case, prednisone, albuterol, and Advair), which can be filled right then and there. Patient follows up with pulmonologist who agrees 100% with telemedicine doc's decisions.

If you are interested in learning more, send me an email.

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David Moll I should also add that this is good for any reason, not just affordability, but access and timeliness of care in this new age of OBAMACARE and the current shortage of primary care docs.

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Rick Pugach David, I think telemedicine is a very interesting space with great potential. But it seems off point with the subject matter of this thread. Beginning a new discussion may a better way to explore interest from our advocates.

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David Moll Rick, I will start a new thread...thanks for the the suggestion!

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Claudia Kim Nichols My clients seem to have difficulty understanding this.... but not convinced they've read the policy language carefully

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Maureen Lamb

Maureen Lamb is a Medical Billing Advocate in the Greater Boston Area

NY Times Article discusses impact of ACA, Insurance and Medical Billing

This NY Times article explores many of the major issues which are happening with insurance, medical bills and the ACA.

[pic]

Paying Till It Hurts: As Insurers Try to Limit Costs, Providers Hit Patients With More...

As insurers and providers fight over revenue in an era of cost control, patients often find themselves nickel-and-dimed between them. ()

Terri Seibert Maureen,

There are "free and low cost preventative" services for ACA consumers as well as Medicare beneficiaries...the "expectations" of the services have caused much confusion. For example Colorectal Screening....many folks think it is a colonoscopy, however there are lab tests that are approved for colorectal screening, such as an FOBT (Fecal Occult Blood Test), far less expensive than a colonoscopy. In the case of a "colonoscopy screening" if a polyp is found, the "screening" can become "diagnostic" and have financial consequences. This is an area that billing becomes a nightmare, I have heard that a "screening" should be billed as a "screening" if that was the intent of the order, most of the time, it is not billed that way.

The same thing applies with the "wellness visit", it does not include blood work. It seems to me ( as I am unaware of the scope of defined contents of "free & preventative" services) that it may be up to the physician/practitioner what is "essential" in such a patient encounter. I am actively seeking the answers, which I think will be defined and embedded in the practice management systems, and most likely will reside in the patient encounter templates. Health education is so important, not only for consumers, but also for providers.

Christine Kraft

MedReview Solutions

Dental Fees

Does anybody have a resource for the national average dental fees in 2012? I have National Fee Analyzers for medical fees but not dental.

Kathryn Gohman

You can find the 2012 National Dental Advisory Fee Report on Amazon. The fee is 

$99.00.Here is the link:

()

I looked for this report on several other sites and the charge to purchase the report is up to $200.00 even for a used copy. I could not locate another place other than one

website that was a search of libraries in your are and it told you which ones had it available for download. You might try this too:

Here is the link  

().

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David Moll Dentists have it the best of all providers and have had it that good for years; its almost like they saw this health care wave coming and just refused to be a part of it every time (as a unit). It doesnt surprise me that researching cost information is so difficult; but as appears as written above, can be done...

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Maureen Lamb

Maureen Lamb is a Medical Billing Advocate in the Greater Boston Area

How do you challenge Upcoding in your work? Medicare Advantage plans are being scrutinized more for these practices. You can read more about this topic here: ().

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Rick Pugach

Personal Health Advocate, Health Navigaid, LLC

Health Care and the $20,000 Bruise.........

..........was a great piece in the 9/2/14 Wall Street Journal () for medical billing advocates and the unfortunate victims of hospital upcoding and overbilling nonsense.

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