Thursday, February 26, 2009

So, how do we keep moving on.....

Recently I have been regularly lauded by people I know and meet, including medical professionals about my endurance and great attitude. It is awkward to be told about my positive attitude these days. This got me to wondering and thinking about my attitude. I certainly know that when I started this journey, in 1994, when I was orignally diagnoses with MS, that I did not have a great outlook on the world. I did a lot of flaying, crying, and self destructive acts in the face of being really sick. And, boy, that MS episode was a real nightmare. I got really sick from the steroid drip, which unknowingly at the time, caused the future long term nightmare I am "happily" living.

When I found out I had this crazy bone disease in 1997, I did plenty of flaying, crying, and more self destruction. 

Frankly, I have only gotten this far, in the end, because I seem to be quite stubborn, I had to take my life into my own hands, and I have a great support network of friends, family, and some key medical folks that have helped me along. I truly couldn't do it without that. Also, I have been fortunate to play certain cards rigth (certainly no easy task) to get the help I needed. That was in large part in the face of what most people thought was reasonable. How many people are willing to invest in their healthcare to the point of traveling back and forth to a remote destination (Vail Colorado) to seek treatment, especially without deep pockets? Thank you Mom and Dad! 

After 9 surgeries there I have lost tract how much time I have spent/lived there. The last two years I have spent over 8 months in the Rockies? And, made some many great friends in the process. 

Thursday, February 19, 2009

More about Medical Bills and the Insurance Morass

Following up to my rant/post yesterday I want to share two articles on dealing with the medical bill morass.

The first outlines some of the important techniques that can be successfully employed to help reduce out of pocket costs. It comes from a real life experience of a couple that tackled their spiraling costs. I have used a number of the techniques and it mostly works. Sometimes, like I said yesterday, it is random based on who is on the other end of the line. So, it always good to try and try again. 10 Ways to Cut your Medical Bills

Another article a couple of days ago addressed how a family member stepped up to help advocate for her brother. Negotiate Your Medical Bills And, through Htzpah, persistence, looking over an itemized bill for a hospital visit (that is enough to make anyone sick) -- Crimminy, up to $10 for a Tylenol pill. It is a sad state in this country that we have come to this.

In addition to some of the techniques identified I use the following:
  1. Always, Always, keep notes for each conversation. Write, the date, who you spoke to, what about, and followup action item. This is useful when some action agreed to does not happen (no matter who it is) you can leverage that they said that they would do x, y, and/or z. Lack of Followup is great leverage.
  2. When you review a bill, there are CPT codes associated with the charges, if the charge has been denied by your insurance company, find out why, then go back to the provider of services and see if they can legitimately change the CPT code (sometimes they can) and re-bill.  That has helped save me money in a number of circumstances. Each insurance company has slightly different policies and coding. I am beginning to see this as a new pattern.
If all this too much to do on one's own, or if, one doesn't have a family member, there are always professional advocates, who charge a fee, however, the reduction of stress of dealing with, let alone understanding, EOBs ( "Explanation of Benefits" for the luckily uninitiated), medical bills, insurance policies, and negotiating down the bills, may be worth the up to $80/hr fee some people pay. Benefit Advocates Help Reduce Fees.

Those are my hot insurance billing tips of the day. Good Luck and give a shout if you have further suggestions or need help.

Wednesday, February 18, 2009

Random Resolutions: Keep on Calling your Insurance Company

Most people may think that being a chronic patient allows for swathes of time and relaxation opportunities, in between medical appointments and other healthcare activities. Well, I can attest that is entirely not true. I cannot keep up with nearly anything. If I tried to not live any type of meaningful, proactive life, maybe there would be time. I have become passionate about not being complacent in the system -- this includes treatment, billing and insurance, and rehabilitation -- easily packaged as wanting to be an empowered patient, which is a full time job.

After all my broad medical experiences over the years, including treatment and consumer challenges I cannot simply blindly believe what anyone has to say, which can make me a pain in the ass to some, but my own best friend. It is exhausting and sometimes incredibly frustrating, but, if I don't do it, no one will.

There are so many times, I could just walk away from an insurance debacle or medical procedure decision and, just avoid dealing with them. And boy there are times I have, but I find I have to drag my sorry ass back to the table because I wouldn't be able to stand myself for giving up.

Here is a short story about dealing with insurance, which resulted in a success story, but when you consider the method of resolution I think it is immensely frustrating:

I have found nearly 9 times of 10 with insurance/billing problems the more I simply go back, make another call, find another operator to speak to, I can resolve my insurance/billing issue and have them pay, or get the doctor to write off charges.

Recently on one series of bills, it took 5 or 6 times of sending the documents insurance said they needed/didn't have to find out that they never undated the newer documentation in the system. In and amongst those 6 calls one insurance operator for Aetna, said, Mam, you need to appeal, that is all you can do. I threw my hands up, but several weeks later (2 weeks ago) I tried again, and finally got a reasonable rational result. The result I originally expected which is that insurance should have paid the charge. The bummer is that the result was merely achieved by persistence, nothing really savvy, but not giving up. It is frustrating because it is random. There is often no rhyme or reason and that sucks.

The lesson of the day: Keep on Calling!

Saturday, February 7, 2009

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