What if a patient is too sick to manage their own healthcare?

[Alnitak7]

I was looking at this web article about balance billing.

http://www.ncsl.org/documents/health/HRMedicaid.pdf

"Balance Billing-How to Handle it"

As I read this I'm thinking about the amount of work that must be involved in dealing with the insurance companies and with dishonest practitioners.

I was wondering how many clients become helpless victims when they have to manage their own healthcare and have no PCP to manage this for them.

"You can negotiate the balance-billed portion with your provider. "

"You can negotiate with your insurer. "

"If you feel like you've been treated unfairly by your insurance company, follow your health plan's internal complaint resolution process. "

If you're being illegally balance billed and "your discussion with the provider does not fix the problem, complain to your insurance company... Tell the insurance company you're being balance-billed, and ask it to intervene on your behalf."

The amount of work that must go into this makes me sick just thinking about it.

What would be a patient's options when they're managing their own healthcare,

and when they're too sick to handle all this work?

What if they do not have the experience to handle issues like this?

What if they have no family member, nurse or caregiver that knows how to assist in managing their healthcare for them?

Tell them this and tell them that

Ask them this and ask them that.

If this does not work try that...

I'm not sick and this makes me tired just reading about it

Well what if the patient is not capable of handling all this work?

The media talks negatively about "the hassles" of being assigned to a PCP.

[OCNRN63, RN]

An older woman in my church had that problem (this was sev. yr. ago). She was getting "balance billed" and she just kept paying the bills. I guess one day she said something to my mother about it. My Mom, who is very savvy when it comes to medical billing, got all her medical bills together and started calling the various doctors' offices. Funny how all of a sudden our friend didn't owe that money.

[Esme12, ASN, BSN, RN]

I fight with them very day.

[KelRN215, BSN, RN]

Yup, I've been fighting with one of my providers since October about a bill. Hospitals will screw anyone they can and, if you let them, they'll screw you too. I went to an appointment in October and paid my co-pay at that very appointment. A month later, I got a bill for the co-pay I already paid. I called them and they basically told me to pay it again. I started sending them copies of my receipts proving that I'd paid the co-pay but they continued to send me bills every month, bills for something that's LONG been paid. A couple weeks ago, I got a collections notice. I filed a complaint with the state's attorney general. They can't charge me more than my co-pay and they're trying to threaten me into paying double for something. Actually, the verbiage on the letter I got really aggravated me. "Prompt payment will ensure that we meet our obligations to the community" or something like that. So basically, you pay for private insurance, your taxes pay for the state's Medicaid system and you already paid this bill but pay it again to make up for the money we lose caring for people who don't pay.

[Alnitak7]

I fight with them very day.

I'm wanting to hear that this actually works.

[Esme12, ASN, BSN, RN]

I have successfully argued charges for things that were never done and "found" over sights or "mistakes" ..... I was thanked for finding the "clerical error".

I was once charged $150.00 for a spot O2 sat in a doctors office (a part of normal vital signs) for "interpretation" of the result. I called the office and told them I will use my own pocket O2 pulse ox for the vital signs in the future. I told them I was going to tell the insurance, and the state, about the bill padding and that they would have to drag the payment from my cold dead hands in a court of law.

The charge was removed and I was discharged from the service. Whatever

[Esme12, ASN, BSN, RN]

I am still fighting a bill for a work related exposure. They refuse to file with their workman's comp until I sign a release of responsibility. I'm NOT going to sign that release. They were responsible. Butt heads.

I get collection letters and I tell them I'll see them in court I'd LOVE to hear them explain why they aren't paying for a work related exposure and how they are not responsible.

I'll never see them in court they will be exposed for what happened and be in hot water with the state and OSHA.

[Esme12, ASN, BSN, RN]

Can you imagine how many poor patients just pay these bills and never know they are being ripped off? They disgust me.

[HouTx, BSN, MSN, EdD]

I have a nurse colleague who voluntarily helped a few older people in her church with healthcare issues... helping them untangle insurance, billing & other confusing stuff. Before long, she was inundated with requests for help & considered turning it into an entrepreneurial venture but did not follow through. But this (independent ombudsman, case management) may be a real opportunity for savvy nurses as things get even more complex.

Just a thought.

[nurseprnRN, BSN, RN]

There is an association of professional patient advocates. I spoke to their national meeting once. Many are lay people but a good number are entrepreneurial nurses. Grat business model, especially for elders whose family live states away.

[Alnitak7]

What I'm hoping to come up with is a list of options that a sick, low-income patient might have if they're being abused by their hospitals, practitioners or insurance companies.

As is already mentioned, this is a good income possibility for someone who knows what they're doing.

If a patient can't afford to pay an advocate and doesn't have a good PCP then they need a list of places where they could get help.

[toomuchbaloney]

I have long been an advocate of EVERY patient having a patient advocate (nurse) assigned to their case paid for by the insurer to protect them and advocate for them relative to their care and their financial responsibilities. We are the profession and discipline specifically trained to advocate for the patient in all areas of health care.