doctors

How to Cut the Cost of a Hospital Stay

Aja McClanahan — Mon, 05 Feb 2018 09:30:08 +0000

Let's face it: No one wants to get sick or be in pain in a strange place. For this reason, going to the hospital can be an unpleasant experience. To add insult to injury, you can be faced with a huge bill once the whole ordeal is over.

Though going to the hospital may not be something you can avoid, you might be able to lessen the blow by cutting the cost of your stay. Here are some tips that could lower your final bill from the hospital. (See also: How to Handle a Massive Medical Bill)

Consult with your doctors

Before going to the hospital, ask your physician to explain, in detail, the services that will be rendered during your stay. Maria Townsend, an insurance adviser, says you should take it a step further and get this information in writing. "Get an itemized summary of treatment that will be provided during the hospital stay and send it to your insurance carrier for preapproval," she says.

You can also inform yourself ahead of time by researching the costs involved in certain medical procedures and treatments. Fair Health Consumer can help you get an estimate based on your location and whether or not you'll be going through insurance. By doing this research beforehand, when your bill comes, you can compare your initial estimate from your doctor and identify mistakes or charges that should not be on your bill.

Talk with your insurance

Once you are aware of the services your doctor is proposing and estimating, make sure every aspect of your care is covered and approved by your insurance. This alone can cut down on the prospect of a huge bill for your hospital stay.

For example, you need to know whether the physician (or anyone else) rendering services is in your insurance network. Alicia McElhaney, founder of She Spends, a money management website says, "Basically, what happens is that a hospital may be covered by your insurance, but a doctor working there may not be. As a result, you may receive bills for services from the doctor after receiving care."

If you find out that some service providers or facilities aren't covered under your insurance, ask for a list of providers and facilities that are. It might be a hassle to change doctors, but it could be a worthwhile activity that can save you a lot of money.

Shop around

If you've contacted your insurance and received a list of in-network providers and facilities, you may still want to compare prices for two or more options in your network. This can help you reduce your total out-of-pocket expense.

Another way to save money is by having lab work and X-rays done at clinics or imaging centers outside of the hospital. These services are almost always more expensive when performed in a hospital. If you are shopping these services around, clear this with your doctor first. You want to make sure that you are getting the exact diagnostic and imaging information they need to treat you effectively.

Be thrifty

There are a few money-saving methods that most people don't think about when staying in the hospital. You don't have to use every product or service that is provided to you.

For example, you can ask if the hospital will allow you to bring your own prescription or even nonprescription drugs. In some cases, you may save on both the cost of some drugs and the fee charged to administer them.

You might also be able to save on other things like meals or paper products you'll be given during your stay. The cost of even basic items like plastic baggies and tissues are inflated when passed on to patients.

Log your stay

While you are in the hospital, you should document every part of your stay. If you're not able to, ask a friend or relative to help you. Things you want to keep track of include how long you were in different places in the hospital and with whom: operating room, recovery, anesthesiologist, surgeon, etc.

You'll also want to document procedures and medications that were given to you. This way, if there are any errors on your bill, you'll have a log to help clear up errors. (See also: 6 Ways to Avoid Surprise Medical Bills)

Check your bill

Once the bill arrives, go through it with a fine-tooth comb, as medical bills sometimes contain errors. You'll want to check your bill against both your insurer's explanation of benefits and the log you kept for yourself during your hospital stay.

If things don't add up or you don't understand a charge on a bill, don't be shy about calling your insurer and the hospital. You can request an explanation or even a further break down of vague line items or anything categorized as miscellaneous.

For claims your insurance denies, follow up with the company to find out why. They should give you information on the next steps for getting your hospital stay covered. Depending on their response, you may have some recourse by following up with your doctor or appealing the decision with your insurer.

Negotiate with the hospital

It might be scary to get a hospital bill that seems larger than life, but it's not set in stone. Once the bill arrives, you can try to negotiate with the hospital a few different ways.

To begin, you can offer to pay your entire bill with cash. The hospital may also extend a discount if you pay at the time you receive the service. The hospital likely prefers cash to drawing out payments over an extended period of time or sending your account to collections for nonpayment.

The next thing you can do is ask for a payment plan. This may not technically reduce the amount of the bill, but it can reduce the blow to your pocketbook if you can't pay the entire bill at once. Plus, it doesn't hurt to ask for a discount anyway. Many times, the hospital is just happy to collect and is willing to make payment that much easier for you.

Another alternative is asking for financial assistance or charity care that could reduce your bill. There may be an application process to be eligible, but it's worth a shot if it means you don't have to pay the entire amount billed to you. (See also: 7 Ways to Negotiate Medical Bills)

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This article is from Aja McClanahan of Wise Bread, an award-winning personal finance and credit card comparison website. Read more great articles from Wise Bread:

The One Question You Need to Answer to Choose the Best Health Care Plan

Christa Avampato — Tue, 08 Aug 2017 09:00:06 +0000

Health insurance: That term alone may be enough to give you a headache, considering all of its confusing language, acronyms, high costs, and pages upon pages of fine print. If you're feeling lost, you aren't alone — and I'm here to help.

As someone who has purchased their own insurance from health care marketplaces in several states, and worked professionally for a health insurance company, I've learned quite a bit about buying health insurance. Here are the main points you need to know to choose the best insurance plan for you and your family.

The two main health care costs

Health care costs are broken down into two main categories: fixed monthly costs and variable service costs.

1. Fixed monthly costs

Your health care bill is a fixed monthly cost that you pay in order to keep your insurance in good standing. Your bill is often referred to as your "premium" or "monthly premium." It may change from year to year, but within a given calendar year, it's the same every month provided you don't have any life changes such as adding a new dependent to your plan.

It's critically important that you pay this monthly charge every month when it's due. If you miss a payment or multiple payments, the insurance company could cancel your coverage or charge you a late fee. If you're having trouble paying your monthly premium, ask for help. Call your insurance company. There are often programs and payment options to help you manage your payments and keep your insurance active.

2. Variable service costs

These are costs that you will pay when you receive medical services such as doctor visits, prescriptions, visits to the emergency room or hospitalizations, and lab tests, just to name a few. The costs to you for these services depend upon your insurance and the provider of those services such as the doctor or pharmacy you use. When you pay these costs, they count against something called your deductible.

Your deductible is the amount of money set by your insurance plan that you must pay before insurance contributes money to your medical costs.

Your copay is the amount of money you must pay upfront to a service provider before you can receive care, medication, or tests.

An example of how all of these costs work together

Let's say you sign up with ABC health insurance company. These are the terms of the plan:

Monthly premium: $100.
Variable costs: $25 copay for a visit to your doctor (often called your primary care physician or PCP), $200 copay for a visit to the ER, $10 copay for prescriptions.
Deductible: $1,000 in-network, $2,000 out-of-network. In-network means that a provider is approved by the insurance company. As a general rule, you should check to see if all of your providers are in-network with your insurance company, because in-network providers will be cheaper for you than out-of-network providers.

Every month, you must pay the $100 premium, whether or not you receive any medical care that month.

Now let's say you get a bad cold. You go to the doctor and they write you a prescription for some medicine to help you manage the congestion in your nose and chest. They're also a little concerned that this is more than just a cold, so they recommend a few tests from an in-network lab. Since you are feeling very sick, you agree to the lab tests. You pay the $25 copay to the doctor for the visit, and the $10 copay at your pharmacy for the prescription. Total variable costs so far are $35.

The lab tests come back and it turns out you have an infection and need a second prescription. You pay another $10 copay to your pharmacist for the second medication, and the lab that ran the tests sends you a bill for $50. Total variable costs are now a total of $95.

Now what about the deductible? Copays usually do not count toward your deductible, but billed costs do. Let's say this is the first time you're seeing a doctor this year. You can count your $50 lab cost against your $1,000 in-network deductible because the lab that ran the tests is in-network.

Because you haven't yet hit the $1,000 in-network deductible of medical expenses, you must pay the lab the $50 for your lab tests. Your insurance doesn't cover any of that cost so long as your total billed in-network provider costs for the year (not counting copays) are below $1,000. Insurance does not cover any of your copays — you are responsible for those costs as well.

The one question you need to answer to choose the right plan

Health care is a complicated industry. There is one main question you need to answer to choose the right plan for you on the exchange: Would you rather pay a higher fixed monthly premium and pay lower costs for a serious illness or injury, or would you rather have a lower monthly premium and pay higher costs for a serious illness or injury?

Once you answer that question, you significantly narrow down your choices and the decision becomes much simpler.

Narrowing down your choices

If you need some help answering the question above, here is a way to break it down into two smaller questions.

1. What is your risk tolerance?

You have to be able to sleep at night. If you are worried about a high monthly premium and not too worried about your potential for getting sick or having some kind of accident, then you could choose a higher-deductible plan with a lower monthly fee and higher service fees. If you would rather have the peace of mind of a lower-deductible plan with higher monthly fees and lower service fees, then a high monthly premium plan may be better for you. That is a very personal choice and there are no right or wrong answers.

2. How much financial flexibility do you have if you get sick or injured?

Another point to consider is your financial flexibility. In the event that you become sick or have an accident, do you have a substantial enough savings to cover high medical costs? If so, then you may be just fine with a plan that is cheaper on a monthly basis and has higher fees and a higher deductible. If you don't have significant savings for services, but you do have money to cover a higher monthly premium, then a more expensive plan upfront may be better for you.

What's covered in every plan (for now)

For now, the Affordable Care Act (commonly called the ACA or "Obamacare") is the law of the land. When it was passed in 2010, it included a required set of services that all health insurance plans on the marketplace (also called "the exchange") must include.

That means that all of these services must be offered by all plans that wish to be a part of the marketplace. It does not mean that these services are free of charge. It just means that they have to be offered as part of the bundle of services, and there can be costs to you associated with them.

The mandatory services, as long as the ACA is in effect, are:

Ambulatory patient services. This includes any service outside of a hospital such as visits to a doctor's office, a clinic, or urgent care center.
Chronic disease treatment. Chronic conditions are illnesses that must be consistently treated to prevent or slow their progression, but may never be fully cured. These include conditions such as diabetes and high blood pressure.
Emergency services.
Hospitalization.
Laboratory services. Lab services include all tests that help doctors diagnose your illness or condition. Blood work is an example of a lab service.
Maternity and newborn care.
Mental health services and addiction treatment. This includes services in which you go for an office visit to a therapist as well as services that require you to check in to a facility for multiple days of treatment (known as inpatient services).
Rehabilitative services and devices. This includes services that help you to recover from a mental or physical illness, injury, disability, or chronic condition. It may be inpatient or outpatient depending upon the recommendation by your physician.
Pediatric services. This includes checkups, vaccines and immunizations, dental care, and vision care.
Prescription drugs.
Preventive and wellness services. This includes physicals, immunizations, and screenings such as mammograms and colonoscopies that are meant to prevent and/or detect certain medical conditions that would need treatment. For women, this also includes annual visits to a gynecologist. Many times these services are included in the insurance plan with no extra fee other than a copay provided you go to a service provider who is in-network.

Remember, no matter which plan you choose on the exchange, it must include some provision for these services though the costs to you for providing them may vary significantly from plan to plan.

The main drivers of your health insurance costs

There are several factors that determine your monthly charge from the insurance company.

Your age.
Your home address. Where you live makes a difference in cost, for now, so you must go to the marketplace that is associated with the state in which you live. HealthCare.gov will tell you which exchange is yours based on the ZIP code you enter. You will then be able to see the plans available to you.
How many dependents you want to cover, if any.
Whether or not you smoke. Some states have an extra charge if you are a smoker.
The insurance company you choose. Exchanges can have more than one insurance company in the marketplace.

The health care exchanges do an excellent job of giving you side-by-side, apples-to-apples comparisons between different plans. If it's too much for you to figure out online, call your state exchange directly. They have excellent customer service representatives who are very knowledgeable and will help you through the online application. Be well.

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This article is from Christa Avampato of Wise Bread, an award-winning personal finance and credit card comparison website. Read more great articles from Wise Bread:

How to Handle a Massive Medical Bill

Alaina Tweddale — Fri, 05 May 2017 08:30:12 +0000

"Have you noticed that your neck appears swollen?" That's what the nurse practitioner asked about halfway through what I had assumed was a routine office visit.

Soon after, I was swiftly catapulted into a long series of office visits that were anything but routine. There were ultrasounds, biopsies, consults with specialists, an invasive surgery, an overnight stay in the hospital, and eventually, the ok from my docs to go about living a normal life.

That's when the medical bills started rolling in.

Turns out I could kick thyroid cancer to the curb, but it wouldn't be cheap. Medical care is expensive, not just for me, but also for the one in four American adults under age 65 who have past-due medical bills, according to a recent study released by the Urban Institute.

Still, knowledge is power. At least, it is according to the same Urban Institute study, which reported, "Adults with greater financial knowledge are less likely to have past-due medical debt."

That's good news for Wise Bread readers, who are keenly interested in the fate of their financial futures. Even so, a surprise bill, particularly a large one, can take even the most educated saver by surprise. The silver lining here is that there are several specific steps you can take to help minimize the pain that often comes with the arrival of an unexpected medical expense. (See also: What to Do If You're Hit With a Huge Medical Bill)

1. Scrutinize your bill

According to various sources, as many as eight in 10 medical bills contain some sort of error — sometimes even multiple errors. I'm not surprised. Mine sure did.

When that first hospital bill arrived, it was for more than my annual deductible. A lot more. After suffering what felt like a small panic attack, I called my insurance company. As it turned out, they hadn't received a bill from the hospital. Instead, the hospital had billed me directly.

It took a few frustrating phone calls, but the hospital ultimately fixed the mistake. Still, had the bill been for a less egregious amount, I may have overlooked the error and just paid it. I mean, how many of us scour the line items of those bills?

Turns out, we should.

"Sometimes, insurance companies or doctors' offices make mistakes that they don't realize," says financial coach Maggie Germano. "They may have simply miscoded something. It's up to you to follow up and make sure they aren't charging you when they shouldn't be."

2. Negotiate with your health care provider

Looking over an itemized hospital bill is not for the weak of heart. Mine included shocking over-the-top expenses, like $27,000 for three hours in the operating room, $15,000 for an overnight stay in a recovery room, and $108 for a single dose of calcium.

Those inflated fees are all part of an elaborate dance between health care providers and insurance giants. Insurance companies don't often pay the amount that gets printed on those statements. Instead, they use it as a jumping off point for reimbursement negotiations. Sadly, it's those without health care coverage who often get stuck in this line of medical bill crossfire.

"Hospitals are always complaining that they're not reimbursed enough money from the health insurance companies, and therefore increase fees as high as possible," says Adria Gross, founder of MedWise Insurance Advocacy.

Uninsured or underinsured patients typically don't have anyone behind the scenes who can negotiate those fees on their behalf. Instead, they have to advocate for themselves.

According to money-saving expert Andrea Woroch, health care providers are not likely to negotiate costs if you have health insurance. But if you're uninsured, you may be able to talk your bill down by 10 to 20 percent. That's why it never hurts to get connected with the customer service department — no matter how long the wait or arduous the phone tree — and ask for a break. Woroch notes that some centers will even give a discount if you offer to pay in cash. (See also: 7 Ways to Negotiate Medical Bills)

3. Get smart about the actual cost of your procedure

Still, negotiating a medical bill isn't as easy as "ask and ye shall receive." It helps to come to the table prepared with "the usual, reasonable, and customary charges" for your particular medical procedure, says Gross. The first step is to track down the procedure code for the service you've been billed for. A quick internet search should do the trick. Then, check out an online database to start searching for the fair fee associated with your procedure. (Gross recommends Fair Health Consumer and Healthcare Bluebook.)

Gross says that finding that number — before you call — can help you determine whether you've been overbilled so you can fight to correct the charges.

4. Request a payment plan

If you still can't afford the bill, Germano suggests asking your doctor to set up a payment plan. "Most medical centers just want to get paid eventually, so they should work with you to make it easier for you to pay," she says.

The key to this strategy is figuring out how much of the bill you can afford to pay each month. You'll likely be paying it for a while, so make sure you can commit to this amount for the long-term.

"Get the agreement in writing, and make sure they send you a confirmation email or letter whenever you make a payment," warns Germano. Then, keep careful track of your payments along the way. "That will prevent them from accusing you of not paying what you owe," she adds.

It will also ensure that the bill doesn't get sent to collections, which will damage your credit score.

5. Plan for the future

Medical surprises happen, no matter how healthy you think you are. (Trust me on this one. No one was more surprised by my diagnosis than me.) Keeping a stash of cash on reserve in your Health Savings Account (HSA) or emergency savings may just save your future self from a couple of missed mortgage payments. (See also: How an HSA Saves You Money)

As Ben Franklin once wisely said, "An ounce of prevention is worth a pound of cure." That adage applies to your health, but also to what's in your pocketbook.

Start planning now, so you'll be prepared when the unexpected strikes. And if it doesn't? Well, it never hurts to have a few extra bucks in the bank.

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This article is from Alaina Tweddale of Wise Bread, an award-winning personal finance and credit card comparison website. Read more great articles from Wise Bread:

Women Pay More for Health Care — Here's How to Pay Less

Mikey Rox — Thu, 12 Jan 2017 10:00:11 +0000

It's no secret that a variety of factors can affect your health care costs. For example, people who smoke usually pay more for health insurance, and an unhealthy lifestyle can increase the risk of chronic illnesses and lead to more trips to see the doctor. But among the many factors triggering higher health care costs, it's being a woman that's perhaps the most obnoxious.

Before the Affordable Care Act, women buying health insurance on the individual market paid premiums as much as 50% higher than men due to gender rating, a practice where health insurance providers charged women more because they were considered a higher risk. Gender rating is now illegal, but this doesn't mean women are saving big bucks on health care costs.

According to data provided by the health care company Vitals, women spend on average 69% more out-of-pocket than their male counterparts for health care. That's a huge difference — even from the now-abolished gender rating system. Considering how women statistically earn less than men in just about every occupation, many women feel the pinch. But the question remains, why do women pay more, and what can they do about it?

Women Use More health Care Services

Compared to men, women typically use more health care services, which could explain higher health care costs. Go figure. They're more likely to ask questions about their health, get routine screenings, and schedule appointments when sick. Being proactive helps women maintain their health, but it comes at a cost.

Additionally, some women experience higher health care costs because of certain procedures, including gynecologic surgeries. Women are also six times more likely to have knee replacement surgery — a cost that can soar up to $65,000 — and women are two times more likely to develop cataracts, which can cost up to $5,000 per eye to correct.

And let's not forget the cost of labor and delivery for women. That's big business with the average national cost for a routine delivery at $8,775, and the average for a C-section at $11,525. (Worse, this number doesn't include prenatal care or post-delivery care.) And even if women have health insurance, high deductibles typically mean paying a large percentage of services out-of-pocket.

Women Live Longer Than Men

Women also pay more for health care because they live on average two years longer than men. That's an extra two years of paying health insurance premiums and out-of-pocket costs for health care services. Even if a woman is healthy during her younger years, she may develop at least one ailment later in life that requires regular doctor visits, especially as she moves closer to retirement age. Studies suggest that a 55-year-old healthy woman retiring today would spend about $79,000 more than a similar man on health care costs during her final years.

How Can Women Protect Themselves From Higher Costs?

When it comes to the cost of health care, it is what it is — but there are plenty of ways for women to prepare and possibly reduce their expense.

Don't Ignore Health Screenings

Preventive care reduces risk factors that trigger many chronic illnesses and can thus lower overall health care costs. Under the Affordable Care Act, you don't have to pay for many preventive care services delivered by a doctor or medical facility within your insurance company's network. These include immunizations, annual physical examinations, colonoscopies, mammograms, and other screenings.

Make Healthy Choices

A healthy lifestyle can also reduce your number of trips to the doctor. Eat a healthy diet of fruits, vegetables, low-fat foods, and lean meats. Exercise for at least 30 minutes three times a week. Apply sunscreen when outdoors to reduce your risk of skin cancer and stay physically fit during your retirement years.

Compare the Cost of Services

To lower your health care costs, compare the cost of services at different facilities. You'll find that some facilities within your insurer's network charge significantly different prices for the same services. For example, an in-network hospital may charge $1,500 for an overnight sleep study whereas an in-network sleep clinic may only charge $600 for the same study.

Don't Underestimate Health Care Costs

Prepare for health care costs now and in the future. This includes having adequate health care coverage to reduce your out-of-pocket expenses — as much coverage as you can afford based on your present health care needs. And while you're saving for retirement, don't forget to plan for future health care costs. Women who live longer than their spouses are left to manage health care costs on their own. Therefore, look into purchasing long-term care insurance. Don't wait until you are ready to retire to buy a policy; it's more expensive once you're at that stage of your life. If you lock in a price while you're young and relatively healthy, however, you'll pay lower premiums over the long-term.

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This article is from Mikey Rox of Wise Bread, an award-winning personal finance and credit card comparison website. Read more great articles from Wise Bread:

Health Insurance: How to Fight Back Against 4 Common Claim Denials

Anum Yoon — Tue, 20 Dec 2016 11:00:15 +0000

Denials of medical claims are all too frequent. Roughly 14% of all claims are denied every year, according to Department of Labor records. Not only that, but almost 10% of claims processed by insurance companies contain errors. Your claim could have been denied because it was coded as a different procedure than what you received from the doctor!

There is a silver lining in the clouds of denial or error, however. You can always appeal a health care claim denial. Patients who appeal win about 50% of the time. Not only that, but the more familiar with health care claims you become, the more you will learn about what's covered — and what is not.

The passage of the Affordable Care Act (ACA) increased rights to appeal, whether you are covered under ACA or not. Think of it this way: You or your employer, or both, are already paying a hefty price for health care. Appealing your denial and knowing how to determine errors is part of getting what you and your company have already paid for.

Before You Appeal: Know the Codes and How to Appeal

Any appeal to a health insurance company has to contain some basic knowledge of the information they provide you, as well as your rights.

After a visit to a physician's office or a procedure, you will receive a form called an Explanation of Benefits (EOB) from the insurance company. An EOB arrives for all claims, approved or denied. It details what was charged, what the insurance company paid, and sometimes a remainder of what the patient is responsible for.

If a claim was denied, it will receive a code. Most insurance companies provide a key to the code. (Check the back of the form.) If it does not, call and ask the insurance company what the code means.

The Four Most Commonly Denied Claims

At times, knowing the code will immediately help you appeal a denial. Sometimes the denial is the result of sheer error. Here are the four most commonly denied claims.

1. Your Plan Does Not Cover the Procedure

If the code indicates that the denial occurred because the plan did not cover the procedure, check your plan to see if it is, in fact, covered. If you received a vaccination, for example, double check what kinds of services your plan covers. Many plans cover preventive care (care received to prevent disease before it begins, rather than to treat a condition that exists). Vaccinations and flu shots are both examples of preventive care. This type of denial is surprisingly common.

A similar situation can occur with vision claims. You may receive a denial stating that vision care is not covered. However, many policies cover eye care if it is needed medically. People with diabetes, for example, are covered for annual exams because the condition can affect vision, while regular eye exams are not. Plans can cover surgery for cataracts, but not eyeglasses.

Errors of this kind can be appealed fairly easily. If you were denied because of lack of coverage and the procedure was in fact covered, call the health insurance company. Be sure to make note of the name of the person you spoke to, their title, and the date.

2. Errors in Coding

Knowing the code can also help you discover a coding error. You may find that the code for the service doesn't actually match what you visited the doctor for. The procedure or diagnosis code could have been entered incorrectly. You should also check every piece of information, including your name, date of service, place of service, and provider number. If any of these are erroneous, it can result in a denial.

If you find a coding error, call the billing office of the doctor or hospital involved and ask them to resubmit the bill with the correct code. Again, it's vital to get the name of the person, their title, and the date.

3. Payment for a Procedure Was Included in the Allowance for a Related Procedure Performed the Same Day

Patients are not responsible for a charge like this. Call your provider's office and ask for an adjustment to the bill.

4. You've Reached the Maximum Amount of Times a Service Is Covered

Again, the best action is to double check your policy. Is it true that it is only covered a maximum amount of times? If there is a dollar limit, check it against what you received. Contact your insurance company in the case of any errors.

For a denial of this type, check what the provider's discount is as well. Many doctor's offices and suppliers contact an insurance company to set a price for goods and services that is less than the market rate. You could be charged the market rate unless you specifically follow up about the discount. Even if you are denied legitimately for the maximum number of times a service is covered, you are still eligible for the discount the provider offers.

Given the frequency of denials and related errors, it's wise to be on your guard every time a denial is issued. Don't assume the denial is correct! Appeal and follow up on your appeals as needed.

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7 Simple Ways to Protect Yourself From Medical Records Theft

Carrie Kirby — Fri, 28 Oct 2016 09:30:25 +0000

Hacker attacks on medical records are exploding, with more than 113 million health files stolen in 2015. Criminals are using health records to commit medical identity theft, a crime that causes even more suffering than financial identity theft.

Think having credit cards or a mortgage opened in your name is a nightmare? Maybe, but it's nothing compared to what victims of medical identity theft have suffered. Victims of this crime often suffer from financial fraud, just like those who have their credit cards compromised, says Ann Patterson, program director of the Medical Identity Fraud Alliance.

Resolving medical identity fraud is much more difficult than cleaning up a case of financial ID theft. The majority of medical ID theft victims reported spending an average of $13,500 on lawyer fees or medical bills in their names, compared to an average of just $55 to clean up financial ID theft, according to a 2015 Ponemon Institute survey. And with no centralized source to consult like a credit report, and no real-time alerts like banks and credit monitoring services, it may take a long time to even realize you're a victim of medical identity theft, Patterson warns.

Whether you have just received a discomfiting letter from your health care provider that a data breach has occurred, or you simply want to head off this kind of life disruption before it happens, here are seven steps you can take to protect yourself from medical ID theft.

1. Read Your Mail

Those explanation of benefits statements from doctors' offices and hospitals may not be light reading, but you should look at them, at the least to verify that you saw the provider named on the date listed. Also, if you get mail from an unfamiliar doctor's office, don't toss it out without reading it — what you might think is junk mail could actually be a bill taken out in your name by an identity thief.

2. Review Your Medical Records

One positive thing about medical records going online is that it makes it easier for patients to periodically check that all the procedures listed there were actually performed on you, and that the details listed match your identity. If your records aren't online, you can ask to check your file when you're at the doctor's office.

Reviewing medical records could be a matter of life and death, because "information, such as an allergy to penicillin, is often deleted from a patient's medical record when it is stolen by a hacker or used by a buyer," warns the Institute for Critical Infrastructure Technology in a report that was presented to the US Senate in September.

3. Ask About Safeguards

Whether it's your doctor's office or your kids' school collecting data about your family, ask what happens to the paperwork you fill out. Is it shredded after being entered into a database, or tossed into the recycling? What kind of security protects those databases?

4. Don't Always Do as You're Told

Medical forms frequently ask for the patient's social security number. Patterson leaves that line blank, and if challenged, she explains that the omission is for privacy reasons. "I have yet to be refused medical care because I refused to provide my Social Security number," she says.

5. Treat Health Information Like Financial Information

Just as you should shred your tax documents and bank statements before tossing them, you should shred your doctor's office visit receipts, prescription labels, and even destroy prescription bottles with information stickers on them, Patterson says.

And if you wouldn't post your bank account balance on social media, don't be so quick to divulge upcoming medical treatments either. While it might be hard to imagine the harm in asking for thoughts and prayers for an upcoming surgery, Patterson urges patients to look at their profile from a criminal's point of view.

"You're putting out free information to give a detailed profile of you," she says, such as what region you live in, what doctors you frequent, and what ailments you have. If a criminal knows you have cancer, for instance, they may be able to "buy painkillers in your name and not raise a red flag immediately, because it fits your profile," she says.

If you think it's okay to share such information because your posts are only seen by friends and family, consider that, according to the Ponemon Institute, about half of medical ID fraud is committed by people who know the legitimate account holder.

6. Use Monitoring Services When Offered

It's now common for health insurers and other providers who have been hacked to offer members free fraud monitoring services. Take advantage of the offer! Patterson says that less than half of consumers offered free subscriptions actually sign up. Although they monitor for financial fraud — they won't tell you that someone checked in as you at a hospital — the services can provide valuable red flags. For instance, if a fraudulent medical bill goes into collections, it will show up on your credit report, and therefore trigger a fraud monitoring alert.

7. Be Careful What You Tell Your App

There are lots of fitness and health monitoring apps and websites nowadays, and while it's fine to sign up for one, look into the company that made the product, and think carefully about how much personal health data you share with them.

"Most of these companies are not regulated in the same way as your health care provider or health plan to protect your personal health information," MIFA warns.

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This article is from Carrie Kirby of Wise Bread, an award-winning personal finance and credit card comparison website. Read more great articles from Wise Bread:

The One Time Short-Term Health Insurance Makes Sense

Dan Rafter — Wed, 04 Nov 2015 11:15:30 +0000

Sarah O'Leary, founder and chief executive officer of national health care consumer advocacy group Exhale Healthcare Advocates, says that you should only pay for short-term health insurance one time — when you have no other options.

"We call them Swiss-cheese policies," O'Leary said. "They are less expensive because you get what you are paying for. I don't recommend that anyone stay with a short-term policy for long. And I recommend that people only pay for one if they have absolutely no other choice."

What Is Short-Term Coverage?

As the name suggests, consumers aren't supposed to take out short-term health policies for a long time. The insurers that market these policies pitch them as insurance that consumers can use to bridge the gaps when, for whatever reason, they are between more traditional, long-term healthcare insurance policies.

Insurers say that the policies are right for consumers who are between jobs or for those who missed their employers' open enrollment periods and don't want to go months without health insurance coverage. Consumers who think that COBRA temporary insurance — which allows former employees to continue their health insurance coverage after leaving their jobs — is too expensive might consider signing up for short-term health insurance, too.

O'Leary, though, said that short-term health insurance should always be treated as a last option for consumers. COBRA insurance, if consumers can afford the higher premiums, is a better choice. And traditional long-term health insurance policies always provide better coverage.

Lack of Coverage

Short-term health insurance policies have become even less appealing under the Affordable Care Act. Since they have so many holes in coverage, they don't even meet the Affordable Care Act requirement that consumers carry adequate health insurance. Those relying on short-term health insurance policies will be subject to the same tax penalties as people who have no insurance.

Short-term health insurance policies usually don't cover maternity care, treatment for mental illnesses, routine office visits, or preventative care. Because they don't follow the mandates of the Affordable Care Act, short-term health policies also aren't required to provide coverage for pre-existing medical conditions.

"Maternity care and delivery usually aren't included. That's a big one," O'Leary said. "That can cost you up to $40,000 if you don't have the right coverage. You don't see much preventative care covered, either. The holes in these policies can add up to a lot of money."

The Last Resort

When do these policies make sense? O'Leary says that you should consider them only if you really don't have any other choices for insurance.

"These policies are better than no coverage at all," O'Leary said. "And that's about it."

Say you are switching jobs. You might sign up for a short-term health policy if you know that the gap in your insurance coverage will be especially brief. Some consumers would rather pay the lower premium prices that come with short-term insurance than the higher ones that come with COBRA, which provides far more comprehensive coverage.

Maybe you missed the open-enrollment period to sign up for a traditional health insurance policy, and you don't expect a qualifying life event in the near future that would allow you to sign up before the next open enrollment. A short-term health insurance policy will provide at least some coverage before that enrollment period rolls around again.

If you have no other choice but to take out a short-term health insurance policy, make sure to ask your provider exactly what coverage you are getting for your money. You don't want to be surprised by a big medical bill when you visit your doctor.

Have you ever relied on a short-term health insurance policy?

This article is from Dan Rafter of Wise Bread, an award-winning personal finance and credit card comparison website. Read more great articles from Wise Bread:

9 Ways to Save on Prescriptions

Paul Michael — Mon, 07 Sep 2015 13:00:31 +0000

If you look at the hard facts on prescription drug use in the U.S., almost half of Americans are taking one pill a day, while 10% of the population pops a staggering five or more pills daily. Meanwhile, health care costs continue to rise.

So, what can you do to cut the costs of your prescription drugs? Here are nine ways to slash the bills and save money on your medicines.

1. Double the Dosage

Asking your doctor for a higher dosage can turn a 90-day supply into a 180-day stash. It does involve a little extra work on your part, and you'll need to invest in a pill splitter to do the job properly. (These are usually under $10.) However, you must make sure that you can safely and effectively split the pill. The simplest way to check is to look for the line down the center. If it has that, it is designed to be split. Capsules absolutely will not work, so don't ask.

2. Get Generic Whenever You Can

Some people are sticklers for buying brand names, and in some cases they have every right to be. From foods and electronics, to jewelry and shoes, name brands are often more favorable. But when it comes to prescription drugs, it makes little sense to pay for a brand name when a generic is available. As MedicineNet.com explains, "Generic drugs are copies of brand-name drugs that have exactly the same dosage, intended use, effects, side effects, route of administration, risks, safety, and strength as the original drug. In other words, their pharmacological effects are exactly the same as those of their brand-name counterparts."

As you don't wear prescription drugs, or taste any difference, there is no reason to pay extra for a brand name. The only exception, of course, is if the generic version of the drug is not yet available. In that case, you really do have to pay through the nose.

3. Ask Your Doctor for Alternatives

When your doctor fills out a prescription, make sure and ask about alternatives to the medication they have recommended. There may be several different types of medication that will do the job, but some could differ vastly in price — especially if one is available as a generic, and the other one isn't. Don't leave the doctor's office until you know that you have options to work with. The difference could be hundreds of dollars a year.

4. Use a Discount Program

There are many different discount programs available nationwide, for people with and without health insurance. Many stores and pharmacies have discount and loyalty programs that you should definitely take advantage of, and they're usually free to join. There are also other ways to save, such as the NACo Program, Familywize, and special savings for seniors from the AARP.

5. Order in Bulk

One of the best ways to save money on your regular prescriptions (those you take month after month, year after year) is to buy in bulk and take advantage of big savings. For instance, Cigna's online pharmacy Tel-Drug is a very handy resource that can save you a lot of money. Most of the 90-day supplies are charged at a 60-day supply rate, saving you 33% every time you place an order. Shipping is usually free, unless you need the drugs at a rush speed.

6. Use Coupons

There are coupons for almost everything these days, and prescription drugs are no exception. You will find coupons at your doctor's office, the weekly circulars, and of course, online. Do not underestimate the efficacy of these coupons; although some are for only a few dollars, they can add up over the course of the year. And if you take multiple prescription drugs, the savings can really start to snowball.

7. Get Samples

This is a tricky one. On the one hand, samples are great because they're free. However, samples are also readily handed out by doctors as a way to get you started on a brand new drug that you may, or may not, want to take. It's common practice for drug companies to slightly change the formulation of a drug that is about to go generic, give it a new name, and charge a brand fee. But, they will give out free samples to get people to try it. So, talk to your doctor about the differences between the new drug, and the one that's similar (or almost identical) at a fraction of the cost. However, if you plan on taking that pill, the samples can sometimes add up to weeks, or even months, of free drugs.

8. Look Into "Extra Help"

If you are a Medicare beneficiary, you should definitely look into the government's Extra Help program. Applicants who qualify can look forward to around $4,000 of assistance every year, but you must fall below a certain income threshold, have limited resources, and reside in one of the 50 states or the District of Columbia. If you do qualify, it could be of enormous help.

9. Finally, You Could Try Canada, But…

It's illegal. For the moment. Yes, although it can save you a lot of money, buying any kind of prescription drugs from a pharmacy outside of the United States is against federal law. However, Congress is considering new legislation to allow Americans with valid prescriptions to purchase their medications from licensed Canadian pharmacies. Of course, this could all depend on the power and persuasion, not to mention the vast amount of money, that lobbyists for the U.S. drug companies will bring to the table.

How do you control the cost of prescription drugs?

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This article is from Paul Michael of Wise Bread, an award-winning personal finance and credit card comparison website. Read more great articles from Wise Bread:

7 Ways to Negotiate Medical Bills

Mikey Rox — Sat, 27 Jun 2015 00:24:32 +0000

When you've just had a medical procedure, you should be concentrating on recovery — not how you'll cover the bills. But what happens if you can't make a payment? While you can't make the bills disappear (unless you pay), you can probably reduce your financial burden if you know the right questions to ask. Get a leg up with these seven ways to negotiate your medical bills.

1. Learn to Spot Common Medical Billing Errors

I don't want to suggest that medical bills purposefully contain errors, but sometimes honest mistakes do occur, and you need to know how to spot them.

"Every procedure performed by a health care provider has a code that allows the provider to bill your insurance company," licensed health care attorney David J. Holt explains. "The issue with coding is that the average person has no idea what the codes mean."

To catch you up to speed, Holt deciphers the definitions behind some those codes for you.

Upcoding

A medical bill that is improperly charged as a different treatment, typically a more expensive one. This is most common when a name-brand medication is billed for a generic medication.

Unbundling

Where services that should be packaged together are split and billed separately. This is common when multiple medical tests are ordered, but all relate to one medical diagnosis.

Duplicate Billing

This is more common than you would expect. This is where you are billed multiple times for the same procedure, perhaps 25 times instead of 23.

Mismatched Coding

This is when the treatment code does not match the diagnosis. In this situation, the insurance company then denies the claim. The bill is sent back to the provider and will either be corrected or sent down to you, the patient.

Balance Billing

This is the leftover balance after the insurance company pays. All of the charges may be covered under your policy, so you may not actually owe this "leftover" amount. Uncommon, but still happens with automated billing processes.

In effect, you should question all charges and make sure the bill lines up with the actual treatment. It's important to be an educated patient.

Don't be afraid to "call your biller and health care provider to determine what a bill and code mean," Holt says. "It is your right as a patient and health care consumer to know what you are paying for."

2. Go Into a Procedure Knowledgeable of Fees

While knowing what the codes and charges on your bills actually mean is important, so is knowing all the fees you're incurring from your procedure. Because how will you know after the fact what's legit, if you didn't know beforehand?

There's nothing wrong with raising these question in the initial stages. Cheryl Reed, a representative for Angie's List, says the company has been advocating for years that patients need to be more empowered and bring their negotiating skills with them when they work with the medical community.

The first step is to get the quotes in writing. "If you're price shopping before you have a procedure done, get a signature, name, and title to go along with the price quoted," she says.

You also want to cover every doctor in the room.

"When getting prices, be sure you cover all fees associated with your procedure, rather than just the surgical costs — e.g. anesthesiologist, radiologist, laboratory costs, etc.," says Reed.

3. Ask If You Qualify for Discounts

There are very few instances when I'm buying something that I don't inquire about a discount. Many times it's under-the-radar savings that I would never know about unless I speak up. Such is the case with medical bills. There are discounts available in some situations — all you've got to do is ask.

"The doctor I go to is part of a hospital network that automatically gives you 10% off if you pay the bill over the phone," says Zina Kumok, whose frugal habits helped her pay off her student loans in full in three years. "You have to ask for the discount, but it's an easy way to save money."

Kumok also revealed another back-door tactic to lower the cost of medical bills — something called a charity care program, and it can save you big bucks if it's available to you.

"A lot of people probably qualify for some kind of charity care program," she says. "I applied for my doctor's program and found out that I'm eligible for a 30% discount after what my insurance covers. The key to saving money on medical bills is to ask. Usually providers won't tell you about any deals you can make. You have to be proactive and pursue any discounts you're eligible for."

4. Familiarize Yourself With Health Care Mumbo Jumbo

There's a lot of insider jargon associated with health care and insurance companies in general, and my opinion is that they're banking on you not knowing what much of it means, being too afraid to ask because you don't want to look uneducated, and then taking their word for it. You're doing yourself a major disservice by accepting your bills at face value. If you don't understand any part of it, question it; your wallet might thank you.

Holt knows that this problem is all-too-common, as he's dealt with plenty of patients who have fallen victim to it.

"How many Americans read through the entire health plan contract?," he asks. "Not many, and not knowing the terms may lead to thousands of dollars in medical bills because you were unaware of your coverage. Don't let this happen."

Here are few prominent terms with which you should absolutely familiarize yourself.

Deductible

This is the amount that you pay out-of-pocket for health care before your insurance starts to pay. For example, for a $2,000 deductible, you would need to pay $2,000 before your health insurance would start covering costs.

Co-pay

This is a certain dollar amount associated with a type of care. For example, you may need to pay $25 for every visit to a doctor.

Co-insurance

This is similar to the co-pay, but in this case, there is a percentage you will pay for a certain type of care. For example, you may need to pay 30% of the cost for an outpatient surgery. Therefore, your insurance would pay the remaining 70%.

In Network vs. Out of Network

In-network refers to providers (hospitals/clinics) that are covered by your insurance and out-of-network means limited or no coverage by your insurance. Why doesn't your health insurance cover all providers? It saves them on costs. Health plans contract with specific groups of providers for group discounts. Other providers are "out-of-network" and have different coverage rates, or are not covered at all. You should avoid out-of-network care if possible.

5. Visit the Hospital's Billing Department

Spotted an error on your medical bill? Does something seem fishy? Don't brush it off and resolve to pay it just to save time. Because if it happens once, it's likely to happen again — and you need to nip that in the bud right away. Visit the hospital's billing department in person to sort it out.

Another reason you may want to visit in person is if you're having a hard time paying. Maybe there are no errors on the bill, but you just can't afford the monthly payment. Instead of letting yourself go deeper into debt with late fees and other charges, have a one-on-one conversation about your financial situation with the source. You may be surprised by what you can work out.

Chicago-based RN and patient advocate Teri Dreher advises her clients to do the same.

"My tip would be to go to the hospital's medical billing department directly if one is having a hard time paying," she says. "Even if you pay a small amount every month, they will not give the payment to collections. It's the person who does not pay at all that has the case go to collections."

"If your economic situation improves after a few months, sometimes one can negotiate for a portion of the bill to be forgiven if the remainder is paid in full," Dreher says. "I would also review the entire bill very carefully for accuracy as hospitals and physician offices often send out incorrect bills and charges. Accuracy is sometimes sacrificed for speed of getting the bills out."

6. Be Polite, But Not a Pushover

You know the old saying: You catch more flies with honey than vinegar. That's an important rule to remember when negotiating your medical bills. Being rude will get you nowhere. Be polite but persistent, and you'll find the negotiating process much easier to manage.

Holt offers a few suggestions on preparing for the phone call with your biller.

"Don't lose your composure on the phone; remain calm and objective," he says. "The biller is taking notes on your conversation. Clearly communicate your financial situation. Say, 'I am willing to pay something, but unable to pay the entire amount. Given my financial situation, what are the discounted payment options available for me?' Offer to pay a discounted percentage of the bill up front (say $100 today for a $500 bill). Hold strong here. Request for the payment terms to be as long as possible. Generally, you will have a maximum of two years from the original billing date to pay off your bill. Request an 'interest-free payment plan' for a discounted amount of the total bill. Health care providers are getting clever about collecting debt and offering all sorts of 'low interest medical-credit' plans. In reality, this is just a credit card with the health care provider. Since when did my health care provider also become my banker? I do not feel like that is right."

In other words, avoid the medical credit plan option at all costs; it's likely to cost you much more in the long run. Try to find a way to pay the bill down without accruing any more fees. If you can't afford the cost of the bill now, you definitely can't afford to start tacking on high interest fees to lower a monthly payment.

7. Call an Expert for Help

If you feel completely ill-prepared to negotiate your own medical bills, there are experts out there who can help you. These experts aren't free, of course, so you really need to weigh your options before calling in the big guns. Will these additional fees that the experts charge break even after the negotiations? It's hard to tell, so it's wise to proceed with caution in this area.

Nonetheless, Reed points out that these reviewed and trusted experts can be found on Angie's List.

"Medical billing is so complex that it's spawned a new industry of professional bill reviewers, sometimes called patient advocates," she says. "These specialists, who are rated on Angie's List, are trained to look for incorrect billing codes and duplicate charges. Experts say advocates can recover 17% to 49%, and charge an average contingency fee of about 30%. Some charge flat fees, as well."

Do you have other suggestions on how to negotiate medical bills? Let me know in the comments below.

This article is from Mikey Rox of Wise Bread, an award-winning personal finance and credit card comparison website. Read more great articles from Wise Bread: