FIVE WAYS HOSPITALS AND OTHER HEALTH CARE PROVIDERS TAKE MONEY OUT OF YOUR POCKET
The medical industry in the United States is one-sixth of the entire economy. Gone are the days when you could count on the sisters of charity to treat you fairly. Medicine is big business and you must protect yourself. Otherwise, you will be run over and end up in bankruptcy before you know it.
1. They bill your automobile insurance company directly.You absolutely, positively must submit ALL medical bills to your health insurance carrier after you are in an automobile collision. Regardless of how high your deductible may be, your health insurance is an asset you possess and, at a minimum, bills associated with an automobile collision will go toward that deductible.
Hospitals and health care providers want to receive the maximum amount of money they can for the services they provide. They will look to achieve this goal without considering the fact that it will hurt you and your family.
The method hospitals and other health care providers use for billing is incredibly complex. Hospitals receive funds from three major groups: 1) health insurance companies; 2) governmental entities; 3) individuals and automobile insurance carriers. Each group has different rules.
Because health insurance carriers make payments on behalf of tens of thousands of their policy holders, they have very real leverage over health care providers. In order to be a *preferred provider,* and have access to these tens of thousands of health insurance policy holders, health care providers enter into agreements with health insurance carriers. These agreements typically pay only 60 to 70% of the amount that is billed. Allowing the health care provider to bill the automobile insurance carrier is like shooting yourself in the foot. Submitting your bill to your health insurance provider reduces the amount of the bill, even if your health insurance carrier never pays a dime toward your bill.
If you receive Medicaid or are enrolled in Medicare, the health care provider will likely do everything it can to avoid submitting payment to either of these programs. As Medicaid continues to expand, health care providers have become more aggressive in receiving payment from automobile insurance companies. This is because Medicaid and Medicare oftentimes pay 40 to 50% of the amount billed by the medical care provider. This is particularly true of for-profit hospitals like Bozeman Deaconess. As explained below, we have seen providers, like Bozeman Deaconess regularly practice *balance billing* on Medicaid claims. This practice is illegal and the steps these carriers must follow are outlined in more detail below.
Finally, if you do not have health insurance and do not qualify for either Medicare or Medicaid, the applause you are hearing is the hospital*s billing department because the way you will be billed is a windfall. Hospitals never expect to have the entirety of their bill paid. When this happens, the 30 to 60% windfall in their anticipated revenue is cause for celebration. However, as my wife is fond of saying, *everything is negotiable.* You may still be able to negotiate your bill but only if the healthcare provider has not gotten its claws into the automobile insurance policy.
2. They refuse to bill your health insurance.Even though it is in violation of their contract with your health insurance carrier, hospitals and other healthcare providers will often refuse to bill your health insurance carrier. The billing process is done so quickly that you will likely not catch them until payment has been received by the automobile insurance company and now you have to pry the money out of their liver-spotted hands. This is nothing short of theft and hospitals know better. If you do not insist that your bills are paid by your health insurance provider, you can almost count on the hospital billing either your automobile insurance carrier or the automobile insurance carrier of the person that caused the collision.
3. They practice *balance billing.*Balance billing occurs when a hospital or other health care provider receives money from Medicare or Medicaid and then attempts to bill you or your family for the difference. In other words, the health care provider wants to *have its cake and eat it too.* The practice is illegal but that does not stop some health care providers.
Although health care providers cannot practice balance billing, they can forego payment from Medicaid either until the automobile claim is resolved or one year passes. If they do not make a claim within the one year (364 day) time period, their Medicaid claim will turn into a pumpkin and be lost forever. This is a risk most health care providers are not willing to take. Even if your claim does settle before the one year and the health insurance provider stand there with its liver spotted hand out, you can still negotiate a final settlement on the bill.
4. They refuse to accept your Medicare or Medicaid.Many types of treatment are simply not covered by either Medicare or Medicaid. For example, chiropractic care and acupuncture are not considered *traditional* medical treatment and Medicare and Medicaid do not usually cover this type of treatment. Unfortunately, these governmental health care programs would rather pay for opioids to treat your symptoms.
If your health care provider refuses to submit your bill to Medicaid, they are assuming the risk that your claim will be successful and you will receive funds. However, as explained above, you are free to negotiate your bill with that health care provider. Not only are health care providers generally risk adverse, they often do not do as well negotiating with me as they do by just accepting payment from Medicaid. I generally insist on the health care provider taking a reduction for attorney fees and costs that are commensurate with the amount they are billing. In addition, I reduce the amount owed by a percentage of funds that will need to be paid for future care. After including these factors, the health care provider typically receives less than the amount available by Medicaid.
5. They bill you after your automobile insurance settlement.This practice drives me absolutely crazy!!! Prior to settlement, our firm provides notice to health care providers that we are about to settle and we need their final bills. We notify them that we need these final bills to properly evaluate the claim. Even with this information, health care providers sometimes send us bills weeks and even months after the case has settled. When this occurs, we typically negotiate these late bills down to a fraction of the amount they are claiming.