News about Consumer Medical Expense Management

5/27/2008 New York Times: S.E.C. Backs Health Care Balloting The Securities and Exchange Commission, shifting its position, has told companies they must allow shareholders to vote on a proposal for universal health insurance coverage.

5/6/2008 Wall Street Journal: Wal-Mart Widens Drug Discounts Wal-Mart Stores Inc. is expanding its cut-rate prescription-drug program and will sell 90-day supplies of more than 300 generic drugs for only $10. The retailer is also adding a second pricing tier to the discounted program for more-expensive medications geared toward women's health. It is adding $9 generic prescriptions for up to a 30-day supply on a handful of drugs for treating osteoporosis, breast cancer, menopause and hormone deficiency. For instance, 30-day prescriptions of alendronate, the generic version of osteoporosis medication Fosamax will be offered for $9 and a 90-day supply for $24, compared with the previous price of $54 and $102, respectively. Tamoxifen, a breast-cancer treatment, will sell for $9 for a 30-day supply.

4/19/2008 New York Times: Medicare Plans Affected by Rising Drug Costs Employers and patients in corporate health plans are not the only ones affected by the soaring prices of specialty drugs. Enrollees in Medicare drug plans are also feeling the pressure.

4/19/2008 New York Times: President Is Rebuffed on Program for Children The Bush administration violated federal law last year when it restricted states. ability to provide health insurance to children of middle-income families, and its new policy is therefore unenforceable, lawyers from the Government Accountability Office said Friday.

1/17/2008 New York State Child Health Plus New York Governor Eliot Spitzer's Executive Budget expands the State Children's Health Insurance Program (SCHIP). The budget provides funding to expand the State's version of SCHIP, Child Health Plus, by increasing income eligibility levels from 250 percent to 400 percent of the Federal Poverty Level, making New York's program one of the most comprehensive in the nation. Governor Spitzer made this announcement during his State of the State address and full details of the plan will be outlined in Governor Spitzer's Executive Budget Presentation on Tuesday, January 22, 2008.

1/15/2008 Wall Street Journal: Insurers Stop Paying for Care Linked to Errors As insurers roll out the policy across the country, they say they are structuring their contracts with hospitals so that the hospitals also won't be able to charge patients for care made necessary by medical errors. Given the high rate of medical billing errors, however, consumer advocates advise patients to examine their bills carefully, especially if they are aware of errors or problems that occurred during their stay. People with health insurance should check their bills against the explanation of benefits they receive from the health plan, or press their insurers to make sure they haven't been overcharged.

1/04/2008 Wall Street Journal: Major insurance companies claim that they'll pay for second-opinion breast-cancer tests
Breast-cancer patients may be getting the wrong treatment because of errors in two laboratory tests widely used to determine which drugs are prescribed. Several major private insurers, including UnitedHealth, Aetna Inc. and WellPoint Inc., say they will generally pay for second-opinion breast-cancer tests. However, few doctors order them.

2008 Bankrate.com:The Basics: 8 most common hospital billing errors Make no mistake about it: Making sure that all the charges on your hospital bill are justified and reasonable is a formidable undertaking. But it can be easier if you know what to look for.

• Duplicate billing: Make sure you haven't been charged twice for the same service, supplies or medications.
• Number of days in hospital: Check the dates of your admission and discharge. Were you charged for the discharge day? Most hospitals will charge for admission day, but not for day of discharge.
• Incorrect room charges: If you were in a semi-private room, make sure you're not being charged for a private.$100? $200? $300?
• Operating-room time: It's not uncommon for hospitals to bill for more time than you actually used. Compare the charge with your anesthesiologist's records.
• Up coding: Hospitals often shift the charge for a lower-cost service or medication to one that's more costly. For example, a doctor orders a generic drug, but the patient is charged for a pricier brand name.
• Keystroke error: A computer operator accidentally hits the wrong key on a keyboard. It can cost you hundreds of dollars and result in an incorrect charge for a service you didn't get.
• Canceled work: Your physician ordered an expensive test and then canceled it, but you were charged anyway.
• Services never rendered: Did you get every service, treatment and medication for which you are being billed? Here's where your log will come in handy.

SCHIP: State Children's Health Insurance Program (SCHIP) is extended
The extension of the State Children\'s Health Insurance Program is expected to provide states with enough money to cover those enrolled through March 2009. Bush and some Republican lawmakers say the program will still serve those that it should: children from families who earn too much to qualify for Medicaid but cannot afford private insurance.

IRS: What's New for 2007 Tax Returns for Medical Expenses
The standard mileage rate allowed for operating expenses for a car when you use it for medical reasons is 20 cents per mile.

Presidential Election 2008 and Healthcare
Learn more about the solutions for healthcare issues being offered by the candidates for the US Presidency.

11/01/2007 New York Times: Expecting Presidential Veto, Senate Passes Child Health Measure

10/18/2007 New York Times: House Sustains President's Veto on Child Health

10/14/2007 The Seattle Times: Families held hostage by health-care costs

10/17/2007 Los Angeles Times: Child health: to compromise or stand firm

10/4/2007 CNN Money: Health care: Fighting denied claims If your health insurer refuses to reimburse you for a claim, you're not alone. Denial of health care claims happens all the time. But we'll tell you how you can fight back against your insurer to get the coverage you deserve.

6/14/2007 CNN Money: Correcting medical billing snafus Should you notice something amiss in an invoice, she says, don't pay it. Instead, initiate a dispute by phoning the billing office, making sure to write down the time, date, name of person you speak with. Follow up with a letter, sent via certified mail, to the highest person in the department. (Once they have a written complaint, most providers halt the collections process until the case is closed.)

4/18/2006 NPR: Americans Paying for Medical Billing Errors The high cost of health care in America may be even higher than you think. Day to Day personal finance contributor Michelle Singletary speaks with Alex Chadwick about medical billing errors, and what consumers can do to make sure that they're not paying for those mistakes.

2/9/2006 CNN Money: Fight back: Malpractice in the billing department Between errors and bill padding, fighting a hospital overcharge or denied medical claim can take some smart strategies.

1. Know the codes

Your bill will be awash with medical shorthand for the treatment you received. There are two kinds of codes:

• Diagnostic codes (a.k.a. ICD-9 codes), which identify what was wrong with you
• Procedure codes (a.k.a. CPT codes), which describe what treatment you received
Coding problems can be the result of either blatant padding (one procedure to remove tonsils and adenoids is "unbundled" and billed as two separate procedures) or keystroke errors (one typo causes a mismatch between the ICD-9 and the CPT codes, and your claim is branded a "coding error" and rejected). If your claim bounces back or the bill seems high, ask the hospital or doctor for a thorough explanation of each and every code.
2. Be more prepared than they are

Everyone knows you're supposed to hang on to bills, but here's something most people miss: doctor's orders. Every time your physician prescribes something -- blood tests, X-rays, medication -- it's recorded in her standing orders.

You have a right to this stuff, so request a copy from the billing office. Keep it in a personal medical file, which should also include the following documents:

• Reports by any technician handling a procedure, as well as the nurses who administer medication or shuttle you around in your paper gown
• Itemized bills (request these from your doctors or hospital, possibly after your treatment visit)
• Your insurance paperwork
• Your own notes from each doctor visit

6/27/2004 Washington Post: Killer Billing Errors: Duplicate Charges. Faulty Totals. Your Hospital's Mistakes Can Ruin You Just about everyone agrees that the medical billing process makes little sense from a consumer's perspective. Prices vary wildly on procedures as routine as a root canal, even within the same community. One surgical procedure will generate a bill from the hospital, another bill from the surgeon, and more from the radiologist, the anesthesiologist and maybe a pathologist. Then there are those pesky pricing codes, attached to everything from a latex glove to a cotton swab. One slip of a keystroke by a billing clerk can dramatically alter the tally.