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Entries in Medical Bills (4)

Monday
Feb182013

Medical Bills Bankrupt Families of Mentally Ill Children

Comstock/Thinkstock(OMAHA, Neb.) -- Ted Morrissey, a middle-class Nebraska insurance agent with a good health care policy, has spent "hundreds of thousands of dollars" on treatments for his 16-year-old daughter who has complex mental health problems that get worse by the day. At the age of 5, Jaimie was diagnosed with Tourette syndrome, as well as accompanying obsessive-compulsive disorder.

"She had no control over her muscle movement, so we would wrap her in a sheet like a burrito just to keep her from straining her muscles," said her father.

Medication has helped, but it's also caused obesity. Teasing at school by students and teachers triggered life-threatening anorexia by the time she was 12, according to Morrissey. Refusing to eat, the teen developed a gastrointestinal disorder and required a feeding tube.

"We've been battling, doing nothing more than jumping hurdles and falling into pits for 11 years," he said. "This has milked us dry financially."

The Mental Health Parity and Addiction Equity Act, which was passed in 2008, tagged on to the financial bailout, mandates that health insurance benefits cover equally both mental health and medical services -- so that those with, say, depression are treated the same way as those with diabetes or AIDS.

The law, which went into effect in 2010, applies to both in-network and out-of-network care and hung its success on a coalition of lawmakers who all had been touched by mental illness.

But a study published on Monday in Pediatrics magazine suggests that this is not enough for struggling families.

The study provides the first empirical evidence that the law hailed as a victory for families does not "meaningfully improve" their financial protection. Costs have been reduced overall by about 5 percent, but the average savings is only about $178 a year.

"I think that we worry most about the sickest children," said lead author Colleen L. Barry, associate chair for research and practice at the Bloomberg School of Public Health at Johns Hopkins University in Baltimore, because their costs are the greatest.

"The concern is that [high out-of-pocket costs] inhibit treatment seeking and pose a barrier to families trying to get high quality treatment for their children," Barry told ABC News. "There are definitely cases of families being bankrupted from this, taking years to pay off medical expenditures, and making decisions for treatments motivated by cost of care."

Jaimie, which is not her real name to protect her privacy, suffers from anxiety so severe that she goes into a trance-like state called "conversion disorder." Sometimes her parents fear that she might become violent.

"She becomes so overwhelmed that her brain just shuts down and she passes out or goes into seizures," Morrissey said. "We never know when it's going to happen."

The teen has not been in school since September.

This week, she was to go to an expensive residential treatment facility in Durham, N.C., which is 1,200 miles from her home in Omaha. "It's hard to find a place that doesn't want $28,000 up front -- we are at the end of our rope financially."

The Morrisseys have been rejected by Social Security, disability and Medicaid and the out-of-pocket costs have added up, according to her father.

"We have nothing," said Morrissey. "Now I am worried about losing my home. This has been devastating."

The Morrisseys' insurance policy pays 80 percent of Jaimie's costs, but the bills have been overwhelming.

"If you have a $200,000 bill, you have to come up with $40,000 and try to pay that," said her father. "We pride [ourselves] in paying our bills, but you end up buying the groceries on credit."

An estimated 11 percent of children in the United States are affected by mental health and addiction disorders with significant costs, according to the study, and mental health disorders are the primary cause of hospital admissions for early teens.

Copyright 2013 ABC News Radio

Monday
Apr232012

Patients in the Dark on Medical Costs, Study Finds

Jupiterimages/Thinkstock(SAN FRANCISCO) -- A new study has put a spotlight on the astonishing disparities in what Americans pay for health care.  For example, an uncomplicated surgery to have the appendix removed could cost much more than you might think.

The vast difference in costs among hospitals for similar procedures was the focus of a new study by researchers at the University of California at San Francisco, whose findings were published Monday in the journal Archives of Internal Medicine. After reviewing charges from more than 19,000 patients, the researchers found that the cost for treatment of uncomplicated appendicitis ranged from $1,529 to a whopping $182,955. To put this in perspective, the price of a new Maserati is $130,000.

Health care transparency has been a topic of great debate. In a country where most of price-setting for other products is influenced by consumers, many experts said when it came to health care, U.S. consumers had no power. This, they said, was because they lacked fundamental knowledge necessary in a free-market economy -- the cost of the services for which they were paying.

The reasons for this are many. Few people understand the complexities of health care reimbursement, because how hospitals establish what patients are charged is only abstractly related to actual cost. Hospitals record supplies and services rendered during a hospital stay, and charge according to a fee schedule, or "chargemaster." But these amounts rarely reflect what hospitals actually receive as payment. Medicare and Medicaid payments are set by the government, while third-payer insurance prices are negotiated yearly for significantly reduced rates.

"There is no standard in the United States for reasonable prices or reference pricing," said lead study author Dr. Renee Hsia, associate professor of emergency medicine at the University of California at San Francisco. "If you go to a hospital, they can charge you whatever they want. Negotiated rates are trade secrets," she said.

"I see these issues every day," she said. "Regardless of what they are coming in for, the bill is going to be huge. Even if we can take care of them physically, financially, it could be devastating."

And devastating it is for millions of Americans. In a 2007 study by Harvard Medical School and Ohio University researchers, 62.1 percent of bankruptcies were medically related. Most of these happened to well-educated Americans who owned their homes and were in middle-class occupations. Not all these families were struck by devastating cancer or incurable disease. Hsia's findings suggested that it was possible that even a routine procedure could produce a bill in the hundreds of thousands of dollars.

"No one is protected," Hsia said. "Even with insurance, it is a crazy and secret system"

Others working in the field suggested there was no simple solution.

"Consumer empowerment can only occur if prospective patients actually have easy access to user-friendly, reliable information," Princeton economist Uwe Reinhardt explained in his 2006 article, "The Pricing of U.S. Hospital Services: Chaos Behind a Veil of Secrecy."

In 2006, California started to require hospitals to publish average charges for common procedures. However, these charges were rarely posted on hospital websites, making the information difficult to obtain. Furthermore, published charges rarely reflect negotiated payments.

Meanwhile, numerous websites have popped up allowing consumers to search for the average prices of common medical procedures and services according to ZIP codes. And a select few hospitals and insurance companies have made treatment cost estimators available to help patents prepare for upcoming hospital bills.

Despite these efforts, not much has changed to help patients become informed consumers.

Copyright 2012 ABC News Radio 

Wednesday
Sep072011

Want a Lower Medical Bill? Just Ask

Comstock/Thinkstock(YONKERS, N.Y.) -- The economy has left millions unemployed and mounting medical costs have put millions in debt. With financial hardships in mind, a new Consumer Reports column suggests ways to become a savvy health care buyer and haggler.

"I have become impressed with how often American households are unable to afford their medical bills and medications, and they're doing various things, like not taking their medications or taking someone else's, because they can't afford them," said Dr. John Santa, director of the Consumer Reports Health Ratings Center and author of the column.

Because of this, Santa noted that the best time to talk to doctors about medical bills and financial limits is before a patient has incurred any costs.

"It helps to know from folks the degree to which financial issues are a stress for them, especially related to health," Santa said.  "This works best if the physician is aware of this from the start.  If you're struggling to keep your head above water, tell the doctor anything he can do to moderate cost is appreciated."

For many medical conditions, there is a wide range of ways to diagnose and treat the problem and the treatments can vary "enormously" in cost, experts said.

"This recommendation makes sense to me in today's world," said Alan Sager, professor of health policy and management at Massachusetts Institute of Technology.  "In a more reasonable world, of course, all patients would be insured and all would pay the same price for the same care.  And doctors and hospitals would be financially neutral, liberating them to recommend care in light of its clinical value."

When an unexpected exorbitant bill gets handed to a patient, Santa recommends speaking with the doctor who recommended the procedure or treatment to understand why the costs are so high.

And don't ever assume the price on the bill is set in stone.  On average, the hospitals' total charges to patients and insurers are triple the average cost of actually delivering hospital care to the patient, Sager noted.  Uninsured patients are usually charged the highest price, which is the hospital's list price for different treatments and tests.

"That's because no big insurance company or Medicare plan is available to negotiate a lower price," Sager said.  "Hospitals usually offer to discount their initial bill by 10 to 20 percent from those very high charges when the patient simply asks.  That can be offered by the billing or patient accounts department."

For patients hit with an extremely high bill, Sager recommended bypassing the billing department and calling the hospital CEO's office directly.  Explain the problem and ask for help, he said.

Copyright 2011 ABC News Radio

Friday
Aug192011

High Court Hands Down Landmark Ruling for Insurance Companies

Brand X Pictures/Thinkstock(SAN DIEGO) -- The California Supreme Court ruled in favor of insurers Thursday in a case that promises to impact the legal landscape of medical damage civil suits.

In Howell v. Hamilton Meats & Provisions, the court voted 6-1 in favor of restricting whether an injured party can recover full medical costs billed by doctors and hospitals. The court ruled an accident victim can only recoup the discounted figures the victim's insurer negotiates with health care providers.

Rebecca Howell, injured when a Hamilton Meats truck made an illegal turn and slammed into her car, was seeking the full $190,000 in hospital fees billed to the insurer. However, the court overruled a previous decision in the case that limited her to the $60,000 the hospitals agreed to bill to her insurer.

While the decision is being hailed as a victory for insurance companies and business groups, it is seen as a devastating ruling to consumer rights and personal injury lawyers.

Copyright 2011 ABC News Radio







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