Patient Protection

High Medical Bills?

2008-09-07T15:24:00.000-07:00

Have high medical bills? Read our previous blog posting "Lower Your Hospital Bills", then write to us by leaving a comment and we will try to help.

Sincerely,

The Patient Protectors

Finding A Good Doctor

2008-08-17T18:08:00.000-07:00

Having access to "insider information" about a particular physician is the best way to know if they are someone you can trust to take care of you and your family. That means knowing a medical professional who works along side a physician who can attest to their credibility. Unfortunately, most people can't get that type of inside scoop. But, maybe you can.... If your primary care physician (PCP) has personal knowledge of a physician's work, he or she may give you all the info. you need for a successful referral. If not, or if you are looking for a PCP, you can still do a little detective work to get an inside scoop. Start asking family and friends if they know a nurse, physician assistant, nurse practitioner, physician, etc. who may know a particular doctor. Maybe they know someone who knows someone..., and so on. I'll bet you can uncover a trail leading to someone who has, or can get, insider information about any doctor in your area. If you've tried and failed to get a personal reference about a physician, or if a the doctor you are researching is out of your area, then you need to do a little leg work (or, should I say, computer work).

Get on line at http://www.google.com/ and search for the state board of medicine web site where a particular physician practices. Just search for "pennsylvania state board of medicine".for example. Then, look on that site for a link allowing you to verify their license information. The link may be titled "verification" or "license verification". You can search by the physician's name and location. This will tell you if they have a license to practice in your state and if they are in good standing with the state board of medicine. You can also look for a link to a list of physicians who have had disciplinary actions taken against them by the board. You may also find this information by reviewing the state board's newsletter which may also list disciplinary actions taken against doctors.

Next, you should make sure the physician you are investigating is "board certified" in their specialty. This doesn't refer to the state board, but to the national board that certifies physicians in a particular field of medicine or surgery (i.e., "The American Board of Orthopaedic Surgeons"). Again, go to Google at http://www.google.com/ and search "orthopaedic board certification" or "hematology board certification", for example. You can search for a physician by name and location. It is in your best interest to see physicians who are board certified in the specialty that relates to the care you need.

After searching for professionals to give references on a physician, verifying a state license in good standing within your state and checking for national board certification in their specialty, you should ask around to see if you know any of this doctor's patients. Common sense would tell you if a physician is right for you by the way they are treated.

Once you have found a physician, you must continue to investigate him/her. Ask questions to find out if this doctor is right for you (listen to that gut feeling) and your health condition (does he/she treat your type of health problems on a regular basis, etc.). If it doesn't seem right, move on and continue the search for a physician who is right for you.

If you are looking for a specialist to treat a condition, but don't know what type of doctor would be appropriate, just ask your PCP or refer to the American Board of Medical Specialties at http://www.abms.org/ for more info.

It is up to you to do your homework and be an informed consumer when it comes to your health care. Don't shop for bargains. Remember, as with most things in life, you get what you pay for.

Sincerely,

The Patient Protectors

Surviving Weight-Loss (Bariatric) Surgery: Lifestyle Changes for Long Term Results

2008-08-08T16:30:00.000-07:00

Most people are familiar with the two most common weight-loss surgeries, gastric bypass and adjustable gastric band (Lap Band). Unfortunately, many people think they can have one of these surgical procedures and then eat whatever they want, not exercise and still lose weight. If you want to know the reality behind weight-loss surgery, keep reading. Otherwise just sit back on the couch, eat your chips and plan your fantasy surgery that won't yield long term results.

Still reading? Good! No matter what bariatric procedure you consider, long term success depends completely upon lifestyle changes. That's right, there is no way around the old "diet and exercise" thing. Anyone who tells you otherwise is either lying or just ignorant to the truth (that includes doctors). You may have heard stories of people who had gastric bypass and lost weight while they continued to eat bad food. If you can, follow-up on the stories to see how they did in the long term. After all, isn't that what you are after...long term results? You will most definitely find that they didn't lose as much weight as they hoped and, if you stay with the story long enough, started gaining their weight back!

All those who go into any weight loss venture, whether surgical or not, need to deal with the issues they have with food and accept the fact that they are overweight because they eat / drink too many calories. If you are overweight and say "I don't know why I'm overweight... I barely eat/drink anything", then you are kidding yourself. The only way to gain weight from fat is to take in more calories than you burn up.

Many overweight people overeat for comfort. Stress, anxiety, depression can all lead to comfort-seeking behavior. Some turn to sex, alcohol and/or drugs. No matter what your reasons, you must deal with the issues that are causing you to overeat/drink or you will not achieve long term weight loss results. If you feel a psychologist may help, then by all means work with your primary care physician to find one who can help you.

Another important factor in surviving weight-loss surgery is staying healthy while you lose weight. Let's face it, losing weight through surgery is not natural. Your body has been altered and, therefore you must make adjustments in your nutritional intake to compensate or else face malnutrition. Work with your physicians and a dietitian to get the proper diet/supplements you need, especially for gastric bypass surgery. The effects of malnourishment can be devastating on your body!! Also, gastric bypass patients are more prone to developing ulcers. For this reason, it is very important to avoid anything that can increase your risk of ulcers... smoking, excessive alcohol use, drug use, taking non-steroidal anti-inflammatory meds (ie: ibuprofen.), etc. Also, if your bariatric surgeon recommends it, take acid suppression medication to reduce your ulcer risk.

OK, let's first talk about the adjustable gastric band. I won't go into detail about the surgical procedure itself, but you can get that info. from the two companies producing and marketing bands in the United States (Allergan, which produces the "Lap Band"... http://www.lapband.com/ and Ethicon, which produces the "Realize Band"... http://www.realizeband.com/ ). I want to focus on the aftermath. So, a gastric banding procedure is performed to reduce your appetite (by providing pressure on the stomach) and restrict the quantity of food you can eat at any one sitting. You still need to improve the quality of food you eat because you will absorb the same amount of fat and calories in your diet as you did before the banding. If you read carefully, you noticed the phrase "...at any one sitting". If you decide to eat every two hours, then you may be eating as much food in a day as you did before the surgery. Also, foods that crumble (chips, cookies, popcorn, etc.) and foods that melt (ice cream, candy, etc,) go through the band easily so you can still eat them. Since you can still find ways to eat volumes of food (all be it in small portions) and still absorb all the fat and calories in bad foods, it makes sense that the only way to have long term weight-loss success with a band is to change what you eat as well as how much you eat.

Now, the gastric bypass (Roux-en-y Gastric Bypass) helps you to lose weight a little differently. You can get a description of the procedure at www.webmd.com/diet/weight-loss-surgery/gastric-bypass . With this surgery, your stomach is divided to create a small "pouch" which gives you portion control and hunger suppression. Also, your intestines are re-routed, so to speak, to cause poor absorption of fat and calories. Because of this poor absorption, many (but not all) gastric bypass patients get very sick if they eat foods with too much fat or sugar (Dumping Syndrome). All the above creates a recipe for rapid weight loss...for the first 18 months or so! In time, that gastric "pouch" (stomach) will stretch. How much it stretches depends upon how much food you try to put into it. It is very possible to stretch a gastric bypass pouch to a size that will allow a patient to eat as much as they did before surgery. Also, your intestines will adjust and begin to absorb more and more to the point that you will absorb fat and calories just as someone who has not had gastric bypass. So again, the only way to have long term weight-loss success with a gastric bypass is to change what you eat as well as how much you eat. Sensing a trend here?

Let's not forget exercise. Since you have to watch what you eat and how much you eat with both band and bypass surgeries, you will have to exercise regularly to achieve optimal weight loss and to keep the weight off !!

It's that simple...lifestyle changes for long term results.

I have your best interests at heart. Let me know what you think by leaving a comment.

Sincerely,

The Patient Protectors

Lower Your Hospital Bills

2008-08-03T13:15:00.000-07:00

Lets talk about hospital bills that can put most uninsured and under-insured people in the poor house...

It is no secret that hospitals charge outrageous amounts of money for services. One reason is because insurance companies reimburse hospitals as little as 30 cents on a dollar. That means a hospital charging $10,000 for services will receive approximately $3,000 from medicare or an insurance company as full payment. Unfortunately, hospitals have to charge patients with no insurance the same amount ($10,000 in this example) or they would be committing insurance fraud. This raises the obvious question...why don't hospitals accept 30 cents on a dollar as full payment from uninsured patients the same way they do from medicare and the private insurance industry? Well, hospitals claim that they give insurance carriers a volume discount which leaves uninsured or under-insured patients in a poor bargaining position.
Another problem with hospital billing is that of overcharges. Some call this bill "padding ". Whether or not this problem is intentional can be judged on an individual basis. In any case, this can present an even greater hardship for a patient who is having enough trouble paying their artificially inflated hospital bills.
Hospitals may not want the word to get out but they can, and sometimes will, negotiate payments with uninsured and under-insured patients. They know it is better to get a partial payment rather than nothing at all. Patients can also review their hospital records for inappropriate charges in order to reduce their debt. If you look in the right places, you can find large overcharges on many hospital bills. These two strategies can save you thousands of dollars.
Now, lets talk about the two choices you have to utilize these strategies. One way is to hire a lawyer or patient advocate who will work with the hospital on your behalf. They can, however, charge you a fee as high as 50% of the amount they save you. That means a $10,000 hospital bill with $2,000 in overcharges can cost you $1,000 in fees to the lawyer or advocate. That doesn't save you much money. Also, if they are successful in negotiating a lower fee settlement, you will pay even more. The second option is to do it yourself and get all the savings that are due to you. I can help you try for free.

Step #1 is to get an itemized bill from the hospital. This has all the charges listed by department as well as individual item. This will be several pages long and the hospital will provide it to you for free (by law they can't charge you).

Step #2 is to review the bill and focus on the "big ticket" items such as surgeries, diagnostic tests, number of days in the hospital/ICU, expensive drugs, etc. and record any discrepancies. You may have been charged for a procedure or test that was not performed, charged twice for the same test or procedure and even charged for too many days in the hospital or ICU. Make sure you review the itemized pharmacy bill for medications that you may not have been given and for ridiculous charges such as $20 for two Tylenol tablets. If you don't recognize the drug names, look them up on-line so you know why they are prescribed.

Step #3 is to review lesser charges and note any charges that you don't understand or items that you don't remember using while in the hospital.

Step # 4 is to call the billing department at the hospital to arrange a review of your medical record with hospital representatives (most likely from both the billing and medical record departments) to verify your claims of inappropriate or unclear charges. If the billing or medical record departments gives you a hard time, ask for the Director of Operations for that department. If you still can't get anywhere, call the main number of the hospital and ask to speak with a Patient Advocate, Customer Service Representative or Ombudsman. They will intercede for you.

Step #5 is to work with the billing/medical record reps. to have your charges adjusted. Just use common sense about the discrepancies. The burden of proof is on them to justify their charges.

Step #6 is to negotiate a settlement. If you can prove to the hospital that you can't pay the entire bill, they may accept a partial payment as full payment (remember, they accept as little as 30 cents on a dollar from the insurance companies as full payment). If you can pay in full, however, it would be appropriate for you to do so.

Step #7 is to negotiate a payment plan that you can realistically afford. If you make regular payments, they will keep it off your credit report and, most likely, not charge any interest.

Step #8 If you feel the hospital is billing you unfairly, you should contact your state's Office of the Attorney General to file a complaint.

I would like to hear from those of you who are uninsured or under-insured and have hospital bill debt. Let me know if the above steps helped to reduce your hospital bills.

It can be done!!!

Hope to hear from you soon.

Sincerely,

The Patient Protectors

P.S.
Those of you with insurance coverage can have your insurance company do all the above for you at no cost.