Medical Bill Help: Compare Healthcare Costs Before Proceeding With Treatment

The costs of medical and health care services have been rising steadily for many years, and American consumers are feeling the pinch in a big way. Many American individuals and families are now facing extremely high medical debts, some of them for fairly routine or minor health care procedures or treatments. With the private insurance system looking to offset costs, and very little in the way of a safety net for consumers, medical bankruptcy threatens many thousands of families each year.

Now, medical advocates are telling American patients to go a step further than many of them are accustomed to: new guidelines from experts in the industry suggest that consumers should be asking medical providers about how much a certain procedure, treatment or even a consultation may cost before they ever step in the door of the medical office.

Barriers to Asking Questions About Healthcare Services

In prior times, most patients were not used to asking their doctors what something would cost – there was a kind of intuitive understanding that since medical care is something that nobody wants to skimp on, it’s not a situation where prices can be negotiated. Over time, that led up to a system where insurance plans, largely those provided by group employers, covered major costs, leaving a patient with a straightforward co-pay or deductible that would represent their total financial responsibility.

These days, even a group plan doesn’t protect the average consumer from receiving extremely expensive medical bills after getting nearly any kind of health care service. Larger co-pays, larger deductibles and co-insurance mean looming costs for many Americans as medical costs continue to skyrocket and other issues like deceptive out of network charging leave many patients with much more debt than they thought they were going to incur when they arrived at a hospital or other facility.

Can Americans Shop for Health Care?

What new reports are showing is that the best way to shop around for health care is to ask your insurance company. Most of the efforts at cataloging the various rates that different providers charge for services are done by big insurers like CIGNA, Anthem Blue Cross, and other multi-state insurance companies. Patients can also ask their insurance company which providers have a contractual plan that forces them to charge a certain set price for a given medical service.

Over time, this trend will probably continue, to the point where American patients routinely ask their insurance company to help them shop. For most enrolled members, the insurance company has a vested interest in that person getting the cheapest medical care possible. While these kinds of partnerships between private insurers and individual patients can help both parties to rack up less medical debt for the same kinds of treatments and procedures, there’s also a great need for more patient education, where consumer advocates are standing in for states and the federal government when it comes to providing fixes for a problem that is challenging the majority of American families today.

Do You Know Who Is a Patient Advocate?

When illness strikes or a medical need arises it is often suggested that a patient seek out an advocate. However, for many people their first response to this prompting is “Who Are Patient Advocates? What do they do?” and “Why would I need a patient advocate when medical caregivers are sworn to do no harm?”

The American Heritage Dictionary of the English Language defines the term advocate as a person who is a supporter or a defender, one who argues for a cause; a person who pleads on another’s behalf.

A patient advocate is an intercessor who speaks on the behalf of the patient, and at times the patient’s family. A patient advocate can be a professional or he or she can be a family member or friend of the patient. The purpose of this designated advocate is to make sure that the patient’s best interests are addressed, and then met. Further, this person is to be an ongoing source who directs the patient as he or she navigates the entire healthcare system, including but not limited to primary care providers, hospitals, treatment options, pharmaceutical needs, and any host of other concerns that a patient has throughout the treatment process.

Facing a doctor’s visit, ongoing treatment or a hospital stay, a patient may find themselves quickly overwhelmed and difficult challenges, particularly if they are navigating the healthcare process on their own. Whether the patient is embarking on a medical quest for information about their health or facing a medical crisis, an advocate will prove to be an important member of the patient’s healthcare team.

An advocate can be a family member or close friend, or can be a social worker provided by a hospital or a even specifically trained professional. No matter who the patient chooses to have as his or her advocate it is important that the advocate be a person that the patient feels at ease with, and with whom they feel they can openly share their needs or concerns.

There’s a long list of services health advocates might provide including:

  • Knowledge and understanding of the patient’s medical history, and medical needs
  • Track all medications which have been taken, and are newly prescribed
  • Keep records of the patients’ questions, the medical caregivers’ answers and any instructions which may be given to the patient.
  • Translate any information that the doctor, or the staff, gives that the patient does not understand
  • Make sure that the patient’s needs are recognized and then addressed to the patient’s satisfaction by the medical staff
  • Be on hand at all appointments, treatments or hospital stays if the patient is unable to adequately communicate

The most important attribute in a patient and his or her advocate’s relationship is communication. A patient first must decide what he or she wants and needs from a Patient Advocate. Once ongoing communication between patient and advocate is established all those involved in the caregiving process need to be informed of who the patient advocate is – this is required whether the advocate is a family member, an employed advocate or social worker. Everyone from medical professionals to pharmacists, from the nurses and the doctors, and other treatment specialists should be made aware that an advocate will be working in tandem with the patient and should be given any and all pertinent information regarding the patient’s case. With this relationship established the patient will be on their way to more personalized care.

Medical Fraud: A Big Dollar Concern

With reports about identity fraud making waves throughout the news media, it’s especially important for those looking at the American health care industry to consider a specific kind of identity fraud that can be especially expensive for victims. Medical fraud is commonly defined as any kind of identity theft that facilitates the use of insurance or medical information which allows for an unauthorized individual to get access to medical insurance, medical care or other services, or that in some cases, allows for false billing or funneling money directly from the victim to the fraud perpetrator. Learning more about it can help you avoid medical bankruptcies or other problems.

The Numbers on Medical Fraud

Although it may be more obscure than other types of fraud, for instance, credit card fraud, some reports estimate that medical identity theft affects almost two million people in America each year, with an overall monetary impact of over $40 billion. Experts also estimate the costs of medical fraud per victim at over $20,000. That means that this kind of fraud can destroy the budgets of many American consumers or families who become victims of this type of identity theft.

Common Scenarios

Experts suggest that some identity thieves pursue medical fraud in order to get insurance coverage through illegitimate means, while others may be looking to get their hands on prescription drugs that they will sell on the black market. But although these kinds of situations can hit consumers or families out of nowhere, other reports suggest that in many cases of medical fraud, there’s a gray area: the victims of these kinds of fraud may have let their family members misuse their medical information or otherwise been complicit in fraudulent claims or other types of identity theft.

Medical fraud is just one way that the average American family can find itself bogged down in medical debt or otherwise trapped in eternal debt cycles. In order to prevent these kinds of nightmare scenarios, it’s important to safeguard identity information and do regular credit checks and basic financial monitoring. You can also get help from third party medical advocates that understand the health care system and how to fight various kinds of financial challenges to make sure that you and your loved ones are not taken advantage of by a system that often generates extremely high costs. Talking to these types of agencies and organizations can help you gain a better idea of how to prevent medical fraud, unfair denials or bills, or any other financial struggle that could have been avoided through good documentation and vigilance. Get the facts and protect yourself against medical fraud and unfair medical debt for a better financial future.