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.

Be Your Own Medical Advocate

I had been having many medical issues starting at the age of 27 that not any one doctor could really put their finger on and definitively diagnose. I was told by a handful of doctors, what they thought was wrong. I ended up hearing things that ranged from being pre-menopausal to slightly depressed. I even ended up seeing a psychologist to be sure it wasn’t depression. How silly is that? In February of 2007 I ended up seeing a surgeon in University of Penn in Philadelphia. I was told I had to have my thyroid removed due to a goiter. Naturally, being in shock, I go home and research the thyroid function and read all the information I can about it. I then begin to research what it will be like living without my thyroid and what the changes in my body are going to be. What I found is that all of the research and all of the knowledge in the world couldn’t even begin to prepare me for the journey I was about to take.

For any of you who are not familiar with the thyroid or its function, I’ll give you a brief synopsis. The thyroid is one of the largest endocrine glands in the body. It’s a butterfly shaped gland that sits in your neck, right in front of your trachea. Its main job is to produce thyroid hormone. These hormones are chemicals secreted by the gland to act like messengers telling specific body parts what to do such as regulate heart rate, blood pressure, body temperature, proper brain function, and most importantly, convert food into energy. The function of the thyroid gland is to take iodine, found in many foods, and convert it into thyroid hormones: thyroxine (T4) and triiodothyronine (T3). Thyroid cells are the only cells in the body which can absorb iodine. These cells combine iodine and the amino acid tyrosine to make T3 and T4. T3 and T4 are then released into the blood stream and are transported throughout the body where they control metabolism (conversion of oxygen and calories to energy). Every cell in the body depends upon thyroid hormones for regulation of their metabolism. The normal thyroid gland produces about 80% T4 and about 20% T3, however, T3 possesses about four times the hormone “strength” as T4.

Without proper thyroid function, you can expect to see these symptoms:

• Fatigue and weakness
• Low basal temperature (cold intolerance)
• Dry and coarse skin
• Hair loss
• Cold hands and feet
• Weight gain
• Insomnia
• Constipation
• Depression
• Poor memory, forgetfulness
• Nervousness and tremors
• Immune system problems
• Heavy menstrual periods.

The awful thing about having a thyroid issue, is that all of the symptoms of which I had, could have absolutely been menopause or depression. Any and all of these symptoms go hand in hand with many different issues, but today, most doctors will immediately jump to depression first, without looking deeper into the issues. This is how I was NOT diagnosed for years with a thyroid issue.

I was told that after the surgery by an endocrinologist that I would be able to live a pretty normal life while taking thyroid medication for the rest of my life. Part of the research I had done prior to my surgery was about the different thyroid medications on the market today, most of which are synthetic. I did, however, find that there was one thyroid medication that was natural made from Pig thyroid hormones. In learning all of this during my research, I feel like I know my body and how it reacts to synthetic things and that my only option was the natural hormone. Armor Thyroid, the natural hormone has been used successfully since 1891. In the 1960’s, the big pharmaceutical companies were replacing Armor with the synthetic brand, which is very different than Armor in the fact that all of the synthetic hormones are T4 only. What is the problem with this, you might ask? If you recall reading earlier, T3 possesses about four times the hormone “strength” as T4. T3 is the one that puts the spring in your step because it is so potent. So my doctor, like many others, would not even listen to me in the fact that I would like to start out with the Armor Thyroid. She says that first we go with Synthroid, and if there’s a problem, then she’ll talk to me about Armor. OK, I decide, I’m not the doctor, so against my better judgment, I’ll do what she thinks is best.

I proceed for the next year and a half, taking Synthroid, and getting sicker and sicker. Any and all of the side effects of Synthroid AND being hypothyroid were mine to have. Over the course of the next 8 months I gained 25 pounds. I had a lot of muscle pain which I’m sure had to do with the weight gain. I am five feet nothing and was always about 110 pounds after my son was born. With twenty five extra pounds, my body was always feeling physically sick and then I was emotionally sick due to the extra pounds I was seeing. I was still so fatigued that I had grown accustomed to drinking energy drinks to keep me afloat, hence, I’m sure attributing to the weight gain. To make matters worse, I had severe constipation that would make or break each day with discomfort and bloating. I very rarely slept through the night which made my life during the day a struggle to keep it together. I would forget things a lot and couldn’t think straight so soon I became seriously depressed because of all of these symptoms and the fact that my doctor kept telling me to hang in there. I was crying all of the time and couldn’t control my emotions.

My doctor told me this had nothing to do with the thyroid, but I felt like my body was revolting against me and I had no control over anything. I went through a dose change of Synthroid every three months until we were to get it right. The dose change would sometimes make the symptoms so severe that I just didn’t know how to deal with it or myself or my family.

During this period of time while taking Synthroid, I researched and researched things that would help with all my symptoms. It was Rebecca, my healer, who turned me on to a natural product that would help with some of my physical issues.

After reading all about this “Holy Tea” I was intrigued and because of its claims, I tried it. I can say at this time, I will never be without it. I have not had the physical slowing down of my GI tract due to this detoxifying tea that, over time, clears out the so-called gunk that builds up in your system. It’s been used with great results for many things such as: Crohn’s Disease, IBDs, Spastic Colon, Enlarged Abdomen, Excess Stored Fat, Skin Conditions, Allergies, Fibromyalgia, Joint Pain, Insomnia, Low Energy, Loss of Clarity, and Forgetfulness, just to mention a few. This was not a cure all for me, but man how nice life becomes when your body starts to feel like it’s functioning again!

After having great success with the tea, I began researching their other products, one of which is Coral Minerals. Without my thyroid it’s very important to keep my calcium levels up because in the surgery, most of my parathyroid glands were taken as well. The major function of the parathyroid glands is to maintain the body’s calcium level within a very narrow range, so that the nervous and muscular systems can function properly. I’ve found that Calcium is the most plentiful of minerals in Coral Complex 3. Coral Complex 3 has helped people keep their bones strong, people with tendentious, periodontal disease, varicose veins, and even mood swings. I’ve been using this as well and it’s been a great supplemental boost.

OK, so I found a few things that helped make life a little more bearable, but the next time I was in to see the endocrinologist, I told her that enough was enough. I was ready to try the natural hormone, and hopefully feel better. She finally, after a year and a half, agreed. I can tell you that with-in a two week period of time, all of the aches and pains I was going through were gone. I wasn’t so sad anymore. I started sleeping through the night. My head was a little clearer, and things were looking up. I still had quite a ways to go, but at that point life was good, FINALLY!! At this point in my life, three years later, I can say that I’m still struggling because for the past three years, I haven’t been able to stay at one dose yet. It looks like I’m finally on that track now, and it was just 3 years in February. I’m sure I will always have some sort of struggle, but I’m on the right track, I can feel it.

So at this point, I finally find the right medication that works with my body and the manufacturer now has the product on national back order. Boy, I was starting to feel like I couldn’t get a break. No fear, whenever I have issues pertaining to my thyroid, I always go back to http://www.stopthethyroidmadness.com. This is a website that has helped me with many questions that I’ve had as well as be able to chat with people who have the same issues as me. Every now and again, you learn something from someone that you had no idea would help you. It’s a wonderful site, and I highly suggest it for anyone going through these struggles themselves.

Throughout the past three years, I’ve been able to find many things that have helped me through this struggle. The main thing that has gotten me to the point that I’m at today is my support system. I have the best husband, family, and friends that anyone could ask for. They have helped me get through this time, by listening to me talk through it, or sometimes cry and complain. They’ve helped me make sense of it all every step of the way. So to all of the people in my life, I have got to say “I love you!” and “Thank You”. This doesn’t even begin to make you understand how much each of you is an integral part in my life. I treasure all of you and feel blessed that I have so much love in my life to get me through one of the hardest times I’ve had to deal with. And my husband, God love him, was the best support system anyone could ever ask for. I know during this period of time how awful I was feeling constantly and that I was never easy to deal with. But Dave stood with me, and supported me, every step of the way. What I learned most from all of this and mainly from my husband, is that no matter what, you need to trust yourself, and be your own advocate in this world. You know your body better than anyone… including doctors. They know medicine, but only you know when something is truly wrong, and despite the fact that they may tell you your perfectly fine, you need to stand up for yourself and keep fighting until you know in your heart that all is fine.

Thanks to all for listening, and be well.

Do You Need a Medical Billing Advocate?

Do you have a stack of unpaid medical bills? Not sure if you really owe all that your doctor or hospital bill is claiming you do? Did your insurance cover less than you thought they would? Do you have an elderly relative that has been ill and the bills are piling up?

If you have answered yes to any of these questions, it may be time to consider hiring a medical billing advocate to review your bills to determine if you owe what is being claimed. After all, it is reported that 8 out of every 10 medical bills contain errors, and the majority of patients and consumers have no idea that they are being over-charged for medical services that have been rendered (and sometimes not rendered at all). It’s not unusual for billing advocates to detect data entry errors, unbundling of charges (charging for procedures separately, when they are included in one code) erroneous billing for services never received – honestly, the list is infinite.

If your insurance company rejects a service, the provider may simply send you the bill rather than researching and resubmitting the charges for payment. How would you know if this is the case? How would you know that your insurance should cover the charge? It’s so important to have someone knowledgeable review your bills so that you aren’t placed in a position of feeling coerced into paying medical bills for which you may not even be liable.

Medical Billing Advocates review your bills by combing through them, line by line, and also carefully examining the explanation of benefits from your insurance company. They will subsequently compare the charges to your medical records, to ensure that you did in fact receive the services for which you are being billed. This will leave you with peace of mind, knowing that you are only paying for services that were legitimately rendered, thus eliminating the risk of paying thousands of dollars of medical bills for which you are not responsible.

You can be certain that Medical Billing Advocates have the expertise needed, and thorough knowledge of the codes used and how to read a medical record to determine if all charges are appropriate. Additionally, professionals will know what codes can be billed together, and what codes cannot, and when the provider is required to write off charges that have been billed in error, and when you are actually responsible.

It’s time to be proactive. Remember, it’s within your rights to obtain all the assistance you need, and it’s unnecessary to pay another dollar for which you are not responsible.