Managing Medical Bills

Medical bills rank high as a cause for serious financial problems and even bankruptcy. When it comes to health care, more is not necessarily better. But more is what patients tend to get. While America 's health system has achieved important gains against major diseases, it has also encouraged the overuse of costly treatments. The system pays the vast majority of doctors and hospitals on a piecework basis called "fee for service." The more services they provide, blood tests, surgery, MRI or CT scan, the more money they make.

Experts estimate that the nation's $2 trillion annual health-care tab is one-third to one-half higher than need be, in part because of overuse of costly treatments, unnecessary care and overcharging.

A glaring example is the rise and fall of bone marrow transplants for advanced breast cancer. Early reports of dramatic shrinkage of otherwise fatal tumors, and apparent long-term remissions, caused an explosion in popularity of the procedure. Even with no proof the new treatment worked better than the old one, dozens of hospitals started programs to cash in on the demand. An estimated $3.4 billion was spent during the 1990s giving the treatment to more than 42,000 women. But in April 2000, the New England Journal of Medicine reported: Bone marrow transplantation did not improve survival at all, but it did make patients' remaining time more miserable because of its debilitating side effects. Bone marrow transplantation for breast cancer is now discredited, but plenty of other expensive treatments and tests are still being overused and overpromoted for all kinds of diseases.

Research over the past decade has concluded that the Medicare bill of a given community is determined in large part by its supply of medical services, hospital beds, physicians, and specialists, rather than the medical needs of its cancer drug,' even though it may not be effective," said Len Lichtenfeld, M.D., deputy chief medical officer of the American Cancer Society.

34% of a national sample of 300 primary-care physicians surveyed by the Consumer Reports National Research Center in August 2007 said their patients "very frequently" or "quite often" requested unnecessary or duplicative medical tests. 66% said they had acceded to at least one such request within the previous month.

60% of doctors surveyed said they quite often ordered unneeded tests to protect themselves against malpractice suits.

WHAT YOU CAN DO: Designate one doctor, typically your primary-care physician, to coordinate your care.

• If your hospitalization isn't for an emergency, check your insurance policy to find out just what it will cover and how much it will pay. Carefully review the section on "exceptions and exclusions."

• Phone the hospital's billing department and ask them what you will be charged for the room, and what the room charges cover. If tissues aren't included, for example, bring your own. * Ask your doctor to estimate your cost of treatment. Also, ask if you can bring your regular prescriptions from home to avoid overpaying for medications administered at the hospital.

• Make sure that everyone treating you, the surgeon, anesthesiologist, radiologist, pathologist, etc. participates in your insurance plan.

• Keep your own log of tests, medications, and treatments or ask a friend or loved one to do it for you.

• When you will receive an explanation of benefits (EOB) from your insurance company (if on Medicare, you will receive a summary notice). It will say, "This is not a bill." Don't toss it in the trash. Examine it. It will tell you how much the hospital is charging, what your insurance plan will cover, and what you will have to pay out of your own pocket.

• Never pay your bill before leaving the hospital, even if you're told that it's required.

• When you get your bill, read it carefully. Compare it to the log you made, to the EOB, and to the estimate of costs you requested before you were admitted.

• If there are items you don't understand, call the billing department and your insurer, and ask them to explain. Don't accept bills that use terms like "lab fees," or "miscellaneous fees." Demand an itemization. If you don't get satisfaction from the hospital billing department and you probably won't, appeal in writing to the hospital administrator or patient ombudsman.

• Ask for an itemized bill as well as your medical records to confirm whether or not you received the treatments and medications you've been billed for. Every state now requires hospitals to provide itemized bills.

And finally, Focus on Preventative Care: Lifestyle changes, quitting smoking, losing some weight, exercising more, improvements in diet and eating out less or not at all have PROVEN to be the most beneficial and protective for your health. NOT getting sick is the best way to save $!!!!