Wednesday, April 09, 2008

May I borrow that Soap Box?

Please feel free to skip over this entry. I promise you will not hurt my feelings. I am fully aware that I am about to stand tall on a soap box and shout to the crowd who may or may not want to hear what I have to say, but I gotta say it, and rather than ruin a lovely dinner party with my rantings, I will choose to air my thoughts out here:

THESE ARE ONLY MY OPINIONS AND EXPERIENCES BASED ON HAVING BOTH WORKED AND BEEN A PATIENT IN THE MEDICAL INDUSTRY -

1. THE MEDICAL INDUSTRY DOES NOT HAVE AUTHORITY OVER YOU
The medical industry will try very hard to create an environment of authority over you. They will try to make you feel inferior so you ask less questions and allow them to do what they need to do with as little friction as possible. They do not want you to ask too many questions because they may not have the answers and not having the answers takes away their authority.

2. ASK QUESTIONS - but be okay of you do not get the answers right away.
What I am trying to say is if the doctor speaks in medicaleeze and you do not understand what he is communicating to you, don't just shake you head because you are too scared to have the doctor think you don't understand. Say, "I don't understand, I don't follow you, what does this mean, what is the next step, what should we be looking for, what should we be worried about, what shouldn't we be worried about?" But at the same time, even thought medical technology has brought us to amazing places, the answers still are still not available immediately. There are still times when we have to wait and see.

3. ONLY YOU CARE ABOUT YOU AND YOUR LOVED ONES AS MUCH AS YOU DO.
I hate to say this, but the universe does not, in fact, revolve around us. We are not the only patients doctors have at any given time. If you are waiting for the results of a test or some bit of information that was promised to you, don't just sit around and spout off mean and angry things about your doctor and their office. Call them. "Do you have the results? When will you have them? Thank you I will call back then."

4. Your insurance EXPLANATION OF BENEFITS (EOB) is your best friend.
You know those things that you get in the mail that says the doctor/hospital charged "X" amount, it was adjusted to "Y" amount, patient owes "Z" amount? You only owe "Z" amount and do not allow nasty debt collectors to force you into paying anything more. And if "Z" amount doesn't sound right - GET ON THE PHONE - call you insurance company and ask why "Z" amount is so high!! "What is my benefit, what is covered?"

5. DO NOT ALLOW OUT OF NETWORK PROVIDERS TO RUN YOU OVER THE COALS
Have you ever noticed that when you go to the doctor and subsequently go to the hospital or get tests or whatever, there always seems to be ONE provider who is out of network - the anesthesiologist or the radiologist reading the x-ray or whatever. Something you had no previous knowledge of and no control over and now all of a sudden, you owe hundreds of dollars because they are out of network. DO NOT STOP HERE - do not just pay or allow your credit to go to crap because you couldn't possibly pay. You go back to your insurance company and you appeal. You tell them that you went to an in network provider, who then referred you to in network care/testing, and you had no choice when it came the out of network provider. They will, 9 times out of 10, reprocess the claim at an in-network rate.

6. BILLING DEPARTMENTS WILL NOT REVIEW THEIR MISTAKES - OR CORRECT THEM - WITHOUT YOU.
I know this is hard to believe, but they are not perfect. They tend to make clerical errors, but crazy thing is, they do not care. MOST billing is done all electronically, meaning, it is a series of codes that is entered into a computer, those are electronically sent to your insurance company, if the codes match, money is electronically sent to their bank accounts and POOF it is done with no human hands ever reviewing it. So here is what happens - an error occurs - the wrong code gets put into the computer, the insurance company rejects it - notifies the MD/hospital computer that it is not paid - and once a month a statement will get sent to you saying you owe them "X" amount because it is not covered by insurance. THEY DO NOT TAKE THE TIME TO REVIEW OR APPEAL UNLESS YOU PICK UP THE PHONE AND BRING IT TO THEIR ATTENTION!!!!!

Oh I could go on, but I think I have bored enough of you to tears already....

My point to all of this is - EMPOWER YOURSELF - don't just sit there and be railroaded through the system. Be the squeaky wheel. But at the same time don't be the ANNOYING squeaky wheel. Know your rights.

Okay - I am done - anyone need the soap box next? Anyone? Bueller? Bueller?

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