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Down Bad and Buried in Medical Bills
Mike's medical bills totaled more than $350,000. I used funds donated by my paid subscribers to hire a patient advocate who sorted out the mess.
When I met Mike O. a year ago he had suffered through a terrible season of health problems.
In April 2022 the 52-year-old Texas resident had been hospitalized for five days with heart problems. There he suffered an allergic reaction to medication that caused his entire body to swell and his mouth to fill with hundreds of painful sores.
Weeks later his cardiologist diagnosed him with heart problems and he had another stay in the hospital. That led to more allergic reactions. This time his feet swelled so big he couldn’t wear shoes for a month.
In June the allergic reaction flared up more. The sores in his mouth restricted his airway - requiring another trip to the emergency room. His third hospital stay in as many months.
In July his wife left him.
In August, he suffered a bloodstream infection that almost killed him.
In all, Mike had six hospitalizations in 2022, plus a two-week skilled nursing stay, ongoing home health care and doctor visits. He got referred to me because he was getting buried in medical bills - four or five a day for months on end. The hundreds of bills totaled more than $350,000 in charges. But the truth is he couldn’t tell what he owed and feared going bankrupt. He was disabled, alone and emotionally overwhelmed.
Thanks to the paid subscribers of this newsletter, I could hire a professional patient advocate to help him sort through the morass of medical bills and insurance coverage.
This newsletter is free so everyone can have access. But when I launched it I also wanted to do something bigger. My book, Never Pay the First Bill, and health literacy videos, The Never Pay Pathway, are great tools to help people help themselves. But sometimes people are in such complicated situations they need a professional patient advocate or other help. That’s why I invite my readers to become paid subscribers. Then I use 100% of the proceeds to support patients in need.
You readers have been generous. In particular, I want to thank and recognize the Founding subscribers. I’ve spent thousands of dollars to hire patient advocates thanks to your generosity. In previous newsletters I shared how we helped save a patient $224,000, and how we helped a patient whose insurer had denied 273 claims at once. It’s inspiring to see this generosity at work.
Before I continue Mike’s story, I must ask:
Would you like to become a paid subscriber? Click the “Subscribe now” button.
Do you know anyone who needs help with a medical bill or insurance company denial or other medical fiasco? Reach out to me at email@example.com and let’s help them!
In Mike’s case, I hired Gayle Byck, a tenacious patient advocate, and she dug in. There were scores of bills to sort through. A claims spreadsheet she downloaded from one insurance portal showed he owed $8,810. Another provider Mike didn’t recognize had 18 unpaid claims totaling $30,000. A letter from an insurer showed $338,000 in unpaid hospital charges. In another case, he had been paying down a $4,500 bill from a different hospital.
As Gayle dug into Mike’s insurance she discovered that he had more coverage than he realized. He works as an estimator and had benefits through his employer. He had a supplemental policy that could apply. And, the biggie: he had previously been approved for Medicare disability because of a previous spine injury and surgery.
Over a period of months, Gayle worked though the various claims and health coverage options. She found multiple mistakes and disconnects in the way the claims and bills had been processed:
The $30,000 in bills came from a home health provider who hadn’t submitted the right information to the insurer. Gayle worked with a helpful case coordinator from Mike’s employer to get it resolved.
Insurance EOBs mistakenly said they needed information about “the accident” Mike had been in before they could be covered. But Mike hadn’t been in an accident. Gayle let the insurer know and the claims were processed.
A letter from his insurer said it needed an itemized bill for the $338,000 in charges. Gayle got the itemized bill and submitted it to the insurer.
One by one the bills bit the dust.
Mike did owe the $4,500, but Gayle got it covered under his Medicare plan. That resulted in a refund of $1,935 to Mike - the amount he had already paid toward the bill.
If it sounds like Gayle was doing the job of the billing entities and insurers - that’s correct. Our health care system is so fragmented that it can be difficult to untangle who is billing who and for what. The people sending the bills don’t take the time to sort it out and neither do the insurers. Patients are often left holding the bag for bills when they shouldn’t be.
“You can’t count on the billers and insurers to take care of what they’re supposed to,” Gayle said.
Mike still struggles every day, but he’s back to work and slowly recovering physically. He said he is thankful he can focus on his life and work and not medical bills. He thanks Gayle and the generosity of the readers of this newsletter “from the bottom of my heart.”
“This has been the most challenging and difficult time of my life,” Mike said. “To have Gayle help me and have you guys pay for that - I don’t know how I would have handled that. When those bills came in it was devastating.”
Mike said he could have been crippled financially for life. “It’s pretty huge,” Mike said of his relief.
I’m so thankful that the bills got covered, and we all wish Mike well with his ongoing recovery. Many thanks to those of you who have contributed to help patients like Mike, and many thanks to Gayle.
Gayle provided the following takeaways:
If something looks strange on your insurer’s Explanation of Benefits documents, call to ask about it.
For example, if the EOB states, “additional information needed,” ask if they are reaching out to the provider for that information, or if you need to call.
Keep a list of all of your health insurance benefits. In Mike’s case, he had initially forgotten about his supplemental policy. In the end, it worked out because he had retroactively qualified for Medicare.
If you have a complicated situation - health issues, large number of claims - your employer or insurer may assign a case coordinator to help you. It is helpful to have one person you can reach out to for help, someone who knows what’s going on versus having to start over each time you call. Ask for a case coordinator, if possible.
My health care satire contest winner is…drumroll please….Tony Rinkenberger!
A recent edition of my newsletter featured an awesome new Power to the Patients video (click the link above to watch it) that satirizes the idea of hospitals providing estimates instead of prices.
“Satire is moral outrage translated into comic art,” the American novelist Philip Roth said. I love its humor and social commentary and shared some of my health care satire ideas in my column. I also asked readers to submit theirs, offering a signed copy of my book for my favorite idea.
Many thanks to Tony Rinkenberger for his submission. The setup is that you have to imagine if a third party payment system, like the one in health care, existed for other retail products and services. I’ve edited his submission lightly for clarity.
Consider how the price of your morning latte might change if the retailer had to include the costs of all of the administrative tasks associated with getting it paid by a third party. And the additional costs when having to check whether you should be approved to purchase it in the first place. Then add the costs associated with the appeal when the latte purchase approval is denied. And what about the loss of the value of the cash not collected waiting for the appeal. And the approval for the latte? You can only have it made with oat milk, not coconut milk. But you don't like oat milk, so you have to appeal again. But coconut milk does not meet the evidence based guidelines for your your drink profile. You decide not to purchase the drink. Where do the costs associated with your drink request that you didn't purchase go? Your next drink? Price increases across the board? Increase to just lattes? Owner's profits? Other?
When one applies the entire healthcare payment process to these retail situations it gets even more weird doesn't it?
Tony’s satire shines light on the absurd reality of our third-party health care payment system. Doesn’t make a lot of sense, does it?
Thank you for the submission, Tony! Enjoy your signed copy of Never Pay the First Bill!
More satire: Tom Broker episode two: “Check Please!”
Gotta love Spencer Smith satirizing health insurance brokers and carriers in the second installment of the “Tom Broker” series. The video, also starring Sims Tillirson and Chris Hamilton, is a great send up of the conflicts-of-interest that undermine the traditional way employers purchase health benefits.
Let’s hope the satire provokes the reform we need!