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Medical bills No. 2 driver in bankruptcy filings

By Staff | Dec 13, 2008

Falling in debt from high medical bills is the second main reason for Americans to file for bankruptcy.
That fact was outlined recently by a study from the federal government’s General Accounting Office stating that 95 percent of hospitals overcharge for services and many of these services aren’t fully covered by insurance companies.
It’s not uncommon for hospitals to overcharge, explained health experts, because they have to deal with dozens of different insurance companies, as well as the publicly funded Medicare and Medicaid programs.
Furthermore, each health insurance supplier has a bureaucratic cobweb of policies reflecting what is and isn’t covered.
“The medical billing system is complicated and confusing,” said Rick H. Wade, senior vice president of the American Hospital Association.
While overcharges are often a result of medical errors, sometimes they arise from a hospital looking to make up profit losses from not receiving payments.
In other cases patients are denied coverage because they stray from the insurer’s regulations.
John Di Giovannantonio, a Cape Coral resident and U.S. armed forces veteran, said he was taken to Cape Coral Hospital recently after he was found unconscious in his home. He later returned home expecting his VA benefits to cover the hospital visit, but found that he had been denied.
After the hospital visit, Di Giovannantonio, a disabled veteran, applied to refinance the mortgage on his house.
“I had to borrow money and I had excellent credit,” he said. “They were denying me, and I didn’t know why.”
Later, he learned that his credit report showed an unpaid bill to the hospital. He explained that he was denied coverage because he was taken to Cape Coral Hospital and not the veteran’s clinic in Fort Myers.
“Who knows where you are going when you are unconscious?” he asked. “The VA used the fact that we have a clinic to not pay.”
Under these circumstances, Di Giovannantonio and the estimated 202,000 veterans in Southwest Florida could visit Cape Coral’s new veteran’s hospital, but that isn’t slated to open until 2011.
Now, he owes the hospital $1,200 for a blood transfusion on top of more than $1,000 per month in property taxes.
When a patient visits a doctor, the insurance company will negotiate with the hospital and typically cover half of the entire bill, leaving the patient to compensate the rest.
The Medical Billing Advocates of America pointed out that an appendectomy, for example, is valued at $35,000. Yet, Medicare will pay for approximately $5,000 and HMOs around $8,000.
It’s worse for those without insurance who not only cover the entire bill out-of-pocket but typically pay rates 300 percent higher than those patients with insurance.
“The uninsured will be dragged to court and have their wages garnished until they pay,” said Nora Johnson, an advocate with the Medical Billing Advocates of America.
New businesses calling themselves “patient advocates” are offering their expertise to decode muddled hospital bills and advocate on behalf of patients.
These advocates look for overcharges or underpayment by an insurance company and will negotiate with both parties to strike up the best deal for all.