John Felzan has been battling carcinoid cancer for three years. It is a difficult and expensive cancer to treat, with John's bills averaging over a quarter of a million dollars a year. Fortunately, his company and his insurance policy handle most of the bills, but John still has to pay about ten thousand dollars a year out of pocket. In 1999, John received an erroneous hospital bill, and, being a lawyer himself, he thought he could handle it. He was wrong, but fortunately for him, help was not far away.
John spent months fighting with the hospital over the charges, supplying reams of supporting documents to show that everything had been paid and that, according to his insurance company, he owed nothing. All of this effort got him nowhere, and he enlisted the help of Care Counsel, one of a growing number of patient advocacy groups dedicated to helping consumers deal with the incredible complexity of the healthcare system.
The choice proved to be the right one, benefiting both John and his employer. Care Counsel's battery of experts had the time and the know-how to track down the paper trail and discover the billing error, leaving John with more time to focus on his life and allowing him to retain his privacy. John's employer also paid Care Counsel about a third of what they would have paid their own employees to do the same work, and to everyone's benefit, Care Counsel got results quickly.
John is not alone. A recent survey showed that 51 percent of respondents said they had problems with health insurance bills. Last year alone, the Patient Advocate Foundation, a group that assists people in dealing with claims problems, gave assistance to over thirty thousand people. Karen Gallinari, of the Patient Advocate Foundation, says that the key to success is consumer education. All too often people attempt to pursue billing problems on their own, only to end up throwing in the towel in frustration over healthcare bureaucracy without realizing that outside help is available. Fortunately, she says, more and more people are going through the effort to educate themselves and are realizing that taking action can bring results.
If you are having problems with your healthcare bills, here are a couple of tips:
1. Get educated. Learn everything you can about your policy and enlist the assistance of your company's benefits manager and your insurance company's customer representatives.
2. Write a letter. This is the best way to get started and make your claim. As you go along, always keep a log of every piece of correspondence. A paper trail will be helpful in validating your claim, especially if you hit a brick wall.
3. Get help. You may be able to do it yourself, but as John Velzman showed us, even season lawyers can find it tough. Consider an independent agent, your state insurance commissioner, and, of course, patient advocacy groups.
Patient Advocate Foundation