All About Mihran

sheridegrom - From the literary and legislative trenches.:

Aina has created a tribute to one of the kindest individuals I’ve had the pleasure of meeting since joining the blogging world. His willingness to support and urge many of us makes life that much simpler. I consider myself blessed to know Mihran, a remarkable friend to all bloggers.

Originally posted on Lyrics, Sentiments and Me:

All About Mihran

I have blogged for years now. But I never met a man as gentle and kind as Mihran Kalaydjian. Because aside from the fact that he had been so generous reblogging my posts, there was this one very warm conversation I had with him.

When I posted my condolences to our dear Ajaytao, I made Mihrank cry that day. Although I was worried if I made him cry because I wrote bad; or I wrote something for Oscar’s (coz I do have the tendency for drama), but I was really touched with his honest sentiment. Coz Mihran never met Ajay, yet he shed a tear for him. He even asked me “Why am I crying, Aina?” I told him, “It’s because Mihran, you’re a gentleman with a very big heart and beautiful soul.” And so we were both crying in the end.

And I mean those words up to…

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THE FEDERAL GOVERNMENT FACES A BRAIN DRAIN

One Woman’s Opinion
by – Sheri de Grom

 

A congressional committee has recommended federal senior government executives be required to remain in place if recruitment of a replacement is considered difficult. Federal agency leadership (the hired, not the appointed ones) is facing a brain drain and Congress is largely to blame.

It’s understandable that there’s a significant shortage of qualified top managers. There’s been a 36% increase in departures from Senior Executive Service since 2009. It’s become more and more difficult to groom a replacement in federal service than in private sector positions.

A Senior Executive may lose their job if they are even suspected of training someone for their position. A Senior Executive may announce their departure months in advance but the announcement of a new position and the recruitment process cannot begin until the position is vacated. Critical positions remain open for months, sometimes years and are often never filled.

The largest driver of senior executives out of government has been age. Nearly 80 percent of departing SES employees since 2009 was voluntary, non-early retirees.

One in five, however, left through early retirement or resignation.

Senior executives told researchers the financial crisis, pay compensation, award suspension and sequester were major factors that drove them out of federal service.

Senior Executive Employees know nothing will happen this year as congress remains in gridlock. Gridlock is bad, especially if you want action. But if you are the chosen sacrificial lamb, aka a career federal civil servant, gridlock has a certain appeal. If congress can’t or won’t do anything good for you, they also can’t do anything bad to you.

Ultimately, extending the tenure of retirement-eligible managers while mentoring and training new talent will reduce productivity during any transition period.

As with most changes brought about by congress for the federal workforce or the military, it will be too little too late.

It’s difficult for a government employee at any level to think generously about members of congress when it’s public knowledge that the leaders making the employees’ lives miserable are going home to plush accommodations as they leave their offices.

Senate Majority Leader, Harry Reid

Senate Majority Leader, Harry Reid

Senate Majority Leader, Harry Reid props his feet up at the Ritz Carlton Hotel in Washington, D.C. While he may get a discounted rate, the cost per night at the Ritz starts at $649 and goes up to $810. Assuming the senator pays $3,000/weekly, that’s more than his take-home pay. Where does the money come from for such a lavish life-style for a ‘man of the people?’ His personal fortune? Do the taxpayers of Nevada believe Senator Harry Reid is so worthy as to pick up the tab for his living at the Ritz?

While Senator Reid is relaxing, you may take a tour of the Ritz at http://www.ritzcarlton.com/en/Properties/WashingtonDC/PhotoTourPop.htm I can’t blame the Senator for loving the Ritz. I love the opulence, the charm and the feeling of no worries upon stepping through the gilded doorway.

Some say the Senator owns a condo at the Ritz. Oh, my heart be still.

Speaker of the House, John Boehner

Speaker of the House, John Boehner

Meanwhile, Speaker of the House John Boehner has long denied that his perpetual tan skin color is the result of sunless tanning. He just spends a lot of time outdoors; the Ohio Republican is known to say. If Speaker Boehner spends so much time out-of-doors, when does he have time to work?

Despite Boehner’s repeated denials of using tanning beds, he does have ties to the industry. Not only has he accepted campaign contributions from a group called the Indoor Tanning Association, Boehner lives in a D.C. apartment owned by a lobbyist for the American Suntanning Association.

In recent years, federal workers have been a primary target of deficit-fighters. The White House and Congress imposed the pay freeze, created the furloughs and shutdowns and are in agreement that feds should kick in more toward their retirement, and that future cost-of-living adjustments for retirees (federal, military and Social Security) should be trimmed, a tad, by using a new inflation-measuring yardstick.

In addition to raising retirement costs for current feds, there is talk and plans to eliminate the defined-benefit portion of the federal retirement package for future hires.

Many long-time feds, who have lived with cutback plans going back to the 1980s, have learned to grin and bear it. Lots of relative newcomers remain nervous. People who said that sequestration would never happen were proved wrong.

The good-news-bad-news (which is often the same thing when talking about political outcomes) is that Congress isn’t likely to do anything this year. They’ll focus all energy to see that everybody in Congress who wants to stay in the House or Senate stays in the House or Senate.

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SHIFTING THE COST OF EMERGENCY ROOM CARE TO YOU

Medical 2014
by – Sheri de Grom

The telephone startled her. She didn’t recognize the number but today had to be the day she’d break her rule and answer. The official sounding voice was one she’d never heard before. Without preamble, he told her his name and confirmed hers. He also confirmed her relationship to a patient he had in the emergency room of the local medical center.

Before she could ask questions, the voice on the phone was gone. She had questions: what, how, when, why an ambulance. Thank God she’d already had her shower and hurried to find jeans, sweater, run a comb through her hair, grab her purse and she was gone. Gone to the emergency room. Sheer panic had set in and she moved into auto-pilot.

How could it be? He’d been his usual cheerful, energetic self as he’d left the house that morning.

When she arrived at the Emergency Room (ER) the staff explained that her husband had passed out at work and so far, there was no known reason why.

A clerk interrupted, “Do you have your insurance cards with you?” Payment is at the front of every hospital’s mission in today’s economy.

She was advised that the specialists were running tests and she could have a seat in the waiting room.

What would happen to her if she screamed, “No, the only thing I want is my healthy husband, the man I love.” That wouldn’t happen now and she settled into a hard plastic chair in defeat.

It seemed she’d waited hours but it’d actually been less than two. Two hours with her guts turning over and over and a hammer in her head that refused to stop. It banged her front temporal lobe a million times a minute. She was sure of it.

Finally, someone from the ER staff asked her to join them and said, “The doctor will speak with you now.”

Unfortunately, she learned nothing other than her husband passed out at work, numerous tests had been completed, and nothing conclusive explained the incident. He was now resting but the doctor thought he’d be more comfortable if her husband stayed a while longer to ensure his stability.

She nodded her head yes and signed more papers. She didn’t want to take chances and agreed to a new strategy in emergency care (although she wasn’t aware that’s what was happening).

This new movement in emergency care is shifting the cost of expensive emergency care rates away from hospitals, Medicare, Medicaid and all commercial insurance companies. Patients are classified as ‘short-stay emergency department inpatients.’

National data collected by researchers at the School of Medicine at Perelman in December 2013, suggested that keeping selected patients under observation in a dedicated hospital unit with defined protocols could yield hundreds of millions of dollars in cost savings for everyone but the patient. More often than not, the patient doesn’t understand the hidden cost of being transferred to observation status until a large charge appears on their statement.

The ‘kept for observation’ status has been a topic of controversy for Medicare patients for years, and in 2012 an investigation by the Department of Health and Human Services Inspector General found inconsistency between hospitals in how they determined whether a patient was admitted or kept under observation. For Medicare patients, such ‘observation stays’ are associated with higher out-of-pocket care costs and a lower likelihood that nursing home care will be covered.

Please be aware, any time you or a loved one is moved from a dedicated Emergency Room Department to an Observational Unit, there will likely be a reduced amount in what any insurance company is willing to pay.

This shift in cost for emergency care affects all patients. It is not exclusive to Medicare and Medicaid. I encourage you to read your health insurance policy carefully.

Any stay in a hospital beyond 24 hours is considered an admission to your insurance company but you may remain on observational status per the hospital. It is a catch-22 for the individual responsible for the account.

Many same-day surgeries result in observational status (i.e. the recovery room). However, if surgical complications or recovery from anesthesia occur, the surgery patient is placed in out-patient observation status.

Please be aware, any time you or a loved one are moved from the dedicated Emergency Room Department to an Observational Unit, your cost may be higher than expected.

          The entire financial burden could be yours.

 

 

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Victims of Domestic Violence Shouldn’t Be Made Victims to Guns

sheridegrom - From the literary and legislative trenches.:

There aren’t many things I can think of that equal the fear of being stalked. I experienced this fear first hand during the time I lived and worked in DC. My work was not to make friends but neither did I plan to encounter individuals believing they had nothing left to lose if they returned to prison because they shot me. Responsible gun ownership is a must if our nation is to become civilized on any level. It’s the criminal with the guns and not the mentally ill that need heightened regulation on gun ownership. Yes, some mentally ill slide through the cracks but nothing closely related to the criminal element in today’s society.

Originally posted on The Secular Jurist:

Courtesy of americansforresponsiblesolutions.org

Courtesy of americansforresponsiblesolutions.org

By Tanya (a Secular Jurist author)

I recently received this message in an email from a group called Americans for Responsible Solutions, of which I am a member. It was started by Congresswoman Gabby Giffords and her husband to fight for gun control laws:

Victims of domestic violence and stalking are at an unacceptable risk of gun violence. In fact, 30.5% of people in New York killed by their intimate partners were murdered with a gun.That number is unacceptable.

But there’s a bill in Congress that will make it much more difficult for convicted stalkers and abusers to own a gun. Next week, for the first time in history, the Senate will hold a hearing on the links between gun violence and domestic violence.

People need to know the harsh realities of guns and domestic violence if we’re going to change the law. As it stands, the…

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HEALTH CARE FRAUD

Medical 2014BLOG - FRAUD - MEDICAL
by – Sheri de Grom

 

Compiling satisfactory evidence for prosecution of individual(s) committing health care fraud requires thousands of man hours and sheer determination that this time, this one isn’t going to get away. Often it takes years of full-time investigation on one case.

I thought you might be interested in how serious health care fraud must be before it will be considered for prosecution. The following actions occurred in June, 2014 and they represent a small fraction of current cases being worked.

The owners of Elizabethtown Hematology, PLC of Louisville, KY agreed to pay $3,739 to settle false billing to Medicare, Medicaid, Tricare and the Federal Employes Health Benefit Program.

Leonard Kibert, MD and four others of Houston, TX were charged in a 47-count indictment alleging a conspiracy to defraud Medicare of $2.9 million. A trial date is pending.

A Los Angeles physician was indicted for a $33 million scheme to defraud Medicare and one count of conspiracy to commit health care fraud. A trial date is pending.

Husband and wife owners of Ohio Ambulance Company were sentenced to prison and ordered to repay $800,000 to Medicaid for transportation services they didn’t actually provide.

Indictment of two Florida scientists for obtaining government research contracting by fraud. Additional charges included wire fraud, identity theft and falsification of records in a federal investigation. If convicted on all counts, each faces a maximum penalty of twenty years in federal prison. The United States is also seeking a money judgment in the amount of $10,000,000 which reflects the proceeds of the charged criminal conduct.

A Miami Beach osteopathic physician was sentenced to 70 months in prison followed by 3 years of supervised release as a result of a Medicare fraud scheme. In addition, the judge entered a $1.6 million forfeiture money judgment against the physician and ordered the forfeiture of his Miami Beach residence and a 2002 Mercedes Benz. The doctor is also to pay restitution to the Centers for Medicare and Medicaid Services.

The U.S. Department of Justice has ordered Omnicare, Inc., the nation’s largest nursing home pharmacy company to pay $124 million to settle allegations involving false billing to federal health care programs. Omnicare, Inc., has agreed to pay $124 million for allegedly offering improper financial incentives to skilled nursing facilities in return for their continued selection of Omnicare to supply drugs to elderly Medicare and Medicaid beneficiaries.

I could list page after page of medical fraud abuse convictions and indictments for June 2014. However, the purpose of this blog is to give you an idea of the size and frequency of fraudulent claims against Medicare and other health care insurance plans before prosecution will be considered.

I’ve seen thousands of cases wherein individual(s) are committing health care fraud on a daily basis, yet the dollars aren’t deemed high enough to qualify assigning a team of agents to investigate the activities in order to press federal charges.

Due diligence is required of every citizen to insure their insurance company is not being gouged by a medical provider and they are using your name in the process. Insurance fraud is the fastest growing criminal activity of white collar crime in the United States.

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GUNS, MENTAL HEALTH, VIOLENCE AND SUICIDE

 

I didn’t know the title of the theme song for the long-running television show MASH, but Tom did. I wasn’t surprised to learn that Tom could name the song, Suicide Is Painless, and sang along with it whenever it played on the radio.

I hadn’t given much thought to suicide before bipolar became a third party in our marriage. Tom and I’d agreed before we married that we didn’t want guns in our home.

I’d grown up with gun racks and loaded rifles in pick-up trucks in rural Kansas. Tom was taught to hunt as an adolescent and obtained sniper status for the military. Thankfully he was never asked to serve in that capacity.

The military was more interested in Tom’s intellect than his shooting ability and that afforded him comfortable working conditions. His military uniform was most often a suit and tie. He served as a key component of the Army’s Organizational Effectiveness Team. Instead of going to the field, his travel consisted of hotels where turn-down service was provided and a chocolate waited on his pillow.

There’s no disputing that mass shooting episodes are horrific. For the purposes of this blog, I’m addressing the 88 gun-related deaths that occur each day in the United States and not the mass shootings.

Of the 88 people that die each day from a gun: 90 percent of those deaths are suicide, a high portion of which are committed by seniors and individuals living in rural areas.

In cities, gun-related deaths are typically homicides. If we want to reduce this number, it comes to reducing gun-related violence on the streets.

Guns and gun legislation are topics we hear about daily. I couldn’t delay updating my research findings any longer. As recently as May 8, 2014 a team of investigative researchers at the American College of Physicians (APC) based all of their policy decision on scientific evidence.

Family doctors and internists have been identified as the first line of defense against both gun violence and suicide. The APC stated, “When it comes to reducing gun-related violence, physicians must play a vital role in making firearm safety a public health issue so that policy and law are based on scientific evidence.”

I’m in agreement with the APC. The United States will never have appropriate gun legislation while it’s tangled in second amendment rights.

The media has played into the mental health status of each mass shooting. We’ve watched them unfold in the news.

We’ve seen serious mental health issues connected to the shootings that should have been addressed years before these tragedies occurred. These incidents should have been no surprise to the parent(s) or guardian(s) of the shooter firing the weapon(s). The behaviors developed in the mind of a psychotic individual do not divulge over night.

Overall the mental health issues surrounding gun violence are in a complex area that requires a nuanced approach.

People with mental illness are more likely to be victims than perpetrators of violence. Individuals with mental illness who receive appropriate treatment are less likely to commit acts of violence.

Scientific Data Revealed: 32,000 deaths per year are caused by guns (roughly 11,000 to homicides and 19,000 to suicides).

Non-fatal gun-related injuries are more than double that of deaths.

My husband, Tom and I have often talked of the distorted truth regarding bipolar disorder and especially how the disease is misrepresented in the media.

The following facts about mental illness and violence were compiled by the American Psychiatric Association (1994). Fact Sheet: Violence and Mental Illness. Washington, DC: American Psychiatric Association. The Fact Sheet has numerous citations and I’m happy to pass the individual sites on to anyone who’s interested.

FACTS ABOUT MENTAL ILLNESS AND VIOLENCE

Fact 1 – The vast majority of people with mental illness are not violent.

Fact 2 – The public is misinformed about the link between mental illness and violence.

Fact 3 – Inaccurate beliefs about mental illness and violence lead to widespread stigma    and discrimination.

Fact 4 – The link between mental illness and violence is promoted by the entertainment and news media.

FACTS ABOUT MENTAL ILLNESS AND VIOLENCE BY LEADING RESEARCH FACILITIES

“Characters in prime-time television portrayed as having mental illnesses are depicted as the most dangerous of all demographic groups: 60 percent were shown to be involved in crime or violence.” (Mental Health America, 1999)

“The vast majority of people who are violent do not suffer from mental illness.” (American Psychiatric Association, 1994)

“The absolute risk of violence among the mentally ill as a group is small . . . only a small proportion of the violence in our society can be attributed to persons who are mentally ill.” (Mulvey, 1994)

“People with psychiatric disabilities are far more likely to be victims than perpetrators of violent crime (Appleby, et. al., 2001). People with severe mental illness: schizophrenia, bipolar disorder or psychosis, are two and one-half times more likely to be attacked, raped or mugged than the general population.” (Hiday, et. al., 1999)

This blog is the first of a series about Tom’s and my many struggles to keep our home free

Official Logo for 2014 Participants

Official Logo for 2014 Participants

of guns. It should be simple but it’s not. I’ve spoken numerous times in multiple congressional committee meetings about the necessity of protecting the individual who wants to harm him or herself. A data base would not be difficult to set up nation wide and with volunteers such as myself, the data entry would be a free public service. I’ll discuss attempted suicides and how we’ve coped with the situation when it appeared in our lives.

Suicide and attempted suicide are difficult subjects to write about. I understand that sometimes the pain is relentless and there seems no place to turn. I fully understand how suicide can seem the only solution.

Suicide is anything but painless.

 

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“Now? Have you lost your mind?!”

sheridegrom - From the literary and legislative trenches.:

This blog written by Huntie at http://chasingrabbitholes.com is one of the best written essays of how we are losing our country one day at a time. Huntie places the issues front and center of what’s happening, how it’s happening and please, can we wake up and do something before it’s too late. I’d planned to post a blog of my own today, but Huntie’s post demanded prompt attention. Might I also suggest you follow this blog. You will not be disappointed. Not only does Huntie have a marvelous intellect but she’s as funny as all get out. Sheri

Originally posted on Chasing Rabbit Holes:

Perhaps you have heard something about illegal children crossing our southern border? More than 52,000 unaccompanied minors and 39,000 women with children have been apprehended on the southern border this year. How to handle this surge? Especially since a law passed in 2008 forbids returning children from non-contiguous countries, i.e., El Salvador, Honduras, and Guatemala, which happen to be the three countries most of these children are coming from. This law requires that each case be reviewed to prevent abuse of the children from human trafficking. Imagine the chaos ongoing. Something like 70% our our border patrol are taking care of this constant influx of children. It is not as if the children are sneaking through. No, not all. They walk up and present themselves to the border patrol. President Obama has requested $3.7 Billion to deal with this humanitarian crisis. How much of that proposed $3.7 Billion is to…

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MEDICARE PART D HAS ME WORRIED

Medical 2014
by – Sheri de Grom

The Obama Administration (the Centers for Medicare and Medicaid Services) set forth a proposed rule, January 2014. The proposal [Federal Register Vol.79, No 7, Pg1-157] would have brought about broad changes for about 39 million Medicare Part D beneficiaries.

MEDICARE PART D PILLS BOTTLE

The proposed rule would have ended the practice of covering “all or substantially all” drugs within six classes: antidepressants, antipsychotics, anticonvulsants, antineoplastics and immunosuppressants. This policy, known as the “six protected class” policy, has been in effect since the inception of Part D, and has strong congressional support.

Medicare tried to sell the proposal as a way to save taxpayers money and simplify the Part D program for seniors.

The ‘administration’ has indicated they will revisit their proposed plan and will submit a new proposed rule in the future. When the proposed rule is set forth, EVERY CITIZEN has the right to comment.

You do not need to be enrolled in Medicare to comment on any proposed rule set forth. As an American citizen, you’re entitled to express your opinion on every proposed legislative change. A proposal will become law if not enough citizens can support keeping the law as stated in its current format.

The House and Senate advised Medicare to back off and in a letter drafted by Orrin Hatch (R. Utah), clearly placed on record to Medicare that congressional members (both parties) had strong objections to the Medicare Part D proposals and were concerned the changes would disrupt care and unnecessarily interfere with an already successful program.

It’s important to remember the patients qualifying for coverage by Medicare and Part D are not just those over 65 but also those that are disabled and unable to work. This proposed rule would take away the coverage of numerous drugs necessary for mental health treatment.

I’m confident we’ll see further erosion of Medicare Part D. It’s the only plan within Medicare that helps pay for pharmaceuticals and the patient pays the premium and additional co-pays.

Thankfully, Tom and I have my Federal BC/BS and his Tri-Care for Life for our pharmacy coverage. I don’t believe I’d have the sanity to cope with Part D.

David L. Shern, Ph.D, president and CEO of Mental Health America, said, “These policies fail to acknowledge that physicians and consumers should make individualized treatment decisions, recognizing the unique and non-interchangeable nature of human beings and psychotropic medications, and acknowledging that lack of access to medications has both human and fiscal consequences.”

Medicare’s prescription drug program is widely considered to be a Washington success story. However, the Obama administration is proposing a series of significant changes to fix what critics say isn’t broken.

In my opinion, the continued attempts of Medicare administrators to destroy a program that works efficiently (Medicare Part D), is further evidence that our current administration has no one appointed to a cabinet position with ‘real world’ work experience. Their job security has never been threatened by real world performance standards and customer satisfaction.

The nomination of Robert McDonald, to Secretary of Veterans Affairs, former CEO of Proctor and Gamble, is the first executive with actual public leadership ability who understands what it means to be accountable to stockholders. Taxpayers have not had accountability with other cabinet positions.

I expect to see a newly formulated proposed Medicare Part D Rule submitted within the next six months. If you see the proposal before I do, please let me know. I wish to add my comment to the Federal Register plus express my views to elected officials.

What are your thoughts? Have you had success or problems with Medicare, Plan D? There were a significant number of changes with most insurance plans in 2014. Has your insurance changed their pharmacy coverage?

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How Much Is Your Medical IDENTITY Worth?

Medical 2014
by – Sheri de Grom

Few of us think about having our medical identity stolen. The crime of medical identity theft has been happening for years and is rampant today. Most of us are unaware that it’s occurred until something significant happens in our own world of health or our credit rating has crashed.

Medical identity theft is the fraudulent use of another person’s medical identity in order to obtain medical services and medications or to bill a third-party payer such as an insurance company or Medicare and then keep the payment for personal use.

The theft of your medical identity also reveals your social security number, health system ID, driver’s license number, health insurance and other personal information plus critical details a thief can use in multiple ways.

The crime can have long-lasting and dangerous effects, both on your health and your finances. The thief may obtain health services in your name or bill fraudulently for services that, although you never received them, could max out your annual or lifetime insurance limits.

Whether the thief is actually receiving medical treatment or just billing for fictitious treatments in your name, incorrect information—about blood type, diagnoses, or drug allergies, for instance—may infiltrate your medical records as a result.

Collection letters for overdue accounts for an unfamiliar doctor visit or procedure is the most common clue to victims of this crime.

Be vigilant about handling your medical information. Don’t let explanation-of-benefit statements from your insurer sit in a pile of unopened mail. Review them like you would a bank statement or auto repair bill. If you see an unfamiliar procedure, doctor’s name, or service date, call to inquire.

The media tells us when a large number of social security numbers are stolen or when our credit and debit cards are in jeopardy.

Your medical identity will be with you for a lifetime. It is one of your most important assets. Don’t allow someone to steal it from you.

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MEDICAL DEBT WILL CHANGE YOUR LIFE

Medical 2014
by – Sheri de Grom

Medical debt has no distinction apart from other accounts once they are outsourced to a collection agency.

It's a foreign language to many.

It’s a foreign language to many.

The face of medical debt has changed drastically within the past five years. Before the U.S. economy fell apart, most doctors, hospitals and other health institutions carried their own debt.

Combine our weakened economy, high unemployment with the reality of Obamacare and fewer individuals have health insurance than before the recession and Obamacare.

Health care providers can no longer afford to carry their patients’ debt. The providers need ready revenue streams to remain operational. To obtain that money they’re forced to sell their debt to a third-party.

Declining Dollar

Declining Dollar

Medical debt is different from any other debt the American consumer accumulates. Unlike credit cards, auto loans or home mortgages, Americans don’t fill out credit applications for medical services. (Most hospitals and free-standing out-patient procedure clinics require the patient pay their part before care is provided).

In the recent past, most health-care providers never turned patients over to collections so long as they were making regular payments on their debt.

Today, making payments on a medical bill doesn’t necessarily keep it out of collections. If you’re making small payments, or if you make your payment a few days late when you are under a payment arrangement, you may discover your provider has turned the bill over for collections.

Unfortunately, you may not know there is an unpaid medical bill until you get a call or letter from a collection agency. At this point, it may be too late to avoid damages to your credit. Bills fall through the cracks, are sent to the wrong address, or are sometimes not sent to the patient before they are turned over to collections. This should be illegal, yet it’s not.

The above scenario occurred when my husband received a collection letter from a medical laboratory in Memphis, Tennessee. We’d no idea how the debt had occurred and I called    the billing office immediately. My questions: Where was the initial care provided? My husband had never received medical care in Tennessee. I wanted facts. What was the procedure and who’d ordered it? On what date had the procedure been performed? Who had received the results of the procedure and who had authorized the procedure?

I also asked why we hadn’t received notice of the amount before the collection letter—and why hadn’t our insurance companies been billed as we had 100% coverage for the procedure?

Federal law mandates all insurance must be billed and an EoB (Explanation of Benefits) received before an account is turned to a collection agency. Additionally, the patient has thirty days to pay the existing balance after the final EoB has been received by the billing office.

I discovered neither of our insurance companies had been billed for Tom’s lab procedure which had been ordered from his internist office in Little Rock, Arkansas. I was furious! Had the billing office filed with our insurance companies, they would have received payment in full! Instead we were turned to a collection agency and thus the $14.00 amount appeared on our credit report.

I won’t go through the agony or steps I took to remove the account from our credit report. I will say it wasn’t pretty and I used every ounce of my career experience to correct the problem.

Unfortunately, a similar situation occurred two weeks ago when we received a statement that we owed $300.00 for a procedure Tom had at a medical center. Again, I knew the procedure was covered 100% by our insurance but, before I could call the medical center, I needed to pull up Tom’s Medicare Claims Log and research his Blue Cross payments and EoBs. Upon doing so, I discovered both insurance companies paid the appropriate amount and zeroed out the account. The actual problem was that the medical center had billed for the same procedure twice under two different provider names.

I made notes for myself before I called the medical center. Aggravation was certain to appear in my voice. I remembered the individuals who don’t have an intimate knowledge of medical bills and reminded myself if I could help just one person that was my responsibility.

I called the medical center and gave the requisite account number. Before I could say why I was calling, the voice on the other end of the line said, “Oh, yes. We realized the account was submitted twice and we’ve fixed the problem.” There was no mention of, we’re so sorry we caused you anxiety or we’re sorry we didn’t call and let you know we billed you in error or any other warm fuzzy comment. How easy it would have been for them to give me a one sentence thank you?

There’s a myth about medical collection accounts. Consumers believe once the account is paid-in-full, the account will be removed from their credit report. In reality, the truth is you can go ahead and pay those medical collection accounts if you owe them, but there won’t be much change, if any, to your credit score. The medical debt will remain on your report for seven years and then you’ll more than likely have to prove it’s been paid before it’s removed. It’s not automatically removed.

I removed the faulty information from our credit report but, if I hadn’t had my own resources it would have been an up-hill battle and legal resources in the thousands with no guarantee of a positive out-come.

Medical identity theft (future blog pending) is increasing at an alarming rate. If your medical identity has been stolen, you won’t know you have medical debt until the bills arrive. Normally what happens is the thief doesn’t use your address or any of your care providers. The thief ignores the co-payment amounts and finally the account is turned to collection and you’re left responsible for the amount due.

One of your most valuable assets is your health benefits.

Before you pay for any medical service, other than your co-payment at a physician’s office or for ancillary service, ask for an itemized bill. Medical bills have a high percentage of error. Ask questions about anything you don’t understand.

If you believe you’ve been over-charged for a procedure and that there’s a significant difference between what your insurance paid and what is still due from you under the co-payment portion of your medical bill, go to http://FairHealthConsumer.org. This database provides cost estimates for medical services. Of course, you can always fight a steep bill by hiring a medical advocate who will contest the charges (http://billadvodates.com), but bear in mind you’ll pay between $50 to $150 an hour or a percentage of your savings.

Fifty-nine percent or nearly 2/3rd’s of the people who experienced medical debt were assured that they received the care for which they were billed. It may take months before all claims are filed and paid by the insurance company.

It is imperative that you or another responsible individual examine each EOB received for every date of service. I keep a ledger for Tom and myself. I know our insurance covers us 100% but that doesn’t stop every provider from billing us. Medical billing offices are notorious for errors.

Currently Fair Reporting Action allows the consumer reporting agencies to include medical debt on a credit report for up to seven years after the date on which it was reported to be delinquent.

While many attempts have been made to address this legislatively there’s zero relief in sight.

Sadly, Mark Rukavina, executive director of The Access Project asks, “What do you get when you combine a dysfunctional insurance billing system with the flawed scoring algorithms? The answer (could be) $5,000 to $6,000 in additional fees for a home mortgage!”

UNFAIR & SHOCKING NUMBERS

  • In 2010, 44 million Americans, nearly one-quarter (24%) of American adults under the age of 65, had medical debt being paid off over time.
  • Nearly three-quarters (69%) of those with medical debt were paying off bills totaling less than $4,000.
  • Nearly a third (31%) were paying off bills totaling over $4,000 and were insured at the time the care was provided.

We’re in need of a Medical Debt Responsibility Act which would prohibit consumer credit agencies from using paid-off or settled medical debt collections in assessing a consumer’s credit worthiness.

Don’t expect change to come soon. It’s nice to dream but as long as members of Congress can acquire whatever medical care they wish and have all prescriptions along with over the counter medications for free at a military facility, why should members of Congress worry about a Medical Debt Responsibility Act?

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