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Pulse Magazine

Pulse Magazine

Medical Debt Declines with Patients’ Age

Credit report data for more than four million Americans examined by researchers for Health Affairs shows medical bills in collections are declining among older consumers, but their medical spending is increasing.

According to the research, “the share of people with at least one medical bill in collections decreased nearly 40 percent from patients age 27 to 64.”  Overall, as of 2016, about 16 percent of consumers’ credit reports showed unpaid medical bills referred to collection agencies, Health Affairs reports.  While aging consumers’ medical bills in collections decline, spending increases.  For example, the mean medical spending for 2011-2015 ranges from $4,000 to $6,000 for consumers ages 70 to 80.

The authors of the Health Affairs study, Michael Batty, an economist at the Federal Reserve Board, Christa Gibbs, economist at the Bureau of Consumer Financial Protection, and Benedic Ippolito, an economist at the American Enterprise Institute, also found that “un-insurance rates tracked closely with total medical debt, with younger adults having both higher dollar amounts of medical debt and a higher likelihood of being uninsured.

However, the number of people who accumulate medical debt by age was less closely tied to insurance coverage rates.”  Read more on the study on the Health Affairs website:

Emergency Brake

The health care world has many moving parts. As a debt collector, it’s your job to be the health care expert—which means it’s often up to you to explain medical bills and insurance coverage to consumers. 

You’ll hear things like, “My insurance should have paid that!” and “I was told I was covered.” In an emergency situation, medical bills get even more confusing.  The patient might not even have been conscious at the time of care to consent to the treatment.

The Emergency Medical Treatment and Active Labor Act requires hospitals to evaluate and stabilize patients regardless of their financial situation. These requirements are mandatory and not affected by payment considerations. The hospital still bills the patient, and the patient is responsible for paying that bill.

This is particularly stressful if patients aren’t satisfied with the treatment and find out their health insurance won’t cover it.  Sometimes patients go to the emergency room, change their mind and refuse treatment, but are still charged a facility fee. Facility fees are charges for a hospital’s services and equipment, and they often come as a surprise to patients.

Even if patients disagree with these charges, unless they can negotiate a lower amount with the health care provider, they are responsible for paying the bill.  Sometimes patients aren’t familiar with their copays. Depending on the insurance plan, copays can vary depending on the type of service used; for instance, payments often differ when you have a preventative medical exam in your doctor’s office versus going to the emergency room after you tumble off a ladder.

Many emergency room doctors–and even ambulance services–are private contractors who might not be covered by a patient’s insurance plan. When a patient receives care from an out-of-network physician, even if it’s at an in-network facility, the patient may be charged for the out-of-network fees.

When patients apply for financial assistance through the hospital, they may believe their bills will be taken care of completely. However, the hospital’s financial assistance policy only covers the hospital’s bill—not those of the emergency room physician, the radiologist, the anesthesiologist or other providers that gave medically necessary care in the hospital. 

Hospitals must list which providers delivering emergency or medically necessary care are covered by financial assistance and which are not.  Here are some helpful questions you can ask the patient:

“What does your explanation of benefits tell you is owed?”

“Why do you feel you are not responsible? Tell me what happened.”

Many consumers feel by carrying insurance, they’ve fulfilled their financial obligation to the medical provider.  But insurance doesn’t relieve patient responsibility. The terms of a patient’s insurance policy will differ between insurance companies. The bottom line: the patient is responsible to pay for services not covered by insurance.


News & Notes

CMS Finalizes Rule Including Price Transparency Initiatives

CMS Finalizes Rule Including Price Transparency Initiatives

The Centers for Medicare and Medicaid Services is advancing a rule designed to improve access to hospital price information, give patients greater access to their health information and allow clinicians to spend more time with their patients. One component of the rule focused on value-based care and reducing administrative workloads at hospitals requires health care providers to publish costs and policies for price transparency online. 

Study: Why Do Consumers Use Out of Network Providers? 

Nearly 18 percent of inpatient admissions for consumers with health insurance coverage from their employer are with out of network providers, which may increase their costs. Why do consumers have care from out of network providers? The Kaiser Family Foundation analyzed employer plans to find out. One reason is consumer preference; however, in some cases they may not have a choice in their care provider, such as treatment in the emergency room. 


Safe & Sound-How Well Do You Understand Privacy Considerations Under HIPAA

Safe & Sound-How Well Do You Understand Privacy Considerations Under HIPAA

If your agency collects health care accounts, you need to be familiar with The Health Insurance Portability and Accountability Act (HIPAA.) HIPAA privacy laws were put in place to safeguard consumers’ protected health care information, or PHI. HIPAA governs how you access, distribute and protect PHI, and failure to comply can result in huge consequences, not only for your company, but for you, personally.  

While there is no private right of action under HIPAA, Health and Human Services can take action against those who violate HIPAA and consumers can file complaints with them for HIPAA violations. In 2010, for instance, a doctor who accessed medical records without a valid reason was fined $2,000 for violating HIPAA and sentenced to four months in prison. And in 2015, a lab employee at a student health center was fired after she mentioned the results of a patient’s pregnancy test to a coworker. 

What is PHI? As a debt collector, you are expected to help protect consumers’ sensitive and confidential health care information. Anything that could be used to identify consumers in relation to their health care information is considered PHI. This can include a person’s name, address, phone number, medical history, insurance details and health care bills. 

How Can You Protect PHI? Don’t discuss information in the consumer’s file with anyone but the consumer—unless the consumer has given you permission to do so. This includes idle chit-chat with co-workers, even if you don’t mention the consumer’s name. Sometimes a situation may call for you to contact the consumer’s insurance company or you may get an information request from an attorney.  

Before you email, fax, mail or discuss PHI with third parties, ask yourself: Do my company’s rules authorize me to do this? If so, has the consumer consented to the PHI release under HIPAA, and will the information I send be encrypted? (Email in particular is an often-overlooked PHI disclosure risk because it might not be secure.)  

Although the Fair Debt Collection Practices Act allows you to communicate with a consumer’s spouse, parent or guardian, HIPAA may not. If consumers request that they do not want certain people, such as family members, to have knowledge of their situation or condition, you can’t disclose any health information to third parties. 

How Should You Store PHI? While your company is responsible for securing its computer system and designing its collection notices to protect PHI, you also play a key role in this process. Don’t leave consumer information on your computer screen when you’re not at your desk, even if you just get up for a minute to get a drink of water.  

Only print out documents containing PHI when you have a legitimate business reason to do so, and even then, you’ll need to dispose of those papers in a secure environment—a shredder your company uses for such a purpose, for example, not the day-to-day recycling bin by your desk.  

Even written notes you leave on your desk referencing PHI can be considered a HIPAA violation, so either avoid doing this altogether or use HIPAA as good motivation to keep your desk clean and free of clutter, safely disposing of these written reminders as soon as possible.

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