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“Soul Sherpa (R) is a patient healthcare advocacy, life care planning, and educational company, founded in 1990.”
Lisa Berry Blackstock, based in the Los Angeles area, is engaged nationally as a patient healthcare advocate, life care planner, and mentor to her peers. Lisa's mission is to assist her clients with information and autonomy when it comes to healthcare issues, preventive as well as presenting. She is a published author, workshop presenter/speaker, and hands-on patient advocate. Over 26 years of experience dealing with physicians, hospitals, medical insurance, and estate planning has resulted in Lisa's wealth of knowledge assisting individuals with successful strategies when navigating our healthcare system and remaining as financially and emotionally protected as possible. Understanding the emotional and practical needs of patients and their loved ones has resulted in a successful brand, Soul Sherpa (R) whose goal is to add to the quality of life and well-being of all clients, despite the physical and emotional health challenges everyone is forced to face at some point in life. Whether one's concerns are proactive or the need to address a healthcare issue already presented, Lisa is an experienced patient advocate in all realms involving physician care, medication management, safe hospital discharge, medical insurance policy and billing issues, maintaining quality of life, and, in the event of a terminal diagnosis, a certified palliative care specialist and grief and bereavement counselor.
Soul Sherpa (R) does not provide medical, legal, financial, or insurance advice that is intended to replace the recommendations of physicians, attorneys, financial advisers, or insurance brokers. Soul Sherpa (R) provides information intended to assist individuals with sound and comprehensive evaluation and management of professional advice previously provided or not provided in depth. After consulting with Soul Sherpa (R) responsibility for any decision made lies with each individual, who agrees to indemnify and hold harmless Lisa Berry Blackstock, founder and owner of Soul Sherpa (R.)
Assuming the dermatologist accepts Medicare and your AARP supplement as payment in full (this is called
Assuming the dermatologist accepts Medicare and your AARP supplement as payment in full (this is called "accepting assignment" and should ALWAYS be confirmed with a physician's office BEFORE receiving treatment; I recommend you ask this question now) there may very well be an error in the manner in which your bill was coded, as the cost seems inflated to me. Ask your dermatologist's billing person for an itemized copy of what was submitted to Medicare, where 80% of the cost is covered (Medicare will pass the information on to your supplemental carrier, who will cover the remaining 20% cost that Medicare doesn't cover.) Should you discover the doctor does accept assignment and the bill for services was coded correctly, I would appeal directly with the doctor's office (in writing) asking the balance be "written off" by them. Even if you had seen the doctor and not a nurse, the charge is out of line. If your request is not granted, I would report the doctor to your state's attorney general as well as your state's medical board which oversees physicians' conduct. In the future, before going to any doctor appointment, I would ask for a written quote of what your visit will cost, as well as whether that doctor accepts assignment. Protect yourself before you seek treatment whenever possible, and get that information in writing.
Level IV emergency room care involves a critical medical concern, but not one that is life-threatening.
Level IV emergency room care involves a critical medical concern, but not one that is life-threatening. All levels of emergency care are inflated by every single hospital's internal pricelist (their Chargemaster.) That you were sent to another ER that is a member of the same hospital group sounds like price gouging to me. An emergency room that can't address a fractured wrist doesn't sound like much of an ER to me. It's possible the specific type of physician you needed to see may not have been at the first ER and that is why you were sent to the second one. Request detailed copies of both bills as well as your medical records (by executing a HIPAA release.) You will find your answer in those records as to why you were sent to the second ER. If the first hospital was unable to treat you, in my opinion, that is not your responsibility; it's theirs. I would fight (in writing; ALWAYS DOCUMENT IN WRITING) the double billing, as well as the inflated charges. A paper trail is crucial. Documenting conversations is not as reliable. Good luck.
I am so sorry to learn of your situation. I understand your desire to lower your insurance premium.
I am so sorry to learn of your situation. I understand your desire to lower your insurance premium. Given you're in need of good care right now, please understand the lower your premium, the fewer benefits you will receive by quality providers. I would begin at the point of assessing your medical care needs, WHO you want to provide that care, and what insurance they accept. Also research other providers. Before you change policies, be certain you know what providers your new insurance will cover. I don't recommend sacrificing quality care for the sake of saving two or three hundred dollars per month. When one suffers a stroke, there is a one-year window to recover. I recommend you do everything you can to take advantage of this window to hopefully regain at least some of what your stroke took away from you. Stay focused. Surround yourself with as much emotional support you can. My best to you.
Best to confirm with Blue Cross directly to verify their coverage plan for you covers 80%, which is typical
Best to confirm with Blue Cross directly to verify their coverage plan for you covers 80%, which is typical for primary medical insurance coverage. For the remaining 20% you need to purchase what is known as a Medicare supplemental policy, which covers the remaining 20% of hospital and physician costs. Supplements are priced differently. Before purchasing a policy, be certain you know what hospitals and physicians will accept that policy. Another strategy to avoid finding yourself in a bad situation is to execute an Advanced Health Care Directive, HIPAA release, and POLST (Physician's Order for Life-Sustaining Treatment.) While not sexy to deal with, execution of these documents while you are healthy will guarantee your stated wishes will be followed in the event you are unable to state them yourself. By not having these documents in place, by default, you will find yourself at the mercy of other healthcare professionals making decisions on your behalf. That would be very bad.
Depending upon the state you live in, the most affordable plans are likely the Affordable Care Act (ACA,
Depending upon the state you live in, the most affordable plans are likely the Affordable Care Act (ACA, also known as Obamacare) plans. But a note of caution: Affordable does not mean these plans are the best ones for you. In general, those who elect to purchase ACA plans are limited in the numbers of providers who will accept those coverages. If I were in your position, I would begin from a different vantage point. Identify the physician who you'd like to be your internist, what hospital you'd like to be treated if necessary, what dentist you'd like filling a cavity. Once you know what providers and facilities you prefer, call and ask each one directly what insurance policies each accepts. Only then would I begin searching for the most affordable plan for me. What good is coverage if you don't know who will be treating you? Ideally, your medical and dental team should know who you are so you can receive personalized attention (as opposed to being just another patient file with a number attached to it.) You may discover your preferred providers do accept an ACA policy. If so, realize there are different ACA plans (platinum, gold, silver, and bronze,) all with different deductibles and co-pays. The higher a deductible you select, the lower your premium will be. In general, a young person in his/her 20s can afford to go with a higher deductible to save on premium cost. Should your preferred providers not accept an ACA policy, understand you will likely be paying a higher premium and higher co-pay. A tip regarding the physician you select: Verify he/she has privileges to practice at the hospital of your choice. Some hospitals have their own doctors (hospitalists) and won't allow private MDs at their facility.