When being a bad patient is good.

There are some scary statistics out there:

• When you see the doctor, the diagnosis will be wrong as many as one out of four times, according to a report by the Agency for Healthcare Research and Quality.

• One out of 14 times you have an abnormal test result, doctors will fail to let you know, according to Archives of Internal Medicine research out last year.

• In 2006 the Institute of Medicine reported that 1.5 million Americans are sickened, injured, or killed each year by medication errors.

It is because of stats like these that it pays to be a 'bad' patient.  One who speaks up and asks questions.  If your doctor says you need a certain procedure, do not be afraid to ask why. Get involved in your decisions about your medical care including prescriptions being prescribed and diagnostic tests being ordered, all which are increasing the costs of health care.

Be an empowered patient. Share in the decision model when it comes to your health. The reality is that a significant number of medical errors can be prevented or even eliminated by taking a proactive role in your health care. 

San Diego Reader | That's ok, sir, I am authorized to offer a 50% discount

An excellent, article appeared in the San Diego Reader by Chad Deal on Wednesday, July 7, 2010

Key points I feel everyone needs to be aware of:

1. When choosing a hospital, get a quote on your visit from the hospital’s billing department
2. Research fair prices ahead of time. www.healthcarebluebook.com
3. Ask what the room price includes, bring your own tissues, prescription drugs, toothbrush and towels
4. Keep a detailed log of every test, treatment, and medication you are given when in the hospital, or ask a family member or friend to do it.
5. When you get the bill, confirm admission and discharge dates.
6. Be aware of charges for items you did not receive (see #4) and double charges on your hospital bill. If you’re not sure, ask.

How can insurance dictate your medication?

Overview
A common feature of all insurance plans whether it's Medicare, a group or an individual policy is to regulate the prescription drugs prescribed for its members. This is done in four ways: requiring a prior authorization, step therapy, maximum dispensing limits or excluding certain medications from its prescription drug list.

Prior Authorization

Some drugs must undergo a criteria-based approval process by your insurance carrier prior to being covered under your health insurance plan. The approval process varies by insurance provider.

Step Therapy

Step therapy protocols require you to utilize medications commonly considered first-line medications prior to being able to using a medication considered second line or third line. You receive benefits for drugs subject to step therapy only after trying alternative medications first.

Prescription Drug List (PDL)

Your insurance carrier creates a prescription drug list (PDL) each year which dictates which medications are or are not covered by your insurance plan. The list can also change during the year depending on your policy guidelines.

Maximum Dispensing Limits

Maximum dispensing limits are based on the product information approved by the Federal Drug Administration (FDA) and recommendations from the drug's manufacturer. Your carrier limits the quantity of medication you are able to receive from your pharmacy at one time.

Restrictions

According to Humana, a health insurance company, the cost of a drug drops in price between 30 percent to 80 percent once the patent expires and it is available as in a generic form. Step therapy, prior authorization and PDL are ways to help control health care costs with maximum dispensing limits in place as a safety measure.

Considerations

You may not like the measures implemented by your insurance company to restrict dispensing specific medications; you can however get an exception made to each of the restrictions. The procedure for doing this will vary depending on your insurance carrier.

Report Medical Insurance Fraud

Medical insurance fraud is committed in a number of ways. For instance, when a consumer files a claim for services or prescription drug he never received or a provider bills for a service it never actually provided, a crime has been committed. Anytime a consumer or provider knowingly presents to her insurance company false information with the intent of receiving health care benefits, medical insurance fraud has occurred. According to Cornell University Law School, "statistics now show that 10 cents of every dollar spent on health care goes toward paying for fraudulent health care claims." Such unscrupulous acts need to be reported.

Step 1

Find the insurance fraud bureau for your state. This can be located on the Coalition Against Insurance Fraud website using the link in Resources. If your state does not have an insurance fraud bureau, search for your state's department of insurance website.

Step 2

Call the hotline number listed for your state insurance fraud bureau or the consumer helpline found on your state's department of insurance website. You will want to provide the agency with the name or any details and information you have about the medical insurance fraud situation.

Step 3

Contact the insurance company you believe the fraudulent activity occurred against. You can locate a company's phone number by finding its corporate homepage on the Internet.

Step 4

Report Medicare or Medicaid fraud by calling the Department of Health and Human Services' Office of Inspector General Fraud Hotline. You can either call 800-447-8477 or email HHSTips@oig.hhs.gov. You will need to provide information such as who committed the fraud and where and how it happened. Plus, according to Medicare, "your identity will be protected to the maximum extent allowed by the law."

 

Step 5

Voice your concerns to the National Insurance Crime Bureau (NICB). You can submit the information via the link in Resources or call the bureau's national hotline at 800-835-6422. If you are using a cell phone, you can send a text by typing the word "FRAUD" and then the fraudulent information you are reporting in the message section. The text is sent to TIP411 (847411). You are allowed to keep your identity anonymous when reporting fraudulent information.