Ignorance of Commercial Procedures

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Ignorance of Commercial Procedures

Post by editor » Mon Feb 23, 2015 2:07 am

Okay, I'll admit it in advance. This is going to turn out to be a rant. I'll put in some educational stuff along the way though, so you'll probably learn something. First, the background.

A few months ago my mother-in-law broke her leg. She went to our local hospital's emergency room. Treatment was given, healing commenced, and she's actually walking on it now. All good. Except now here come the bills.

More than $30,000 from the hospital. Another grand from a doctor. A grand and a half from the anaethesiologist. Half a grand from the radiologist. Another grand from the hospital for stuff they presumeably forgot the first time. Really? All this for a simple broken leg? How did we ever get to a place in society where such a thing could happen, and people (ANY people) would think it is normal?

My mother-in-law is uninsured. Luckily for her, she has read my book How to Survive Hospital Costs Without Insurance. So before she signed the admission form, she modified the "promise to pay" clause to read,
"...pay all valid charges subject to Blue Cross Blue Shield schedule of fees."
Of course no hospital ever honors that stipulation, until you hold their feet to the fire, which is what my book teaches people how to do. But that's not exactly the subject of this rant. I'm not here to discuss the hospital right now, I want to shed some light on the sub-contractors like the doctor, the anaethesiologist, and the radiologist.

Hospital admission forms nearly always have a clause which authorizes third-party providers to give you treatment, and to bill for their services. The question becomes, how do you get these third-party providers to recognize the contract you have with the hospital, and force them to accept payment at the same rate of discount you have pre-arranged with the hospital?

The hospital has sent you this huge bill. Even though you've requested a detailed statement readable by a layman, the best they've provided still has "miscellaneous charges" or unintelligable charges amounting to thousands of dollars. How do you know the third-party provider's charges aren't already in the hospital's own bill? For that matter, how do you know the third-party provider really did anything at all, or even has the right to charge you?

If you send them the same sort of correspondence my book teaches you should send to the hospital, it is quickly evident the third-party providers have never seen that contract and are, for the most part, very reluctant/resistant to honoring it. Which got me thinking. People just assume everything is right, when many times it is not.

Now don't get me wrong, if these third-parties provide a service, they deserve to be paid. But if the average amount providers accept from BCBS is 12% to 15% of what they commonly bill uninsured patients, and if you've limited your liability to what they would otherwise accept from BCBS, then a $1,500 bill becomes more like $180 to $225. That is, provided they actually have a right to bill you at all, and haven't already been paid by the hospital out of what the hospital expects to get from you.

Here's what I did for my mother-in-law: I sent each third-party provider a letter, on her behalf, that basically said,
"Please produce a copy of the contract which obligates me to pay for your services."
Seems simple, right? But it turns out none of them can do it. What's more, under commercial law, once you've demanded it, if they can't produce the contract upon which their claim is based, then they don't have a leg to stand on to collect from you.

A couple of them responded asking her to sign a waiver giving them permission to disclose her private records.

In the response I designed for her, she returned their waiver to them refused for cause, without dishonor. She chastised them for trying to trick her into authorizing them to do something which they would otherwise have had the right to do without her authorization, if they were in fact lawful contractors of the hospital. And she reminded them the clock was still ticking for them to produce evidence of their claim.

Bottom line, these people are going to end up not getting paid, and believe it or not, that really frosts me.

Once I saw things clearly, this challenge was the only lawful route available. It's a lawful challenge that has been around for thousands of years, and for very good reasons. But apparently the third-party provider and the hospital have no mechanism in their procedures for allowing the third-party provider to satisfy the challenge. Why not? Can it be for any other reason than ignorance of commercial procedures?

Evidently, no one (or almost no one, at least until I came along) ever asks for evidence of the obligation. Why set up procedures for something that's never going to come up?

Now this is bothering me on a deeper level. Why doesn't it come up? Why is the general public so ignorant of their rights, and so easily put at a disadvantage?

The only answer I can think of is public school. In the very beginning, the only way government could convince parents to voluntarily give over the raising and education of their children to someone else, was to offer a better education than the parents could provide. Gradually though, the quality could be shaved away. As people became less educated, they were easier to fool. Now, people are so stupid they'll send their kids to schools teaching Common Core, and just be glad they have a sitter for most of the day.

These people will probably always be sheep, easily led to be shorn or slaughtered. Further, they'll never understand people who see the big picture, and the sheep will scorn those of us who know better, and think of us as part of the problem, not the solution.

Only occasionally will someone wake up, and that's why I maintain this site.

Okay, I feel better now. Rant over.
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Re: Ignorance of Commercial Procedures

Post by Dumpster » Mon Feb 23, 2015 12:50 pm

I'm sorry to hear of this ordeal and I'm glad your mother is healing.

I, myself, was unaware of the third party not having any contract to follow through with. The only other thing I can remember is if the third party had anyone (patient) sign a contract before they did their job in the hospital room and not at admitting, is something I experienced back in the 80's when an Anesthesiologist had my wife sign something before he gave her an epidural for child birth.

It's just crazy how the cost for medical treatment/medication has gone so high. I was reading an article about a week or two ago that stated a certain pill, can't remember what exactly, cost $1,000 per pill in America, but could be bought in Egypt for $10.

I can't recall where I came across that article, and of course consideration as to it's validity would be of concern. Ahha, I found it, here is the link - http://www.naturalnews.com/044463_Big_P ... drugs.html

Anyhow, sorry if I got a little off topic there.

My best wishes and prayers to you and your mother getting through this dilemma.
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Re: Ignorance of Commercial Procedures

Post by notmartha » Mon Feb 23, 2015 3:11 pm

It's no wonder nobody understands the billing process, being the tangled web it is. Hospitals and their agents (service providers) contract with billing companies that handle all the third party billing. These billing companies look like they are part of the hospital, but are actually separate corporations. They will even have names such as XYZ Hospital Billing Department and have an office in the hospital.

From "HHS", who regulates billing companies:
Billing companies provide services for virtually every aspect of the health care industry. Among the areas of greatest concentration for billing companies are: physicians, ambulatory surgery centers (ASCs), durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) industry, home health
agencies (HHAs) and hospitals.

Training and education programs for billing companies should be detailed and comprehensive.They should cover specific billing and coding procedures, as well as the general areas of compliance.
It is so convoluted that there are schools specifically to teach health care billing. And now with all the new Ocare regulations, even those doing the billing don't understand the billing.

You are right though. "Show me the contract" should be the learned response to any purported obligation.

Hope your mother in law heals up nicely.
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Re: Ignorance of Commercial Procedures

Post by editor » Mon Feb 23, 2015 8:57 pm

Thanks, Dumpster and Notmartha, for your responses.

Just to clear up one point-- It isn't that the third-party providers don't have a contract upon which they can rely, they do. The part that frustrates me is that there is a contract, but either the third-parties won't ask the hospital for it, or maybe the hospital won't give it to them.

It boggles my mind that these companies perform a service, and then would rather walk away from any legal claim to just payment, rather than comply with simple commercial procedure. Or perhaps they're just ignorant of the law, and that brings me back to my original point.

In the process of holding them to a rate-ceiling, I have to get them to first establish (and recognize for themselves) the document that gives them a right to send a bill in the first place. Then, and only then, can we talk about the rate.

Those of you who have read my book will see this as very similar to the way I teach readers to handle collection agencies. First, they must establish their lawful capacity to stand in the shoes of the original (alleged) creditor. Only then can you allow the conversation to address the merits of the bill itself.

In more than fifteen years since I published the first edition of my book, having received feedback from hundreds of readers, I have never seen one instance of a collection agency willing to document their right to collect a bill. In my experience, and the shared experiences of all my readers, they always walk away with their tails between their legs. Most of those collection agencies are not working for hospitals. They purchased the debt with actual money, which they stand to lose if they do not collect. Yet when they are asked to prove their capacity (right to collect), they walk away.
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Re: Ignorance of Commercial Procedures

Post by editor » Sat Mar 19, 2016 9:27 pm

This seems like the best place to post a related rant.

Many of you know I wrote a book called How to Survive Hospital Costs Without Insurance. The only ad that appears anywhere on this site is for that book. I give away the book for free, through a subscription email service. People subscribe, and get one chapter a day for a dozen days, until they have the whole book. They have the opportunity to buy the companion letters that go with the book for $50, if they choose.

Today I got this email from a subscriber, let's call her "Alice", who had only received the Introduction (first installment):
Before we go any deeper in this does this book work with the new health insurance laws? From the looks of the introduction it may be out dated. If the parts you are not going to send is the reason to buy the ebook why not send all the chapters now so I can decide quicker?
I could have probably been a little kinder, but you be the judge. Here was my reply:
Dear Alice,

I think if you read my book you can decide the answer to these questions for yourself. Time is our one irreplaceable asset. With my decision to give most of my book away for free, I have reduced your cost to the risk of your time. Am I correct in my assessment that you would now like me to spend even more of my time convincing you as to why you should read a free book?

Most people who subscribe to these chapters buy the book around the time they get to chapter six. About 5% cancel their subscription after getting chapter two. Where you want to place yourself in those statistics is completely up to you.

God bless you, Alice, and please don't take offense where none is intended.
Her response was to quietly unsubscribe.

A very small part of me feels bad. Maybe I could've been a little nicer? On the other hand, to me her email reeked of a sense of entitlement, and I guess it rubbed me the wrong way. These are the people who, if they buy my book, email me to ask questions that are clearly answered in the book. If I refer them to the Forum, they get mad.

I could have said some of these things:
  • The new health care laws did not repeal the hundreds of years of case law upon which private contracts rely for their enforcement.
  • My book will teach you about contracts, commercial law, how to modify contracts to your advantage, and how to enforce your modifications. It will show you the fundamental flaws in a typical hospital admission form, and why you can legally modify their contract even over their objections. You will learn how to save hundreds, or even thousands of dollars the very first time you go to the hospital. It will not teach you how to avoid federal penalties for not having insurance.
  • I offer my free book by installment emails because on the whole that's the way I sell more of the paid books. It's not because I want to make you wait. I think it works because people have short attention spans. If I offer a book as a free download, the odds are pretty high that you'll download it and five minutes later you'll forget about it without ever reading it. On the other hand, if you get the book in segments with an email in your inbox every day for twelve days, you'll stand a better chance of remembering it's there. I'm guilty of the same thing-- I have plenty of files on my computer that I've downloaded and never read. I'll bet you do too. The bottom line is that this method works. And it's my book I'm giving away for free, so I'll do it however I want. Every segment after the second chapter tells you how you can get the whole thing at once, including the letters, by simply buying it.
Maybe I'm just grumpy today? Apologies for the rant.
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Re: Ignorance of Commercial Procedures

Post by notmartha » Mon Mar 21, 2016 4:46 am

I think you showed more grace than I would have. The "entitled" are annoying.
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