Let me tell you about a dirty little secret of the healthcare industry. Here it is; you are being ripped off by a system that systematically hides the truth from you. Patients are simply pigeons in a collection system that makes the Mob look like pansies. What you don’t know and they do are the real costs of health care services.
Let us begin with a Fairy Tale.
Once upon a time there was a fair billing system for you to determine how much you owed for a hospital visit. Do you hear that echo in your head? Yeah that’s right; it is just a fairy tale.
I am a personal injury lawyer so I deal with medical bills every day. Besides being a lawyer I am a licensed real estate broker, a commercial real estate broker, a businessman, a landowner, a homeowner and a consumer. I consider myself educated. So if anybody should be able to figure out medical bills shouldn’t it be me? And if Obamacare is bad it should be me that knows why. Well, shouldn’t it? But I can’t; and I’ve yet to hear any politician explain why I should dislike this method for the working poor to negotiate a better deal with the medical industry. Have you?
Have you ever heard anyone explain why the Affordable Healthcare Act is bad? I haven’t. I have a feeling the lack of an explanation revolves more around who it is bad for rather than what is actually “bad” about it.
For the past thirty-four years I have dealt with the medical billing industry as a personal injury lawyer. In my experience I have found what this industry wants the system to be confusing. If you and I can’t figure what we owe then the bill collectors have an enormous advantage.
It is never clear to me what is owed, for what we are paying, what has been reimbursed by health insurance and whether or not the charges are reasonable. I even find many medical bill collectors to be deceptive in their approach to collecting. While personally I have come to believe most of their representations border on being outright lies. After thirty-four years of experience with reading medical bills shouldn't I have the knowledge to clearly understand how to determine a fair charge for needles and syringes along with being able to determine how much BlueCross BlueShield has already paid the medical service providers? I can’t, believe it or not after thirty four years I am still unable to make this determination. And that is the game they are playing.
While I remain determined to figure this out, my thirty-four years of experiences has allowed me to make certain conclusions about the hows and the why’s this system is working the way it does. By now I can easily conclude this confusion is exactly what those who make money off of the health care system want. The patients are not supposed to understand what they are being charged, why they are being charged and how much insurance has already paid. They aren’t supposed to know if they are being gouged for the supplies and services they used.
It is all very simple. The first principle of this collection institution is clear, patients are uninformed. The second principle is even simpler, keep them uninformed. And the third is even simpler. If the patients and consumers stay uninformed the medical industry wins.
Why? Because if we remain uninformed we can’t argue with them about what is reasonable.
Why they don't want you to understand your medical bill is simple: It is because we are overpaying, and paying twice for much of our medical care and those who are ripping us off are making ten times more than what they deserve to make. Yes, after thirty-four years that is the only conclusion I am able to make. We are being ripped off on a massive scale by an industry that has long gotten away with systematic fraud.
HERE IS WHY THEY WILL TELL YOU TO HATE WHAT THEY CHARACTERIZE AS OBAMACARE
With the AHA, Medicaid takes over “negotiating” and then paying for more of the American consumer’s healthcare costs with those who provide the healthcare. Medicaid is a scary monster to the healthcare industry. Why? Because it has all the answers that you and I don’t. Medicaid knows what would be a reasonable charge for needles, syringes and sponges and Medicaid knows when the patient is getting ripped off. What, a knowledgeable consumer?!! We can’t have that! We need to scare the consumer that the Constitution is being invaded! Let’s scare the consumer and get rid of Medicaid by getting rid of Obamacare!
According to the established medical Mafia here is what is wrong with Medicaid and Obamacare. There is no question of how much the hospital should be charging you for the OR and that room on the ICU. You and I don’t have that answer, but Medicaid does. And when Medicaid pays it is the end of the debate about whether the patient should be paying more than was charged or collected. (i.e., you don’t owe anything after Medicaid pays the bill.) There is no reason to call you and try to scare you into paying any more. The BCBS scam is toast. After Medicaid pays the health care industry is done badgering the patient for more money. It is illegal for the healthcare collection thugs to try and get you to pay more. Did I say try? I meant lie to get you to pay more. You think I’m exaggerating? Let me give you a recent example.
I represent a client who was injured when the motorcycle he was riding on crashed. His bills amounted to over $72,000. BCBS approved and paid just over $64,000. There was almost $9,000 difference between what was charged and what was paid. One bill from a helicopter ride was a monstrous $53,000. But the difference is minimal. You would think the medical service providers would just go away feeling lucky we bought them a new helicopter. But they aren’t satisfied with just going away. I get a call from a clinic who charged $9,89.80 and was paid $8,257.90. So you might think they will want to collect the difference. Nope, not even close.
A collection agent phoned claiming to represent the clinic and was trying to get money out of me to pay what she claimed was for an unpaid bill. She first started by asking for $8,257.90. Then went to $9,789.80, refusing to say if any of it had been paid and then saying it was going to collection saying "we filed a lien". (That was meant to scare me, except I’m a lawyer not an uneducated patient.) When I asked if they billed BCBS she claimed to have no knowledge and then saying that it really didn't matter. After being asked repeatedly about BCBS payments she admitted the bill was really less than the $9,789.80. By the time I was through with her the claim was down to $1,745.99, but she still wanted the $9,789.80. It felt like I was talking to a crazy person. When I then asked if under state law balanced billing was even legal she admitted to having no knowledge of what this meant because according to her, she'd never heard of balanced billing.
But that wasn't the end of this charade. Fifteen minutes later the auto insurance carrier phoned to ask about the $9,789.80 bill for the clinic because this same bill collector had hung up with me and called him trying to collect the same $9,789.80!
Medical billings are confusing and in my opinion meant to be that way. The medical community has long gotten away with confusing the patients, scaring them with debt collectors, talking in circles, chirping mumbo jumbo, talking complete nonsense and then getting the scared patient to pay more than they owe or even paying twice; once through medical insurance and then again by private pay. This is what I put up with every day. So, don’t be fooled.
THEY WILL LEAD YOU TO BELIEVE THAT “OBMACARE” IS A WEAPON OF MASS DESTRUCTION
It is a weapon of mass destruction, but ask yourself for who? I have no way of actually knowing the truth about the ACA but I do know what I see and how it works and that tells me a lot about why the “sky is falling” scenario’s are being promoted and repeated over and over and over again. When Medicaid steps in the bill collectors are on notice that they are now cheating the government, not a bunch of unrepresented consumers who lack the organization to figure out they are being cheated. When you cheat the Medicaid you are really cheating the US Government and sooner or later you will get caught and when you do there are fines and jail time.
That’s not so with consumers because as a group there is no coordination of information and a lack of understanding as to what a reasonable charge is and how much has really been paid.
Those who are losing access to “a boat load of cheating us” out of healthcare dollars want you to believe that by having the ACA we will all go broke. But like the “frivolous lawsuits” movement there is an error in their logic.
LIKE THE “FRIVOLOUS LAWSUITS” MOVEMENT THERE IS AN EMOTIONAL TRIGGER
Remember when the insurance industry claimed contingent fee lawyers were getting rich off of filing frivolous lawsuits? Wow, weren’t we all scared that tasseled toed plaintiff lawyers were going to ruin America? I was even afraid of myself for awhile, until I put facts behind the words “contingent fee lawyers getting rich off of filing frivolous lawsuits”. First of all a contingent fee pays lawyers only if they win and when they win they get paid a third of the amount won. A frivolous lawsuit is worth very little but mostly those frivolous cases are worth nothing. When I was in grade school they taught us that any number times zero is zero. Meaning, if a million lawyers filed a million frivolous lawsuits and recovered nothing then their fees would be nothing. So how then are the million lawyers filing a million frivolous lawsuits getting rich off of fees equal to a big fat zero? This is preposterous and the fact that juries bought it is just as ridiculous.
But who made out like a bandit? Well, the insurance industry did. Jurors kept being charged the same premiums while awarding very little to legitimate claimants and the insurance company executives got fat and happy by paying themselves bonuses and keeping all your money. They headed off to the country clubs to laugh mostly at the jurors. The insurance industry was laughing all the way to the bank.
If you want help ripping off the face of the rip off artists call me and let me settle your million dollars of unpaid medical bills for a fraction. Hopefully I won’t be too busy to take your case. And with a name like Lombardi I will feel right at home talking to the Medical Mafia.
Here is what I will tell them,
Forgettaboutit! After all it was just a broken leg!