Medical Insurance Billing Nightmare

It is a medical insurance nightmare that began with a physician simply trying to make things easier for a patient.

A simple favor turned into money seizures, bill collections, and a lawsuit that were spinning out of control.

So, it was time to Get Gephardt.

The doctor patient relationship can be very personal.

So personal that I know many kind doctors will go out of their way to provide special help to a patient who is in particular need.

In this case, such a personal favor turned into a medical insurance nightmare for the patient...

With the energy Tiffany Schoenfeld displays to supervise her children around her home, you wouldn't suspect that she has a heart condition.

But she does...

Back in February of 2007, Tiffany wound up here at the University of Utah Medical Center Adult Congenital Heart Clinic, where Tiffany's insurance covered treatment by only one of the doctors. Her insurance did not cover an electrocardiogram heart test.

But, in Tiffany's need, the doctors worked out a deal.

"They all came back in and said, oh, it's your lucky day," Tiffany says.

The doctors arranged that no matter what happened, all of her treatment would be billed through that one doctor who took her insurance.

But then someone filled out insurance forms that sent the bill through the wrong doctor. And that was the beginning of a 2-year medical insurance nightmare.

The first bill from University Healthcare rejected by the insurance company came to $978...And Tiffany sent in her appeals.

"None of it was supposed to be charged," she says.

But after Tiffany appealed to the University of Utah Medical Center, another bill came...with late charges.

So, this time, the nurse went to the billing department to tell them about the mistake.

But that didn't work, as Tiffany found out when the state of Utah seized her money.

That's right. The state of Utah with no trial, or even a hearing, can seize a citizen's tax refund. The Utah Attorney General acts as the collection agent if a state institution, like the University of Utah Medical Center simply says a citizen owes money

The state seizure was $500 dollars. But, by now, the bill had now grown to nearly $1400.

So, this time, the University of Utah Medical Center sent the bill to their collection agency, Express Recovery.

And that brought tiffany to Second District Court in Layton for mediation with Express Recovery's lawyer.

Tiffany was armed with a letter. It is from the nurse who tried to stand up for Tiffany once before. The nurse wrote that she "was personally present" when the doctor said he would be "waiving his fee." Tiffany gave the letter to the lawyer, but that didn't do any good.

The lawyer sent Tiffany back to mediation, and when she tried to explain again Experess Recovery Lawyer Edwin Parry sued Tiffany. Now Tiffany needed a lawyer. It cost her $130 an hour on a bill she never owed.

A court date was set, but Tiffany's lawyer got the trial postponed...and that's when she called me...nearly 2 years later.

I called Chris Nelson, the head of Public Affairs at University of Utah Healthcare. And over night, this medical insurance nightmare was over.

"You know, this went to the highest level of our hospital's administration. And as everyone looked at this, it was kind of an obvious thing. Yeah, this was not handled well...so we need to do what's right for the patient," Nelson says.

And within days, a check came from university hospital for $503. The amount seized so long ago from Tiffany's state tax refund.

And that lawsuit to collect the rest of the money is dropped...Tiffany got lumped into a collection system that sometimes doesn't look closely at individual cases.

“For every one Tiffany,” Nelson says, “unfortunately, there are probably 40 or 50 other cases where folks are trying to maybe not pay their bills. But we need to not be brushing everybody with the same stroke."

And University of Utah Healthcare is paying all of Tiffany's attorney fees.

So, the problem here stemmed from a doctor trying to do a patient in need a favor, but when the doctor did not carefully follow his own paperwork to have it properly billed, the favor wound up as a billing system medical insurance nightmare.

Source:http://www.kutv.com/content/news

Types of health insurance

There are many different types of health insurance programs, most of which can be divided into three basic areas of protection. The first type of protection is called a fee-for-service indemnity plan and generally provides for hospital, surgical and medical needs, including major medical, comprehensive, catastrophic, and dental plans. This insurance is provided by commercial insurance companies, independent organizations, and by Blue Cross and Blue Shield.

Rates depend on which plan you buy, the level of coverage your employer or you choose, and whether you purchase individual or family protection. The second basic type of health insurance protection is the prepaid health care plan. The major providers of prepaid care consist of HMO's or health maintenance organizations, and PPO's or preferred provider organizations.

These are groups of doctors, hospitals, and other health care professionals who have joined together to provide members with prepaid medical care. Instead of paying a premium, each member pays a flat monthly or quarterly fee. The last type of coverage available is governmental health insurance, including both Medicare and Medicaid. check
your local governmental offices to see if you qualify. For more information about health insurance, contact a local insurance professional in your area.

Source:http://www.abc15.com/guides

Mass. health plan has national appeal

WASHINGTON - Key players in the debate over how to provide healthcare coverage for the nation's 47 million uninsured say they view Massachusetts' landmark 2006 law as an important model for what Washington could do and how to get it done.
"To those who say these challenges can't be met, I say, 'Look at Massachusetts,' " said Senator Edward M. Kennedy.

Healthcare leader

Massachusetts achieved near-universal coverage by investing heavily in patching the holes in the existing system, where most people get coverage through work - something economist Jonathan Gruber of MIT calls "incremental universalism." This centrist approach rejects both the liberal vision of a Canadian-style Medicare-for-all system and the conservative preference to move to a deregulated market where people buy policies on their own with the help of tax credits.

"The architecture of the Massachusetts plan is very similar to the architecture of what everyone is talking about, which is essentially building on the existing system and not throwing it out," said Drew Altman, president of the Kaiser Family Foundation, a nonpartisan health policy group based in Menlo Park, Cal.

With a new administration and Congress gearing up to push a major initiative to expand insurance access for the first time since the Clinton administration's spectacular failure in 1994, Washington policymakers are eager to avoid making the same political mistakes. Massachusetts leaders made sure that people who liked their coverage could keep it, and they built consensus among a web of healthcare interests to create a new safety net for the uninsured.

"What Massachusetts demonstrates is, it can be done," said Helen Darling, president of the National Business Group on Health, which represents the views of large corporations on health care. "It's really important because people have talked about what we might do for years and years and years. This shows it can work, and for the most part, it can be highly functional."

Senator Edward M. Kennedy, a leader on health care in the Senate who also helped create the state law, cited new figures released yesterday showing that 97.4 percent of Massachusetts residents now have insurance, compared with 90 percent when the law was passed in 2006.

"To those who say these challenges can't be met, I say, 'Look at Massachusetts,' " he said in a statement.

Source:http://www.boston.com/news

Prudential unit to bid for AIG Japan units -sources

A Japanese unit of Prudential Financial Inc plans to bid for two Japanese life insurers put up for sale by American International Group Inc, people familiar with the matter said.
Saved from bankruptcy by a U.S. government bailout that has now ballooned to about $152 billion, AIG is looking to raise cash by shedding assets globally.

AIG's push to sell assets was underscored by comments from chief executive Edward Liddy to the Wall Street Journal. Liddy said in an interview that AIG will try to renegotiate the terms of its rescue package if it can sell off assets to repay the government.

The insurer has said it will sell its three Japanese life insurance businesses -- Alico Japan, AIG Edison Life Insurance Co and AIG Star Life Insurance Co.
Prudential unit Gibraltar Life Insurance Co will bid for AIG Edison and AIG Star, three sources told Reuters. The individuals spoke on condition of anonymity because the bidding process is not public.

The sale could fetch several hundred billion yen, the Nikkei business daily has reported.
Spokespeople for Prudential Financial and AIG in Tokyo declined to comment.
Although its population is shrinking, Japan is still seen as a growth market by some overseas financial firms.

Thanks to a culture of frugality, Japanese household savings are now estimated at a staggering $16 trillion. The desire to tap that pool has brought in big overseas financial firms such as HSBC Holdings Plc and Citigroup Inc.

Insurers have also been drawn by the country's rapidly ageing population. U.S. firm Aflac Inc has made an aggressive push in recent years, blanketing the country with advertisements for insurance products.

With insurance revenue of 407 billion yen ($4.37 billion), AIG Edison ranks No.22 in the Japanese industry. AIG Star ranks No.23 with revenue of 266 billion yen.
AIG has hired JPMorgan Chase & Co and Goldman Sachs to advise it globally on asset sales, while Prudential is using Nomura Securities to help it weigh a bid for the AIG operations, sources said.

A deadline for the bidding has been set for Dec. 9, the sources said. It was not immediately clear whether Gibraltar was the sole bidder or other potential buyers were involved. ($1=93.14 Yen) (Additional reporting by Nathan Layne, Yumiko Nishitani and Dave Dolan; Editing by Michael Watson)

Source:http://www.guardian.co.uk/business/

Investors Buy $17.25 Billion in Banks' Bonds

A fresh asset class is quickly carving a new niche for itself on Wall Street.

In just two days, Goldman Sachs Group Inc., Morgan Stanley and J.P. Morgan Chase & Co. sold a cumulative $17.25 billion of government-guaranteed bank bonds as part of the Federal Deposit Insurance Corp.'s Temporary Liquidity Guarantee Program.

The program has opened the financing door for banks that were otherwise shut out from repaying or refinancing debt as a result of the credit crisis. The government guarantee allows banks and firms that have been approved to participate, such as General Electric Co., to take advantage of cheap financing.


Barclays Capital fixed-income analyst Rajiv Setia estimates financial institutions may use the program to issue $250 billion to $350 billion of debt by June 30 of next year, when the issuing period expires.

Approximately $215 billion of U.S. bank debt is set to mature during the first two quarters of 2009, according to Dealogic.

Mitch Stapley, chief fixed-income officer for Fifth Third Bank who has bought some of the new bonds, classifies them as better-yielding Treasury bonds.

"With yields on Treasury bonds that can make a goat just about choke, these are a no-brainer alternative," Mr. Stapley said.

On Tuesday, three-year Treasurys yielded 1.37%. In comparison, Goldman Sachs's new three-year guaranteed bonds were priced with a yield of 3.367%, Morgan Stanley's sold with a yield of 3.262% and J.P. Morgan's notes yielded 3.147%.

Reduced credit risk coupled with additional yield has helped the new bonds blaze their way into portfolios.

Mr. Stapley and others expect the market for these bonds will continue to flourish and anticipate a surge of supply next week.

"The universe for this product is growing day by day as more and more accounts sign on and/or get approval to participate in the program," according to Paul Spivack, head of U.S. debt syndicate at Morgan Stanley.

Citigroup Inc. and Bank of America Corp. have said they are preparing to sell FDIC-backed deals as early as next week, and others are sure to follow.

Global interest in the new bonds also has been sparked, as the FDIC will insure debt that is denominated in a foreign currency. J.P. Morgan is planning to sell a two-part, euro- and sterling-denominated bond issue under the FDIC program, a person familiar with the situation told Dow Jones Newswires on Wednesday.

Goldman Sachs was the first firm to offer the new bonds. It sold a $5 billion three-year issue at a risk premium of two percentage points over Treasurys on Monday. That issue snapped after it was freed to trade, fetching a risk premium of 1.84 percentage points in the secondary market.

Morgan Stanley sold a total of $5.75 billion of bonds in four parts Wednesday.

According to syndicate participants who worked on the deal, 347 investors placed orders for the debt, with 70% of the debt sold going to U.S. buyers, 20% landing in European hands and only 10% going to Asia.

The Morgan Stanley deal was the first issued under the government program to include a floating-rate note, an instrument recently absent from the corporate-bond primary market.

The Morgan Stanley fixed-rate notes also traded well in the secondary market.

And J.P. Morgan sold a combined $6.5 billion of securities Wednesday. The bulk of the issue consisted of J.P. Morgan's $5 billion three-year fixed-rate note, which was sold at a risk premium of 1.775 percentage points over Treasurys.

Source: http://online.wsj.com/article/SB122782428906462449.html

AIG Mulling Overseas Life Unit Sale to China Fund, Nikkei Says

American International Group Inc. is in talks to sell a stake in an overseas life insurance unit to a group led by a Chinese sovereign wealth fund, the Nikkei newspaper said, citing unidentified people familiar with the matter.

AIG is negotiating to sell a minority stake in its American Life Insurance Co. unit, which operates in more than 55 countries including Japan, the newspaper said. The group including the China Investment Corp. and China-based insurers and have until yearend to come to an agreement with AIG, the Nikkei said.

Chief Executive Officer Edward Liddy is trying to sell almost all of AIG's businesses excluding property-causality insurance to repay a U.S. loan that saved the firm from bankruptcy. The company said Oct. 3 that it would look for buyers or investors in two overseas life insurance companies -- one operating in Japan, parts of Europe, Latin America and the Middle East, and the other operating in China, Korea and India.

AIG wants to keep majority control in the American Life Insurance unit, the newspaper said, and a 49 percent stake may cost 500 billion yen ($5.2 billion) to 1 trillion yen. An agreement may lead to other deals with the sovereign wealth fund, the Nikkei said.

Nicholas Ashooh, a spokesman for New York-based AIG, didn't immediately return a call seeking comment. An e-mail to the China Investment Corp. wasn't immediately returned.

Source:http://www.bloomberg.com/apps/news?pid

Children's insurance program may need wait list

SACRAMENTO—The state's budget woes could leave thousands of California children on a waiting list for health care.

State officials who oversee the Healthy Families Program are scrambling to find ways around a $17.2 million budget shortage.

The program provides low-cost health, dental and vision coverage to uninsured children of working families.

Currently, 883,589 children rely on the low-cost health insurance state program, and about 27,125 new applicants enroll each month.

The Managed Risk Medical Insurance Board warns a long waiting list could amass quickly, with an estimated 160,000 children waitlisted in the first six months.

The board is slated to meet in Sacramento on Wednesday. If approved, the stoppage could be implemented as soon as Dec. 18.

Source: http://www.mercurynews.com/news/ci_10977114