Alabama Personal Injury Blog

Why are Medical Bills so High?

Jon Lewis — Sat, 05 Dec 2009 13:49:34 GMT

Did you know that hospitals and physicians rarely ever receive the amount they charge for their services? Health insurance companies do not pay the actual bills invoiced by medical professionals. Why is that?

We had a client who was injured in a truck collision. His injuries were serious enough to warrant several nights in the hospital and a couple of surgeries. What were his medical bills? Approximately $72,000.00. What did the hospital and physicians get paid? $11,714.01, approximately 16% of the amount billed.

If you had a retail store, would you accept 16% of your prices? Why do hospitals and doctors? Are they over-charging, or are they getting paid too little?

What if you don't have health insurance? What happens then? Well, I can tell you that I handled collections for a hospital about 13 years ago, and if patients came in for emergency treatment and didn't have insurance, we sued them for the full amount, not 16%. Why do private pay individuals have to pay the full amount? I understand why health insurers receive a discount, but an eighty-four percent (84%) discount? What if Bill Gates doesn't want to get health insurance? He can pay any amount billed so why doesn't he receive the same discount as a company like BlueCross?

Is this a form of fraud or misrepresentation? In Alabama, BlueCross BlueShield has such a monopoly on health insurance that they dictate to hospitals and physicians what they can charge for their services. Many doctors speak poorly of BlueCross BlueShield as a result of their influence. Some won't even accept their rates as a result. Should the health insurance companies be setting the rates for medical treatment? Is that capitalism?

I don't have the answers to all these questions, but I think they need to be discussed, especially in light of healthcare reform. What are your thoughts?

Originally posted at InjuryBoard by Jon Lewis

$40 Million Settlement with Walmart

Jon Lewis — Thu, 03 Dec 2009 11:27:19 GMT

How are Walmart's prices so cheap? Well, you can start by not paying your employees the proper amount of overtime under the wage and hour laws of our country. Add to that a lack of benefits, and you have the makings of low prices.

Walmart has settled a 2001 class action lawsuit brought by 87,000 current and past employees of the company in the Commonwealth of Massachusetts. These plaintiffs alleged that Walmart denied them overtime pay, refused to give them meal breaks, and manipulated the employees' time cards to their advantage.

We tend to place these companies on a pedestal. The more money they make, it seems like the more credibility we give them. Oh, that's Walmart. They could do no wrong. Who could believe these greedy little employees?

We listen to the media so much. We believe everything we see and hear. Well, I'm here to tell you that there are always two sides to every story. I will bet that when this lawsuit was brought in 2001, many people, if asked, would have said that it was frivolous. Well, Walmart doesn't pay $40 million for a frivolous claim. Walmart pays $40 million and enters into a confidentiality agreement because it doesn't want the public to know what it did.

Next time you hear a story about a lawsuit in the media, stop and think. Give both sides thought. You may not be given the whole truth by the media. You may not understand all of the ins and outs of the legal issues. This is why we have our legal system. This is why juries get to listen to ALL of the facts and ALL of the law. The media just gives you soundbites.

Originally posted at InjuryBoard by Jon Lewis

Health Insurance Is A Life Or Death Issue

Pete Mackey — Tue, 01 Dec 2009 08:53:23 GMT

A recent study by researchers based at harvard has found that the lack of health insurance causes almost 45,000 deaths annually in the U.S. The American Journal of Public Health first published the study in its Septemeber, 2009, online edition. The statistics cited by the study's authors are disturbing:

Dr. Steffie Woolhandler, study co-author, professor of medicine at Harvard and a primary care physician in Cambridge, Mass., noted: "Historically, every other developed nation has achieved universal health care through some form of nonprofit national health insurance. Our failure to do so means that all Americans pay higher health care costs, and 45,000 pay with their lives."

Dr. David Himmelstein, study co-author and an associate professor of medicine at Harvard, remarked, "The Institute of Medicine, using older studies, estimated that one American dies every 30 minutes from lack of health insurance. Even this grim figure is an underestimate - now one dies every 12 minutes."

Do you think that any member of Congress would be willing to admit that they could not help an accident victim because they did not have health insurance? Of course not. Now that there are bills to consider, the opponents' cry is "we are for health care reform, but just not what is proposed." The debate over the best solution has been raging for a long time. It's too late in the game to pull out the "we can do better" card at this late stage. Opponents of health care reform have had plenty of time to put forth their own proposals, but decided instead to backseat drive. Time has run out, on the naysayers and on the 45,000 Americans who will not be alive next year without insurance.

Originally posted at InjuryBoard by Pete Mackey

Pet Doors are a Danger to Small Children

Billy Cunningham — Fri, 27 Nov 2009 11:16:23 GMT

This past week in Mobile a 2 year old girl crawled out through a pet door and nearly drowned in the family swimming pool. Her mother had left her in front of the family TV long enough to go check on laundry. When she returned, her daughter was not there and her 7 year old brother spotted her in the pool. The family pulled her out and called 9-1-1. CPR was performed at the home by the paramedics and she was taken to the hospital. On last report she was in critical condition at the hospital. The only way she could have gotten out to the pool was through a pet door was all the other doors were locked and the alarm system was on.

A website has been created by Carol Ranfone who lost a 2year old son, Matthew, by drowning. She created http://www.petaccessdangers.org/ to provide access for the public to be aware of the problem. Her tragic story was followed by Good Moring America ABC News report on May 12, 2009. It is too bad that the Mobile family did not see that report or know of the website.

More than a hundred children have died or been seriously injured in the last decade after squeezing through tiny pet doors and getting into swimming pools or other dangerous places, new research has found. "What we see is a picture that's emerging which shows that the pet door is a really serious hazard in a home that no one has really had on the radar screen," said Sean Kane, of Safety Research and Strategies. The pet door that the Rafones had contained no warning that young children could get through them. The news report also demonstrated the possibility of children getting through these rather small door. You can view it here. Click here to see the demonstration.

In most states the law requires that if there is a known hazard in the use of a product, the manufacturer is obligated to either ‘engineer’ out the hazard, guard against the hazard (like a guard over a pinch-point) and/or warn against the hazard.

The manufacturer of the door that Matthew went through also makes a pet with a remote device attached to a pet's collar unlocks the door as the pet approaches. The door then locks again after the pet exits. In its marketing materials, the company touts that the electronic lock "will prevent children from leaving the home." I also read reports where some manufacturers supply a plate that go over the opening to prevent the pets access. Those certainly should be employed to keep children from gaining access.

If you have pet door and small children around, please take all safety steps you can to make sure they do not get out through the door undetected.

Originally posted at InjuryBoard by Billy Cunningham

Won Your Workers Compensation Case? Not so Fast

Jon Lewis — Tue, 24 Nov 2009 13:02:11 GMT

What are the insurance companies doing now? They are using "Utilization Review" in order to cut off workers compensation benefits. How does that work?

Well, the Alabama Workers Compensation Act allows for "Utilization Review". That means that the workers compensation insurance carrier can submit your medical records to a third party physician to review and determine if they are related to the injury. If that third party physician says, "No", the workers compensation carrier cuts off the injured employee's benefits.

How does this work in practice? Take my client for example. She had surgery approximately ten (10) years ago. Her workers compensation case was settled, and her medical was left open for future treatment. Typically, that is what happens in workers compensation cases. The person receives medical treatment for the related injuries for the rest of her life.

For ten (10) years, my client has been receiving prescriptions and medical treatment for her injuries. Out of the blue, the insurance carrier sends her records to a foreign doctor in El Paso, Texas who opines that her injuries and medical treatment are not related. So, the insurance carrier, under the "utilization review" provision, cuts off her medical treatment.

Why did they wait ten (10) years? How can this doctor supersede my client's local doctor's opinion when he hasn't even examined her. Shouldn't the "Authorized treating" physician have the final say? The insurance carrier approved her "Authorized Treating" Physician.

This is ridiculous and unfair, but that is how the insurance industry works. Insurance covers everything but the loss. All they want is their money and to hell with everything else - morals, humanity, sympathy, kindness, and generosity. It is all about the bottom line. People talk about "greedy trial attorneys" when they should be talking about "greedy insurance companies".

Originally posted at InjuryBoard by Jon Lewis

Homicides Predict Traffic Deaths

Jon Lewis — Sun, 22 Nov 2009 12:42:37 GMT

Do State Homicide rates predict traffic fatalities? According to a University of Michigan study, they do. The study found that there was a parallel with the number of homicides and the number of traffic deaths. What seems to be the reason for this? Aggression.

The study looked at ten factors and "found that seven of them accounted for 71 percent of the variance in traffic fatality rates." Those seven are "homicide rates, proportion of male drivers, proportion of older drivers, number of alcohol-related liver failures (as a proxy for intoxicated driving), density of physicians, seat-belt use rate, and income." Apparently, the strongest predictor of these seven are homicides because homicides relate to aggression which relates to aggressive driving.

What does this teach us? We need to respect others on the roadways. We can't be in a hurry all of the time. We cannot drive while we are doing several other things: texting, playing with the radio, putting on makeup, using the telephone, changing CD's, and having too much noise and distractions in the car. We need to realize that we share the road with others, and we need to understand that different people have different driving styles just as different people have different psychological makeups.

During this holiday season, think before you act. Take a few miles per hour off your speedometer. Leave a little early for that appointment or meeting so you aren't in a rush. Be more passive on the roadways, and maybe you will save a life.

Originally posted at InjuryBoard by Jon Lewis

SSA Fugitive Felon Program Gone Bad

Stuart McAtee — Thu, 19 Nov 2009 11:07:37 GMT

It appears the "Fugitive Felon" program had some issues and precluded benefits to rightful recipients. A federal judge approved a civil-court settlement requiring the Social Security Administration to repay $500 million to 80,000 recipients whose benefits it suspended after deeming them fugitives.

The supposed fugitives include a disabled widow with a previously suspended driver's license, a quadriplegic man in a nursing home and a Nevada grandmother mistaken for a rapist.

According to an article in the Wall Street Journal, they were among at least 200,000 elderly and disabled people who lost their benefits in recent years under what the agency called the "Fugitive Felon" program. Launched in 1996 and extended to Social Security disability and old-age benefits in 2005, the program aimed to save taxpayers money by barring the payment of Social Security benefits to people "fleeing to avoid prosecution."

But some federal courts in recent years have concluded that most people the agency identified as fleeing felons were neither fleeing nor felons. The problem: Social Security employees relied on an operations manual stating that anyone with a warrant outstanding is a fugitive felon, whether the person is actually fleeing or attempting to avoid being captured.

The Social Security Administration, which neither admitted nor denied wrongdoing as part of the settlement, declined to comment.

The National Senior Citizens Law Center, an advocacy group for the elderly and disabled, sued the Social Security Administration in an Oakland, Calif., federal court last year on behalf of people denied benefits, and asserted that most warrants -- some decades old -- were for minor offenses and most people were unaware they existed.

Let's hope all of the valid recipients are compensated.

Originally posted at InjuryBoard by Stuart McAtee

New Website to Help Families Learn About Nursing Homes

Billy Cunningham — Sat, 14 Nov 2009 08:40:00 GMT

The National Citizens for Nursing Home Reform (http://www.nccnhr.org/ ), a consumer advocacy group for nursing home residents and caregivers in nursing, homes, announced that the Brown University Center for Gerontology and Healthcare Research has introduced a website designed for nursing home researchers that provides data on nursing home care in the US. The website states that its goal is to allow researchers to trace relationships between state policies, local market forces and the quality of long-term care and enable policymakers to craft state and local guidelines that promote high-quality, cost-effective, equitable care for older Americans. NCCNHR believes the site will also be enthusiastically received by many consumer advocates looking for detailed data and more sophisticated comparison tools than provided on other website such as Nursing Home Compare.

The interactive database, www.LTCfocUS.org, incorporates information from a number of government sources-Medicare reimbursement claims, OSCAR (CMS's Online Survey, Certification and Reporting system), the MDS (Minimum Data Set), and Brown's own survey of state Medicaid policies Users can interact with the website by creating interactive maps and tables with comparative information about states, counties, or individual nursing homes. All data provided on the website are also available to download.

The website provides the type information that users can employ to choose up to five variables. It allows the user to create a chart comparing all nursing homes in a state. The broad range of variables from which to choose includes number of beds; for-profit and chain status; percent of Medicare and Medicaid beds; Alzheimer's units; occupancy rates; age ranges, gender and race of residents; direct care staffing (RN, LPN, CNA); acuity of care; certain MDS quality measures; source of admissions (hospital or home); and 30-day rehospitalization rates (a potential indicator of quality not found on Nursing Home Compare).

The website is sponsored by the National Institute on Aging-funded Shaping Long-Term Care in America project housed at the Brown center. While its stated purposes are to "allow researchers to trace clear relationships between state policies and local market forces and the quality of long-term care" and to allow policymakers "to craft state and local guidelines that promote high-quality, cost-effective, equitable care to older Americans," NCCNHR recommends that consumer go to this site to perform their researches about nursing homes in their areas before placing a loved one there. The more you can know about your options for placing loved one in a nursing home , the better equipped you'sll be to help prevent any nursing home negligence or abuse.

Originally posted at InjuryBoard by Billy Cunningham

Tips to Prevent Medical Errors

Jan Boswell — Wed, 11 Nov 2009 09:22:02 GMT

This blog is written in response to the blog, 98,000 Reasons to Care about Patient Safety, by Jane Ayre at InjuryBoard.com. This is the number of Americans who die from medical errors each year. As a nurse, I know that patient safety is a concept that is foremost in the minds of healthcare providers, administration, and regulatory agencies. How can you, the consumer, help prevent medical errors ? In this blog, I will outline tips to help the consumer prevent other medical errors.

1. Be an active part of your healthcare team. Ask questions not just in the hospital but anywhere you receive healthcare. If you don’t understand something, ask for clarification.
2. If you have a choice, choose a hospital at which many patients have had the procedure and surgery you need and have had good results.
3. When choosing a specialist, ask your own physician for a personal recommendation. I have been known to ask my primary doctor: “If this were your wife, who would you send her to for this condition?”
4. Ask all healthcare workers who have direct contact with you whether they have washed their hands. Adequate hand washing is a primary way to prevent infection.
5. Before you leave the doctor’s office or hospital, make sure you understand the treatment plan. This includes understanding about your medications, follow-up care, and when to contact the doctor.
6. Before you leave the hospital, make sure you understand when you can resume regular activities. Make sure your doctor understands your regular activity level. You should know when you can shower, take a tub bath, lift 5 lbs, return to work, etc.
7. If you are having surgery, make sure that you, your doctor, and your surgeon all agree on what exactly will be done. For example, if you are having surgery on your right arm, make sure all involved knows it is the right arm. Make sure the site is marked before surgery.
8. Make sure someone is in charge of your care. This could be your personal physician. You need a point person to direct your care.
9. Make sure that all health care professionals involve in your care has your important health information. I love patients who come in with a written history. It is important that healthcare professional know your allergies, past surgeries, past and current medical conditions, etc.
10. Have a family member or friend designated as your advocate. Ask that person today. Make sure they know your medical history and your preferences in regards to medical care.
11. Before a test or treatment, ask why it is needed and how it can help you. Be informed before you consent.
12. If you have a test, follow-up and get the results.
13. Learn about your condition and treatments. If you use the Internet, use reliable sources. Treatment recommendations based on the latest scientific evidence are available from the National Guidelines Clearinghouse at http://www.guideline.gov. One of my favorites is www.mayoclinic.com.
You can visit my previous blogs on detail ways to prevent medication errors. I have outlined below the top 6 tips:
1. Make sure all healthcare professionals involved in your care know everything you are taking. This includes over-the counter medications, vitamins, herbs, and dietary supplements. Review these with your doctors once a year.
2. Make sure all healthcare professionals involved in your care know about any allergies and adverse reactions you have had to any medications.
3. When you get a new prescription from your doctor, make sure you can read it.
4. Understand your medications. What is it for? How is it to be taken and for how long? What are the side effects? Can I take it with other medications? What should I avoid while taking this medication?
5. Ask the pharmacist if you have any questions about the directions on your medication labels.
6. Ask for written information about the side effects.

Be involved in your care. Ask questions until you understand. Never consent to a test, surgery, or procedure until you are informed. Do not feel like a nuisance, you are standing up for your right to safe medicine that is appropriate for you and your condition. Your diligence could save your life. Share this with your family and friends.

Adapted from Agency for Healthcare Research and Quality

Originally posted at InjuryBoard by Jan Boswell

SSD Questions About Going Back To Work Later In Life And Short Term Disability

Stuart McAtee — Tue, 10 Nov 2009 14:58:13 GMT

From time to time, we receive questions from potential clients about various subjects regarding Social Security. As our nation ages, more elderly workers are re-entering the work force and they sometimes have questions about withholding, Social Security, and taxes. If you are returning to work, after age 65 for instance, your employer must withhold FICA taxes from your paycheck no matter how old you are. Although you may have been retired, you do receive credit for those new earnings according to the Social Security Administration. Each year Social Security automatically credits the new earnings and refigures your monthly benefit. If your new earnings are higher than in any earlier year used to calculate your current benefit, your monthly benefit could increase.

Another question sometimes asked is about short-term disability. What if a worker will only be disabled for a short period of time(for instance Maternity Leave)? Can a person qualify for SSD benefits for short term disability? In a nutshell, no. Social Security pays only for total disability—conditions that render you unable to work and are expected to last for at least a year or end in death. No benefits are payable for partial disability or short-term disability, including benefits while on maternity leave. The disability evaluation process considers any current work activity you are doing, and your medical condition and how it affects your ability to work. For more information, go to www.socialsecurity.gov/pubs/10029.html

Originally posted at InjuryBoard by Stuart McAtee