Alabama Personal Injury Blog - attorney

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

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

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

What Is This Statement from Social Security and Why Do I Keep Getting It?

Stuart McAtee — Sun, 01 Nov 2009 15:11:53 GMT

Recently, I recieved a Social Security Statement in the mail because my birthday is fast approaching and I meet certain criteria to receive such a statement. If you're age 25 or older, pay Social Security taxes and are not yet receiving monthly benefits, you should get an automatic Social Security Statement in the mail each year about two to three months before your birthday. The statement is a valuable tool to keep track of your annual earnings, as well as to help you plan your financial future. Read Article: www.times-standard.com/lifestyle/ci_13339858

But if your earnings don't meet the threshold for filing a federal tax return, you might not be receiving your annual Social Security Statement. However, you're probably entitled to one.

Everyone who has worked and paid Social Security tax is entitled to receive a statement. So, if you don't get one automatically in the mail, you can request one from Social Security -- and the easiest way to do that is online.

Just visit www.socialsecurity.gov/mystatement and click on the “Need to request a Statement?” banner. You'll need to fill in the following information to make your request:

-- Your name as shown on your Social Security card

-- Your Social Security number

-- Your date of birth

-- Your place of birth

-- Your mother's maiden name (last name only, to help identify you).

You also can provide the following information to make your estimate more accurate:

-- Your last year's earnings and an estimate of your current and future earnings.

-- The age you plan to stop working.(for most this may be difficult)

Once you make your request, Social Security will mail you a statement, which you should receive within two to four weeks. Give it a careful look to make sure your earnings and information are reported correctly, and contact Social Security if you find anything amiss.

After you review your statement, it's a good idea to keep it with your other important papers. And if you'd like to go one step further in your retirement planning, visit the online Retirement Estimator at www.socialsecurity.gov/estimator, where you can get an instant estimate of your future benefits based on your earnings record and plug in various retirement age scenarios. More information is also available at www.socialsecurity.gov.

Originally posted at InjuryBoard by Stuart McAtee

SSA Announces No Payment Increase for 2010

Stuart McAtee — Thu, 15 Oct 2009 11:57:32 GMT

As I have blogged about before, President Obama released extra payments earlier this year to millions of disabled Americans. For 2010, the outlook doesn't look good for a cost of living increase based on the Social Security Administration's denial of increased benefits for the upcoming calendar year. CNN is reporting no increase will occur: money.cnn.com/2009/10/14/news/economy/obama_seniors_payment/index.htm

It marks the first time that Social Security benefits have not been increased year over year since the cost-of-living adjustment was put into effect in 1975. To help counterbalance that, President Obama is calling on Congress to send another $250 relief payment to 57 million seniors and other Americans to stem the economic strain.

Congress approved $250 emergency payments as part of the $787 billion economic recovery act that lawmakers passed in February.

"Even as we seek to bring about recovery, we must act on behalf of those hardest hit by this recession," Obama said in a statement Wednesday. "That is why I am announcing my support for an additional $250 in emergency recovery assistance to seniors, veterans, and people with disabilities to help them make it through these difficult times."

As with the first $250 emergency payment, the second one would be exempt from income tax, a senior administration official said in a call with reporters.

If approved by Congress, the payments would be sent out in 2010, most likely in the first half. "It wouldn't be late in 2010," the administration official said. The measure would cost $13 billion over 10 years, according to White House estimates. The $250 is roughly equal to a 2% increase in benefits for the average Social Security beneficiary.

Let's hope President Obama's efforts to help those in need will pay off.

Originally posted at InjuryBoard by Stuart McAtee

I've Been Denied For SSD, Now What?

Stuart McAtee — Thu, 24 Sep 2009 10:59:38 GMT

In our Social Security Disbility(SSD) Practice, we see clients who have been turned down for their initial application for SSD and simply give up or keep re-applying for their benefits. If your social security disability claim was denied, should you just apply again? No.

A person(claimant) should not submit another social security disability application after he/she does not initially receive approval for benefits. Many people who wish to have their case reviewed again mistakenly apply again. The appropriate next step is to file an appeal. Having your case reconsidered will be your first step in the appeals process. A claimant must file the appeal to have his case reconsidered within 60 days of receiving notification that his initial claim was not approved. You will then appeal for a hearing, after your claim is reconsidered and denied. Having your case heard before an administrative judge offers one last chance to plead your case and allows the judge to comprehensively review your file and all supporting items. If you simply keep filing a new claim that goes through the initial review process, your case never gets to be heard by a judge. Not appealing adds tremendous and unnecessary time as you await a decision that is likely to not be in your favor, given that your claim was already denied at the initial review process stage. You will be back where you started. Appealing gives your case the best chance of approval.

If you have been denied, please give us a call within sixty(60) days to have us look at appealing your denial.

Originally posted at InjuryBoard by Stuart McAtee

Durable Power of Attorney over Health Care Issues

Gaines Drago — Wed, 23 Sep 2009 10:44:56 GMT

No one likes to think about their own mortality, especially while feeling vibrant and alive. The "It could never happen to me attitude," dominates our thoughts, and while it is true that most of the time it won't happen to you sometimes it does, and the people left to suffer through painful decisions are friends and family. Imagine, for example, that you are 35 years old, in relatively good health, good job, engaged but not married, but that you are one day involved in an auto accident and leaves you incapacitated. Your are rushed to the hospital, where your mother, father and fiance agonize over what to do. Your mother wants keep fighting even though you have limited if any chance and you are feeling some high levels of pain, but your fiance, whom you have discussed this scenario with wants to let you go. These kinds of things, while horrible do happen.

However, there is an easy way to resolve this type of problem: awarding durable power of attorney over health care to a trusted individual. This works much like a typical durable power of attorney and gives a trusted person the ability to make decisions about life and death when the other party is unable to do so. In addition you can assign more than one person this power so as to relieve the alone on an island effect this could have over a person. The most appealing aspect is that it allows the victim to have a say in his own life and death decisions. Guidelines can and should be given to the individual who will be given power of attorney over healthcare. This will alleviate much of the pressure on that person, and allow you a peace of mind to know that whatever happens you are in control over what happens in your life.

While, no one certainly enjoys thinking about these things, there is nothing wrong with having a plan in place that ensures you remain the key decision maker in your own life.

Originally posted at InjuryBoard by Gaines Drago