DON'T GET CAUGHT OFF GUARD
THE NEXT TIME YOU GO TO THE
DOCTOR'S OFFICE AND EXPECT
INSURANCE COVERAGE. NEW
TONIGHT... WE'RE UNCOVERING
HOW -ONE- CONVERSATION WITH
YOUR DOCTOR DURING AN OFFICE
VISIT... CAN MAKE ALL THE
DIFFERENCE IN YOUR BILL. EVERY
SERVICE HAS A SPECIFIC MEDICAL
CODE... AND AS ONE WEST
MICHIGAN COUPLE DISCOVERED...
THE WRONG CODE... MEANS YOU'RE
NOT COVERED.
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((28:14 TO 28:15 RICARDO
RAMIREZ, PATIENT: WE HAVE A
HIGHER DEDUCTIBLE AND IT'S 100
PERCENT COVERED.)) RICARDO
AND MARIE RAMIREZ SHOWED US
DOCTOR BILLS THAT HAVE CAUSED
CONFUSION AND FRUSTRATION FOR
ALMOST A YEAR NOW.
NOW. ((30:43 TO 30:50 RICARDO
RAMIREZ, PATIENT: I PAID THAT
OUT OF MY POCKET ALREADY WHICH
I SHOULDN'T HAVE. NOW THEY
SAID THEY'D REBILL IT BUT THEY
HAVEN'T AND IT'S BEEN OVER TWO
MONTHS.)) THE RAMIREZ'S HAVE A
HIGH DEDUCTIBLE HEALTH
INSURANCE PLAN... SO THEY
TRACK WHAT THEY PAY OUT OF
POCKET. AND THAT'S HOW THEY
NOTICED THEY HAD TO PAY FOR AN
ANNUAL PHYSICAL THEY SAY...
SHOULD'VE BEEN COVERED.
COVERED. ((7:38 TO 7:42
RICARDO RAMIREZ: SO THAT'S
WHAT STARTED THIS WHOLE MESS.
IT SHOULD BE 100 PERCENT
COVERED UNDER MY INSURANCE.))
BRONSON HOSPITAL REFUSED AN ON-
CAMERA INTERVIEW TELLING ME
ITS PATIENT RELATIONS TEAM HAS
ALREADY TRIED TO CLEAR UP ANY
CONFUSTION WITH THE RAMIREZES.
THEY DID SEND ME A STATEMENT
READING IN PART: "WHILE AN
APPOINTMENT MAY BE SCHEDULED
AS A GENERAL PHYSICAL, IF
OTHER MEDICAL CONDITIONS ARE
DISCOVERED OR BROUGHT UP BY
THE PATIENT DURING THE VISIT
THAT REQUIRE FURTHER INQUIRY
AND TESTING BEYOND THE SCOPE
OF THE PHYSICAL, THEN THE
VISIT IS CODED TO REFLECT
THOSE ADDITIONAL SERVICES."
SERVICES."
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((21:29 TO 21:39 RICARDO:
SOMEONE MADE THE DECISION TO
NOT CALL IT A PHYSICAL BUT TO
CALL IT A FOLLOW UP. A FOLLOW
UP TO WHAT? I HAVEN'T SEEN THE
DOCTOR IN OVER A YEAR.))
YEAR.)) (( 19:25 TO 19:28
MARIE RAMIREZ, PATIENT: WE'VE
ALWAYS WATCHED NEWS 8, WE'VE
ALWAYS PAID ATTENTION TO WHAT
WAS ON THE NEWS.))
NEWS.)) ((19:36 TO 19:44 AND I
THOUGHT, I'M NOT GETTING THE
RESULT I NEED AND I NEED HELP.
WHERE CAN I CALL FOR HELP? AND
I REACHED OUT.)) TARGET 8
DISCOVERED WHY ONE NUMBER CAN
BE A GAME-CHANGER. EVERY
SERVICE HAS A SPECIFIC MEDICAL
CODE. YOUR INSURANCE COMPANY
USES THOSE CODES TO DETERMINE
WHAT IT WILL PAY FOR ACCORDING
TO YOUR PLAN.
PLAN. ((41:51 TO 41:55 CODES
HAVE ALWAYS BEEN IN PLACE AND
HAVE ALWAYS DRIVEN HOW MEDICAL
CLAIMS HAVE BEEN
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PAID.)) KRISTA DAVIS, AN
INSURANCE AGENT WITH THE
GREMEL GROUP, TOLD ME THE
CODING SYSTEM UNDERWENT A
MASSIVE EXPANSION LAST YEAR...
ADDING TENS OF THOUSANDS OF
CODES TO MATCH MORE SPECIFIC
MEDICAL SERVICES.
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((37:02 TO 37:07 IT REALLY
PAYS TO UNDERSTAND WHAT
SERVICES YOU'RE GETTING AND
HOW IT'S COVERED BY YOUR
PLAN.)) BUT TARGET 8
DISCOVERED BILLING ADVOCATES
AND OTHER HEALTH PROFESSIONALS
ESTIMATE UP TO 80 PERCENT OF
MEDICAL BILLS CONTAIN ERRORS.
AND JUST THIS YEAR... A STUDY
SHOWED THE PROBLEM COULD BE
GETTING WORSE. NON PROFIT -
MEDICAL BILLING ADVOCATES OF
AMERICA - SAYS IT FINDS ERRORS
ON THREE OUT OF FOUR MEDICAL
BILLS IT REVIEWS.
REVIEWS. ((43:49 TO 43:51 I'VE
TALKED WITH A LOT OF FOLKS
SINCE WE HAD A CHANCE TO
TALK.))
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DAVIS POINTS OUT MANY
INSURANCE CARRIERS NOW HAVE
ONLINE RESOURCES YOU SHOULD
USE -BEFORE- YOUR DOCTOR
VISIT. IN FACT - TWO YEARS AGO
I SHOWED YOU ONE OF THE FIRST
COST ESTIMATORS TO GO
ONLINE... AS AN INDUSTRY-WIDE
TRANSPARENCY MOVEMENT GOT
UNDERWAY. UNITED HEALTHCARE'S
ONLINE TOOL SHOWS WHAT YOU'LL
HAVE TO PAY OUT OF POCKET FOR
PROCEDURES OR EVEN A SIMPLE
OFFICE VISIT.
VISIT. ((42:30 TO 42:40
UTILIZE THE TOOLS AND
RESOURCES THAT CARRIERS
PROVIDE ONLINE AND CERTAINLY
BECOME AWARE. I THINK THAT
THERE IS SOME RESPONISIBILITY
THAT WE HAVE AS PATIENTS
TOO.)) BRONSON ALSO SAYS IT'S
LOOKING FOR WAYS TO IMPROVE...
WRITING... "WE ARE NOW ASKING
OUR OFFICE STAFF TO CONFIRM
WITH PATIENTS WHO ARE
SCHEDULING PHYSICALS THAT THE
PRIMARY PURPOSE OF THE VISIT
IS PREVENTIVE IN NATURE VERSUS
A VISIT FOR A MEDICAL PROBLEM
BEYOND THE SCOPE OF WHAT
INSURANCE COVERS FOR A GENERAL
PHYSICAL."
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((9:21 TO 9:31 RICARDO
RAMIREZ: FOR AS MANY TIMES AS
I HAD TO CALL HALF OF ME WAS
LIKE YOU KNOW WHAT IT'S NOT
WORTH MY TIME JUST PAY THE 158
DOLLARS AND MAKE IT GO AWAY
BUT I'M THINKING OF ALL THE
OTHER PEOPLE THAT THEY'RE
DOING THIS TO.))
TO.)) (( 14:57 TO 15:12 MARIE
RAMIREZ, PATIENT: PEOPLE NEED
TO QUESTION. AND OUR
DEDUCTIBLE IS QUITE HIGH, IT
WAS LIKE A SNOW BALL BECAUSE
WE KNEW WE HAD A HIGH
DEDUCTIBLE SO WE WERE PAYING
AND PAYING AND THEN WE SAID
WAIT A MINUTE SOMETHING ISN'T
RIGHT, THIS DATE ISN'T
MATCHING.))
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BOTTOM LINE... DON'T BE
AFRAID TO ASK QUESTIONS RIGHT
THEN AND THERE. IF YOU START
ASKING YOUR DOCTOR ABOUT A
MEDICAL PROBLEM... ASIDE FROM
THE ORIGINAL INTENT OF YOUR
VISIT... ASK IF ANY FURTHER
TESTING IS GOING TO REQUIRE
ANOTHER MEDICAL CODE -BEFORE-
YOU GO ANY FURTHER. MEDICAL
CODING IS SO COMPLEX... THAT'S
WHY WE'RE TAKING THIS STORY
FURTHER. NEW TOMORROW AT 7...
WE'RE HEARING FROM A CERTIFIED
PROFESSIONAL CODER ABOUT HOW
PEOPLE ARE TRAINED JUST IN
CODING SO IT'S DONE CORRECTLY
ON YOUR BILL... THE FIRST TIME
AROUND.
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