For a last will and testament to be considered legally binding, the law requires one be of “sound mind and body.” Yet, when an individual is signing paperwork in a doctor’s office or emergency room, there is no such stipulation. Our laws fight to protect the distribution of our possessions after death, but leaves us wide open to lose everything we own while we’re still among the living.
How many persons in the throws of a medical event involving a child, spouse, parent or themselves would actually be considered of sound mind and body? Judging from the clients we’ve helped over the years, a scant few.
Hospitals, urgent care facilities and doctors offices almost always require patients and their families sign documents that contain “blank check” clauses before services are rendered. These clauses dictate that the patient or guardian be responsible for all costs that the insurance company does not pay. In the middle of a medical event, even as routine as a doctor’s office visit, the average person doesn’t have the emotional bandwidth or time to question or fully process what they sign. The focus in those moments is on making sure that we get the best care possible for the patient and those we love.
So what happens to the person who signed the blank check document, then receives a bill for $5000 from the hospital for something that should have only cost $2000? Chances are, the insurance company will look to pay that $2000, or even less if it can, to the healthcare provider. (Mind you, if the health care provider is a “preferred” provider for the insurance company, they have a contract in place for the cost of services, although this rarely matters). The hospital’s billing department will charge the patient or parent or son or daughter who signed that form in the lobby when he/she couldn’t think clearly the remainder, regardless of whether or not those costs are fair or inflated. It’s such a common industry practice that it has a name: “balance billing”. The patient can protest, but often will simply pay the inflated bill rather than risk having his/her credit damaged. Both the insurer and the healthcare provider know that very few patients file grievances with the state or attempt to take it up within our legal system. In dire circumstances, bankruptcy is the dismal eventuality for patients and families faced with overwhelming debt. The #1 reason for personal bankruptcy in the U.S. today is medical bill related, and of those who filed most said they had health insurance.
There are ways that consumers can try to protect themselves. They can request to have all forms a healthcare provider requires be sent to them prior to non-emergency appointments. By reviewing the paperwork at home and not the doctor’s office or hospital lobby, patients and their families can take more time to study the forms and address anything that isn’t part of an equitable contractual agreement.
In an emergency situation, often patients and their families are in no position to question forms. We implore individuals to look specifically for the blank check phrasing within the paperwork and amend it with “provided the treatment/service received is a) medically necessary, b) priced in accordance to fair market value, and c) is not a cost that should be covered by the insurance company” before signing it. If they’ve already signed the documents and the bills begin to accumulate, patients can and should negotiate with the healthcare provider’s billing department and speak with their insurance company to make certain they are not overpaying for their care.
For those who can’t hire an independent expert advocate to help them with their healthcare management, we suggest they engage a trusted friend who has the experience necessary to negotiate on their behalf. (The hospital appointed advocate, although often well intentioned, is not independent therefore shouldn’t be your trusted guide).
The old adage, “The lawyer who represents himself in court has an ass for a client” can be applied to healthcare management. Healthcare for the individual and his/her family is an intimate experience. Our very physical lives depend on the type of care we receive, and our fiscal health hangs in the balance. It is imperative we keep in mind that it is not an intimate relationship for the insurance companies or healthcare corporations we deal with. We advise clients to place their trust in great doctors, nurses and staff, not the corporations or firms for whom the caregivers work.
The typical health insurance company profit model is to take in more money than the company pays out. For that reason, we discourage clients from blindly trusting their insurance company, or believe that their insurer is committed to honor all of their policy benefits. Instead, question every insurer’s denial of claim or service or underpayment. If you want the benefits you are entitled to, you must be vigilant.
According to conservative industry estimates, Americans overpay over $58 billion dollars annually for our care. The $2.8 trillion dollar healthcare industry is most certainly a healthy and powerful corporate body. It’s up to us to be of sound mind and body when we engage it.