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Medical billing fraud usually begins with a letter. Today I brought the mail in as usual, but unexpectedly Kurt opened up what was soon discovered to be a bill from a medical provider that we used. Kurt as usual handed the bill over to me and said “what is this, you take care of this.” He does not keep track of these things and as in most families I (the wife) am the record keeper and bill payer. I reviewed the bill and was SURPRISED to see that I was being charged for the entire procedure, even though I was informed that our Health Insurance company would be responsible for the claim. I immediately called the service provider to inquire why I was receiving this bill and I was told by the medical provider that our health insurance company indicated that we had not met our deductible. I told the medical provider that we do not have a deductible and that prior to the procedure being done we were informed by the medical provider that they accepted our insurance and a copay was requested and paid. The medical provider indicated that they were an In-network provider, thus the acceptance of the co-payment.
Kurt and I were outraged by getting a SURPRISE bill because we were told that this was an in-network procedure. Outrage then turned to action. I am fortunate and so are you, my readers, because one of Kurt’s areas of expertise is executive level preparation and training to detect fraudulent medical billing practices. Kurt is trained to implement complaints, appeals and grievance procedures with medical insurance companies, including HMO’s ,MCO’s and other managed long term care plans (MLTC). Luckily there are companies that can help support this for future medical billing issues as well, over at Coronis Health there is software that is protected using industry lead technology for medical centers, etc.shutterstock_306283364
These are 10 steps that have been taken to date to resolve this issue of what we consider to be fraudulent medical billing.
1. Call the Medical Provider and dispute the bill (claim).
2. Call your health insurance provider complaint department:
• Their purpose is to try to resolve any complaints you have with both in-network and out-of-network providers. You as the consumer have a right to make a formal complaint and to request an appeal of any medical bill that you feel misrepresents any procedure that was done, including overbilling or any allegation of fraudulent billing. Kurt recommends that you formally request of the complaint/grievance representative that they document this encounter as a formal complaint/grievance.
3. Ask for the Complaint/Grievance Representative’s employee identification number. You have to be able to document the person, date and time you logged your complaint.
4. Clearly inform the complaint/grievance representative of your allegation of fraud and or problematic billing.
5. Documentation becomes more complete if you include these simple steps:
• Always try to complete documentation requirements by answering the following questions: Who, What, When, Where, How and Why, (the why is often the most difficult and most subjective). If you prepare your documentation to answer those questions you can be confident that 95% of your documentation requirements will be accurate and fulfilled.
6. Get the reference number for your complaint.
7. There are different levels of grievance complaints that you can request from Standard to Emergency Expedited levels. The health insurance carrier is required to respond in a specific time frame based upon the level of complaint that you have made. Anywhere between 45 days to as little as 24 hours of turn around time back to the consumer.
8. The Health Insurance carrier may recommend that you to follow the ‘Information for Members in New York Insurance Plans: Emergency Services and Surprise Bills’
Click on link for steps to follow: Info_ Mem_NY_InsurancePlans_EmergencyServices_SurpriseBills
9. DON’T PAY THE BILL! If you feel you have been fraudulently billed or have been surprised by a bill
10. ACT IMMEDIATELY, DO NOT WAIT!

Our next steps; we are going to follow the Emergency Services and Surprise Bills protocol. We may choose to contact the NYS Attorney General Office to inform them of our allegation of Medical Billing Fraud if we need to take that step. This will be contingent on whether or not this SURPRISE bill is resolved appropriately. Stay tuned!

Special thanks to Kurt H. Leggard, R.N. who helped co-write this article. Kurt is a Registered Nurse, Consultant and a specialist in Long Tem Care, Medicaid Services and Heath Care Grievances, Complaints and Appeals.

New York State Department of Health Medical Fraud Link: www.health.ny.gov

Student Athletes Heat and Wind Chill NYSPHSAA Policy
HEAT ALERT POLICY

I am posting this information for both students and parents because my objective always is to help student athletes prevent avoidable injuries and keep them safe. My daughter is an athlete that participates in 3 sports throughout the school year and is often faced with EXTREME WEATHER CONDITIONS. PARENTS it is VERY IMPORTANT that athletes say hydrated in extreme hot weather, the coaches will constantly reinforce this message, but it is advisable that this message start at home.

The information below is listed on the NYSPHSAA website.

  1. Modified Heat Alert – When the heat index reaches 88 (equivalent to T.H.I. of 73), practice sessions or contests in all sports must include:
    a. Forced, frequent water breaks (every 10-15 minutes).
    b. Loose clothing, light colored shorts and tee shirts (mesh recommended) for practice sessions.
    c. Frequent rest breaks in shaded areas.
    d. For football and lacrosse, mandatory water breaks every 15 minutes during which all players must remove helmets. Those players not participating in contact activities during practice, games or scrimmages shall not wear helmets. Players looking to get the latest equipment for their next match may want to check out things like lacrosse sticks available online from sites like String King.

NOTE: During all contests, the rules are to be modified to permit additional time outs for rest and forced water breaks.

  1. Full Heat Alert – When the heat index reaches 95 (equivalent to T.H.I. of 78), no physical activity in any sport is permitted. Team meetings are permitted.HEAT POLICY

for more information on New York State Public High School Athletic Association (NYSPHSAA) Heat and wind chill policies click on links below:
HEAT INDEX PROCEDURES
WIND CHILL PROCEDURESWIND CHILL

Remember it takes a village to raise a child….Parents lets work together to keep our kids injury free and safe.
In addition you can check Accuweather.com for your local temperature and “REAL FEEL” temperature.

Hamptons Happenings: Community: Southampton Urges Residents to Sign-Up Emergency Alerts
Town of Southampton
Press Release
Town Urges Residents to Sign-Up
for Notify Me® Emergency Alerts

Dear Neighbors and Visitors:

As a coastal community, we must prepare for any emergency -whether it is a hurricane, fire, flood, or snow storm. An important priority, Southampton Town is constantly improving its own readiness through planning and hands-on exercises, and by coordinating with county, state, and federal agencies.
Recognizing that preparation is our best defense, we have released a new brochure, Be Prepared. (Available in English & Spanish) Updated, handy, and compact, the pamphlet is designed specifically for Southampton residents, with valuable information such as: important telephone numbers, advice on caring for the elderly and those with special needs, ensuring your pet’s safety, protecting your home or business, and assembling a “go bag” and home emergency kit. Pick up your Be Prepared brochure at the following locations:

Southampton Town Hall
Town Senior Centers
Parks & Recreation Office
Village Halls
Chambers of Commerce
Libraries
Southampton Youth Services (SYS)

In addition, citizens can also register for the new CodeRED notification system. CodeRED is now used by local governments, schools, universities and utilities. The CODE RED emergency notification system is an extremely high speed communication service capable of delivering millions of pre-recorded emergency telephone messages per day to Suffolk County homes and businesses. CODE RED also has high speed email and text messaging capability. Participants may register up to two phone numbers and one email address. Adding your contact information will ensure that you will be included when a message is sent. So if you’re wanting to register your elderly family members to the alert notifications, look into senior ease of use phones, if you were to look here, such phones still exist, then register the given number to CodeRED.

You are encouraged to use these new resources to assist you in keeping you and your family safe. With improved technology and better tracking, we now have the means to obtain advance notification of severe weather events, regional emergencies, and how best to prepare for them. CodeRED-Logo_thumb-2

Should you have any questions or concerns, please contact the Town’s Citizens’ Response Center (CRC) at (631) 702-2440, or contact the Emergency Management Office at (631) 728-3400.
Anna Throne-Holst, Supervisor
SOUTHAMPTON TOWN NOTIFICATIONS

The Town’s Citizens’ Response Center (CRC)
can now provide “followers” and “friends” with real time updates about emergencies and important events. These notices will include public service announcements, notifications about road closures, extreme traffic situations, as well as other important information.

To sign up for CODE RED, click here
CODE RED is a free and secure service offered by the Suffolk County Department of Fire Rescue and Emergency Services (FRES) that can provide you with important information in times of emergency, including the threat of severe weather.

Data collected will only be used for emergency notification purposes. For more information, or to sign up over the phone, please contact the Suffolk County Office of Emergency Management during regular business hours at (631) 852-4900.

Facts about CODE RED:

· If a call is not answered, CODE RED will deliver the message in its entirety to voicemail and answering devices.

· CODE RED messages can be delivered in text format to the hearing impaired via TTY/TDD equipment.

· Message recipients may dial the toll-free number displayed on their Caller ID to hear the last CODE RED message delivered to that phone number.

· When you receive a call from CODE RED, your caller ID will show that the call is coming from (866) 419-5000 and the caller will be Emergency Communications.

(info taken from Newsday)
Did you know Uber has flat rates from NYC to Long Island.
For those interested in hailing an Uber from New York City to Long Island, what fares can you expect? The following rates as of August 16, 2015,these rates can change depending on time of day, demand, etc.

Uber offers various modes of transportation. UberX cars are non-luxury sedans that seat four passengers. UberXL’s are non-luxury SUVs that can fit up to six people. UberBlack cars are luxury sedans such as BMW and Cadillac for four passengers. And UberSUVs are full-sized, black luxury SUVs for up to six passengers. It these rates are split between four people, then the rates are doable. On the low-end an UBer from NYC to the Hamptons could cost four people $75 each. If you’re involved in an accident whilst in a ridesharing vehicle, you will likely want to enlist the help of someone like an Uber accident lawyer.

Long Beach
Rates: UberX – $94-$122; UberXL – $138-$180; UberBLACK – $156-$203; UberSUV – $193-$250
Glen Cove
Rates: UberX – $87-$114; UberXL – $128-$169; UberBLACK – $146-$191; UberSUV – $181-$235
Garden City
Rates: UberX – $74-$97; UberXL – $110-$144; UberBLACK – $125-$163; UberSUV – $156-$201
Massapequa
Rates: UberX – $100-$132; UberXL – $148-$196; UberBLACK – $169-$221; UberSUV – $209-$272
Huntington
Rates: UberX – $115-152; UberXL – $171-$226; UberBLACK – $195-$255; UberSUV – $240-$314
Babylon Village
Rates: UberX – $126-$167; UberXL – $188-$249; UberBLACK – $214-$281; UberSUV – $263-$344
Stony Brook
Rates: UberX – $158-209; UberXL – $236-$312; UberBLACK – $268-$354; UberSUV – $329-$432
Patchogue
Rates: UberX – $162-$215; UberXL – $242-$321; UberBLACK – $276-$364; UberSUV – $338-$444
Wading River
Rates: UberX – $198-$263; UberXL – $297-$393; UberBLACK – $338-$446; UberSUV – $413-$544
Riverhead – North Fork – Hamptons
Uber has flat rates for rides to the East End of Long Island. Rates:
UberX – $305; UberXL – $355; UberBLACK – $405; UberSUV – $505