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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). shutterstock_306283364
These are the 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

National Suicide Prevention Week September 7th-13th
This week marks the 41st Annual National Suicide Prevention Week

Suicide Prevention Is Everyone’s Business!
Here are a few ways to get started for the week:
FBprofile2015.1Post the 2015 Suicide Prevention Week graphic as your profile picture
Share this message on your Facebook Page and Follow us on Twitter @AASuicidology
Learn the Warning Signs and Risk Factors for Suicide
Make a donation
Host a Suicide Prevention and Awareness Event
Are you a clinician? Take a training!
Are you a school professional? Get Certified!
Contact AAS Central Office with your own creative ideas!
http://www.suicidology.org/about-aas/national-suicide-prevention-week

photo credit: www.veteransresources.org
photo credit: www.veteransresources.org

Know the Warning Signs of Suicide Information by:
AMERICAN ASSOCIATION OF SUICIDOLOGY
How do you remember the Warning Signs of Suicide?
Here’s an easy-to-remember mnemonic:
IS PATH WARM?

I   Ideation
S   Substance Abuse

P   Purposelessness
A   Anxiety
T   Trapped
H   Hopelessness

W   Withdrawal
A   Anger
R   Recklessness
M   Mood Changes


A person in acute risk for suicidal behavior most often will show:

Warning Signs of Acute Risk:
Threatening to hurt or kill him or herself, or talking of wanting to hurt or kill him/herself; and or,
Looking for ways to kill him/herself by seeking access to firearms, available pills, or other means; and/or,
Talking or writing about death, dying or suicide, when these actions are out of the ordinary.

These might be remembered as expressed or communicated ideation. If observed, seek help as soon as possible by contacting a mental health professional or calling 1-800-273-TALK (8255) for a referral.

Expanded Warning Signs:
Increased substance (alcohol or drug) use
No reason for living; no sense of purpose in life
Anxiety, agitation, unable to sleep or sleeping all of the time
Feeling trapped – like there’s no way out
Hopelessness
Withdrawal from friends, family and society
Rage, uncontrolled anger, seeking revenge
Acting reckless or engaging in risky activities, seemingly without thinking
Dramatic mood changes
If observed, seek help as soon as possible by contacting a mental health professional or calling 1-800-273-TALK (8255) for a referral.

Women’s Health Hamptons Gala kicks off Run 10 Feed 10….Party under the Stars Gala to Benefit FEED FOUNDATION

Rosario Dawson
Rosario Dawson

As Many of you know the 2015 theme of Hamptons Mouthpiece is Journey to fitness...so when I was invited to attend Women’s Health Magazine annual Hamptons event I was excited to attend. Unfortunately I was unable to partake in the earlier activities in Montauk on Saturday, August 1st, but I was able to attend the evening event Party under the Stars in Bridgehampton a benefit for a wonderful organization FEED Foundation. The FEED Foundation is the non-profit arm of FEED that supports programs and organizations that are effectively working to fight hunger and eliminate malnutrition. It has since grown to encompass hunger relief efforts both stateside and abroad, as well as provide aid during natural disasters and humanitarian crises worldwide. As of January 2015, FEED has provided over 87 million meals globally. www.run10feed10.com

THE DAYTIME WELLNESS EVENT: Took place at the “Well-thy House” with Women’s Health and Domino Magazine–a co-branded event hosted at Women’s Health VP/Publisher Laura Frerer-Schmidt’s newly constructed Montauk home.The event featured top experts leading home and garden workshops, workouts, cooking demos and nutrition consultations. The lunch at the event was in support of Women’s Health’s partner, the FEED Foundation and the charity event series RUN10 FEED10. womens health-47
Joining Women’s Health and Domino at the Well-thy House included:
• Mandy Ingber, celebrity yoga instructor: Yoga class
• Heidi Powell, celebrity trainer and star of ABC’s Extreme Weightloss: Workout
• Jeff Dawson: Garden Manager at Golden Door; crating a backyard herb garden
• Greg Frey Jr.: Executive Chef at Golden Door; garden-to-table lunch and demo
• Keri Glassman, registered dietitian: The Cleanse
• GLAMSQUAD Hair & Makeup
• Owl’s Brew Tea mocktails and cocktails

womens health-31The annual “Party Under the Stars” event was held at the Bridgehampton Surf & Tennis club in the evening. Always a fun event,good energy,great drinks, beautiful location, great weather, amazing appetizers and fantastic music.

Taryn Manning
Taryn Manning
The star-studded event featured music by guest DJ Taryn Manning from the Netflix Series “Orange is the New Black” a live reggae band that was terrific a silent auction to benefit the FEED foundation, beach bonfire and cocktails & Hors d’Oeuvres by Robbins Wolffe.womens health-37
I spotted Rosario Dawson, Taryn Manning and Laura Prep from Orange is the New Black, Anne Burrell from Worst Cook in America, Ginger Zee from GMA, TV personality Andi Dorfman, Adrienne Bailon, Molly Sims,Tashiana Washington & Eric West.
Tashiana Washington & Eric West
Tashiana Washington & Eric West
Anne Burrell-Celebrity Chef
Anne Burrell-Celebrity Chef
Ginger Zee, GMA
Ginger Zee, GMA

Many people from NYC came out to the Hamptons for the day with transportation provided by Hampton Jitney courtesy of Women’s Health Magazine. This is one of my favorite Hamptons events because it is a mixture of real women, not your typical Hamptons event.womens health-53

womens health-49

 Lindsay Brown and Bryan Quinlan.
Lindsay Brown and Bryan Quinlan.

womens health-36

For more information on how you can get involved with RUN10FEED10
womens health-57

Hamptons Happenings: 2015 Mental Health Awareness Day

12th Annual East End Mental Health Awareness Day
“Changing Times, Changing Minds”
Saturday, April 11, 2015
9:00 am – 3:00 pm
Registration begins at 9:00 am
Southampton High School – 141 Narrow Lane, Southampton, NY
Mental illness in word collage

FREE EVENT
CLICK HERE TO REGISTER

Guest Speakers

Kristie Golden, Ph. D
Associate Director of Operations, Neurosciences, at Stony Brook Medicine

Jeffrey Steigman, Psy. D
Chief Administrative Officer, Family Service League
on

The South Fork Behavioral Health Initiative
& Medicaid Redesign – Health Care Delivery System

Panel Discussion – Stories of Resilience
Richard Lawless Th. D.— Moderator
Morning Workshops:
A. The Peer Movement – the importance of peers in recovery
Tracy Puglisi, Association of Mental Health and Wellness and Elizabeth Breier, NYS Office of Mental Health

B. National Alliance on Mental Illness (NAMI) – Support, education, advocacy and leadership Ellen Tollefsen, NAMI member

C. Inspirational Triathlon Racing i-tri – Transporting Girls to the Finish Line, Theresa Roden, Executive Director

Afternoon Workshops:
D. Substance Abuse & Mental Health Concerns in Suffolk County
Kristie Golden, Ph. D. Associate Director of Operations, Neurosciences, at Stony Brook Medicine

E. Psychopharmacology – The Fears and the Facts:
Eric J. Bartky M.D.

F. Helping in a Crisis – Symptom appropriate treatment and care
Robyn Berger-Gaston LCSW-R, ACSW
Division Director of Family Service League.

Exhibitors – All day
Coffee, Lunch & Networking

This Free Event is Co-Sponsored by
Southampton Town and East Hampton Town and Bridgehampton National Bank
For more information call (631) 702-2445

Jeffrey Steigman, Psy. D
Chief Administrative Officer, Family Service League
Jeffrey Steigman, Psy. D
Chief Administrative Officer, Family Service League

If you, a family member, or a friend are living with the effects of a mental illness, or if you have an interest in learning more about mental health issues, you should attend the annual Mental Health Awareness Day.
Co-Sponsored by the Town of Southampton and East Hampton, this free day-long event includes a panel discussion, workshops, vendors, and the opportunity to network with consumers and professionals in the field. The conference should be attended by anyone on the East End concerned with mental health issues, including consumers, community members, and professionals.

Association for Mental Health and Wellness
Suffolk County Division of Community Mental Hygiene Services

Content provided by Southampton Town Government:

Hamptons: Studio 89 celebrates 6 years

I was sitting in Golden Pear having a cup of coffee and Rich Decker walks in dressed in workout attire to have breakfast. I started talking to him and asked what was new at Studio 89, he told me that he was celebrating his 6th year anniversary in April. It seems like it was just yesterday that he opened Studio 89, I was happy to hear this. I have a friend who lost over 100 pounds with Rich and his team, and has kept it off for nearly 3 years. Studio 89 is not just about loosing weight but developing a way of life.

Studio 89 is a boutique Private fitness facility, it is not a gym, you will not find machine-based workouts- the emphasis at Studio 89 is that you are the Machine. The focus is on Core, Agility, Flexibility, Strength Suspension and Gravity Training to give you The Ultimate One-on-One Training Experience. Your workouts are personalized to match your goals, and those who have worked out with Rich love his approach to training.

By using suspension, gravity, resistance and strength training without machines, your body actually becomes the machine. Rich Decker says.. “With all of our training techniques your core is engaged for every movement while you target every muscle in your body. You’ll work more efficiently yielding better results, faster.”

April 2015 will be Studio 89, 6th year anniversary and to CELEBRATE they are offering unlimited classes for just a dollar a day $365/annually.

Classes include: JustAbs, TRX, Spin, Power Pump, Power Sculpt, Stretch Core, Gentle Yoga, Les Milles Body Pump, Body Combat and Body Flow.studio89-4387

The spin classes are not for the masses, it is just you and 15 other cyclist moving and jamming to some great music. No need to bring shoes, they provide shoes & weights. The instructor has an opportunity to give you personal attention. This is how many of their classes are, small groups and individual instruction. If you are really focusing on training then Studio 89 is for you.

Click here for schedule, times and instructors

Now through April 30th all registries will be ENTERED TO WIN 2 FREE TRAINING SESSIONS with Rich Decker!!!! ($300 value)564382_281740151909186_1748110198_n

They offer a wide variety of One on One training tools including BodyWedge21,(invented by Studio 89 founder Rich Decker) Bosu’s half ball, Weighted Med Balls, Swiss Balls, Slide Board, Jump Ropes, Exer Tubes, Stability Discs, Boxing, Free Weights, Octane Ellipticals, Cybex Treadmills, Cybex Recumbent Bike , TRX Suspension System, and The EFI Gravity System. Rich Decker says All our tools require your body to be The Machine and ensure that you stabilize every move with your core.”studio89-4514

Studio 89 is located @ Clay Pit Rd is off of Bridgehampton Turnpike
right at Estia’s Restaurant onto Clay Pit Rd.

631-899-4310*Website: www.studio89fitness.com

Outdoor will open as soon as there is a break in the weather.