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keepingitcivil t1_iujeuhv wrote

Is there money in this? Imagine you hand your hospital bill or insurance claim to someone who reviews it and has it rebilled for a lower cost/high reimbursement. They could charge a percentage of the difference and probably make bank.


ktigger2 t1_iujgw53 wrote

I wish. I’m a medical coder and have helped family and friends with their medical bills. There is zero money in this. Believe me, I thought about it as a side hustle more than a decade ago.

For a $10 grand bill, I’ve negotiated and fought down several thousands. and…the patient still had several thousand to pay. In that case what could they have paid me? It’s be easier if the insurer or facility could do something, but no one is paying to advocate for the patient except the patient. And not a lot of patients have any extra money to pay someone to do that. Also to review a case took me hours or paperwork + time in the phone, PHI release forms etc. I make more at my regular job and it’s less frustrating.


Qbr12 t1_iujnk6q wrote

> For a $10 grand bill, I’ve negotiated and fought down several thousands. and…the patient still had several thousand to pay. In that case what could they have paid me?

Take a cut of the difference. If you agree to a 10% cut, and you drop the bill from $10k to $5k, you saved them $5000 so you get paid $500. Your friend is happy because they save $4500 and you are happy because you get $500! That's a sustainable business model if I ever saw one!


ktigger2 t1_iujojrp wrote

That $100 also took me hours of work, phone calls, digging through their medical policy to make sure they had coverage (or didn’t) plus reviewing itemized billing. I’ve totaled up my time for when I’ve done this, especially complicated cases with high dollars and I’d make more at a minimum wage job. I did seriously look at this as a business model, it’s not profitable.


Qbr12 t1_iujqfcq wrote

Should be $500, I flubbed my math there, but I understand what you're saying. Sometimes the juice isn't worth the squeeze.


falco_iii t1_iujulvj wrote

It would require streamlining and automating the process as much as possible. Have a notary ready, have a checklist of actions to take & have a lower wage assistant to do the basic steps, learn what bills normally look like so you don't chase after crumbs, etc...


ktigger2 t1_iujw44i wrote

LMAO at streamlining anything in regards to medical insurance in the USA. There are 4 employees that are billing related to every provider, and that’s just on the medical side. Medical insurers all have different billing systems, EOBs with info in different spots. Same with providers. You are investigating if it was billed correctly (documented correctly) and or paid correctly. Everyone answering here telling me you could make a living doing this for work has never worked with medical billing. But you are all giving me a nice laugh today.


fuddykrueger t1_iuk7pdy wrote

I know. I worked for a doctor who paid me a whole $20/hr (before taxes) to chase down insurance payments from his patients’ denied claims. I made him way, way more money per hour than what he paid me for my time and frustration.


ktigger2 t1_iuk8enr wrote

I helped work denials for a clinic as a part time gig. I found them way more $ than they paid me. I feel you! Now that I would have done for 10% of what I earned for them and still made bunk.


saltoftree t1_iujutrh wrote

What exactly would the notary be doing in this arrangement?


ktigger2 t1_iujw5f0 wrote

Nothing. It wouldn’t be necessary.


falco_iii t1_iujwvbo wrote

Notarizing the patient's request for full medical records, as per the article.


ktigger2 t1_iujxfx0 wrote

Requests for records do not need to be notarized.


The0nlyMadMan t1_iujymxm wrote

If a third-party is requesting your full medical history on your behalf it makes sense to me to have the request notarized


ktigger2 t1_iujzuhp wrote

HIPPA doesn’t require medical record requests to be notarized.


The0nlyMadMan t1_iuk2lx6 wrote

I never said they did? I just said it makes sense. For sensitive information like that, I would understand it being a requirement.


cheesegoat t1_iuk2y2i wrote

Perhaps people could pay a recurring membership, you pay for their medical bill in full and then whatever you fight down reduces your cost? Incentive for you is to reduce as much cost as possible to make sure the membership fee is profitable.

You could call it... insurance insurance.


ok_itz_zae t1_iuk869e wrote

It's weird to me that someone would be able to make money from something that is made up.

It takes someone minutes for someone to create an incorrect bill... then it costs you your most valuable resource, your time and another valuable resource, your money to get this resolved.

If you got a fake bill, you would consider it stealing if you paid it. Attempted theft if you didn't.

It would be better to take these money loving doctor offices to court or find a better way to hold them accountable...


Fausterion18 t1_iuk6m16 wrote

$500 is about the cost of an auto broker who finds the car you want and negotiate a deal for you. And often they have pre-negotiaged deals with specific volume dealers.

This is maybe a couple hours of work per client at the most. Compare it to negotiating a hospital bill which could take tens of hours.


jgengr t1_iujtlf4 wrote

Could the commission be subsidized by a non profit? Or get paid hourly by non profit and get a commission off of what is saved?


ktigger2 t1_iujxss9 wrote

That would be a thought and one I looked at when it was considering doing this. But what nonprofit? You need one already involved with medical services and has a way to find this clientele plus pay someone to do this. I stopped there a decade ago. Maybe when I retire I’ll volunteer somewhere but for now medical coders are in demand and we can make more working regular medical coding gigs.


DesertTiger26 t1_iuk3rii wrote

If a lay person needed to fight $20k in out of pocket medical bills, what would be the best approach? My partner has a total of $12k from around 8 different medical providers and my son has $8k in medical bills from 4 providers. All within the past 12 months. Needless to say, there is over 50 EOB between the 2 of them. I would love to hire someone like you if possible.


ktigger2 t1_iuk5isx wrote

Start with your insurance policies. Does it look like they were covered appropriately per what your policy states? Get itemized billings from the medical providers and check the COT codes and descriptions against what happened at the visit. Get the records if necessary to compare documentation against what was billed. Call the medical provide and ask questions. Call the insurer and ask questions. That’s where I’d start.


ghalta t1_iujhzy5 wrote

It's not impossible. I pay a law firm to protest my property taxes every year. If they reduce the declared value of my home, and that results in a reduction of my property taxes due this year, they take as payment 50% of the amount saved. If they don't get it reduced, or they do but it doesn't affect my taxes (which happened this year), they get nothing. And, I get all of any compounded benefit for future years.

The big difference I see is that, after signing over the limited POA paperwork to them, I'm a continual client until I withdraw. For medical billing, there'd be a lot more time required to chase after customers with bills big enough to be worth the effort.


ktigger2 t1_iujisfs wrote

But the clientele for this group is mainly people with high deductible insurance policies or no insurance. Not really the clientele that keeps lawyers on retainer.


ghalta t1_iujqeax wrote

It's also people who get hit by large out-of-network emergency balance bills in states where those are still legal. I'm not sure which states that's true for though.


TheSacredOne t1_iujsdu6 wrote

That isn't legal anywhere anymore. Out of network billing / balance bills for emergencies were banned federally back in January (see No Surprises Act).


ghalta t1_iujsmbl wrote

Cool. So the story this thread is based on is probably no longer relevant to anyone. (I don't think the story says that the patient owed 40% because it was out of network, but that's a high percent for in-network coinsurance so I assume so.)


adultry-throwaway t1_iujxb6p wrote

In all honesty the hospital should be held more accountable. Build out a non for profit to help these people. The non profit helps checks gor over/double charges on their clients bills. Put the hospital on the hook to pay the non profit an amount equal to what they over charged their patient.

If nothing else the hospital will be held responsible for their mistakes.


bassman1805 t1_iujojp0 wrote

Do you mind sharing a little bit about your arrangement with the law firm to reduce your property tax? It might be a little personal for a public forum, but what's your property worth and/or how much have you been able to reduce your yearly tax bill by? How'd you go about finding a lawyer with experience in this field?

I'm a new homeowner just learning the ropes with property taxes. And I've never hired a lawyer before.


ghalta t1_iujrtwk wrote

It's pretty common at least in Texas. ProTax (not the company I use) is one of the biggest in the market. Texas isn't a low-tax state; it's in the middle, but with no income tax, a lot of its revenue comes from property taxes. This includes school taxes, which the state takes, redistributes some of, and then uses the rest of balance the general books. So there's a lot of money to be made in small reductions in property value.

My tax rate appears to be like $2 per $hundred in valuation. So, if the appraisal board says my house jumped like $60k in value this year, that's an extra $1200 I'd owe. But the lawyer uses comps (which they found for lots of clients) that show my value should have only changed by +$20k. They protest, spend maybe 30 minutes total on my case (I assume), and get my valuation fixed. The difference in $40k valuation turns into $800 saved on my taxes, so I pay them $400 for their time and I pocket the other $400 they saved me.

Some years the county tries to up my valuation by $150k or more. This year it was a lot more than that. They got it lowered some. Texas caps your valuation change for the purpose of taxes at 10%, so if the county says my house doubled in value in one year, the double value shows up on the books, but I only pay 10% more. Then next year I can pay a compounded 10%, etc, until I catch up. That's why it pays to protest every year. The past five years when they got my value down $50-150k each year means my starting point for the cap is lower.


rbekins t1_iujqlmt wrote

You do not need a lawyer to reduce your property taxes, or to fight increases. Talk to your assessors office about the process and it is something you can do. There are different methods of appealing based on the why your assessment is changing, ie a reassessment or equalization.

Here when it is a reassessment there is the option of talking to the assessor and having them do an informal assessment, basically coming out and walking around the property and giving you a number. You can either agree with the number or disagree. If you agree with the new number you simply sign off and its done. If you disagree you can still do a formal written protest to the board of review.

If the increase is a result of equalization, your only option is to submit a formal written protest.

When talking to the assessor, or in your written protest tell why your taxes should not be increased. For example one time I argued that my taxes were being increased twice in two years while other houses in the area were not. Another time i protested that the increase was greater than what other houses of similar age, size, and design were selling for in my area.


peter303_ t1_iujymg3 wrote

Similar to people who appeal their denial of Social Security Disability application, which happens over half the time. The law firm takes a fraction of the back-paid SS, if successful. Typical appeal takes couple years. If the appeal is successful, you get get bak-pay to time of application.


Manojative t1_iujos3y wrote

If I had a 10k bill and you brought it down to 3-4k. I would happily give you at least 30% of that 6-7k you saved. Don't know if that would be worth your time, but with enough numbers I think it make for a good living..


Flame_Effigy t1_iujysju wrote

If I can't afford a 10k bill I don't know if I'd be able to afford the 3k along with a commission. That's the problem here. The bills are so outrageously inflated and expensive to the point where people can't pay ANY of it.


bedroom_fascist t1_iuk3c4s wrote

It really doesn't. You're talking about ~$2k ... for ... how much time and effort? to say NOTHING of overhead?

Healthcare has become a financial scam, and all the players know it. They are complicit.


JudgeHoltman t1_iujrbnr wrote

> In that case what could they have paid me

10% of the $100k you saved.

Cheapest rate is $200 flat rate for you to go through the bill and give them a crash course on who to call and play secretary tag with, along with some magic words.

Or for $50/hr, you'll do a polite bit of identity theft (or do the paperwork) and make the calls yourself.

Imagine how much more effective you could be if this was your full time job and could make calls all day during business hours.

You'd be even MORE effective if you had the time and motivation to show up at the billing department in-person and just do the damn thing.

If you're good at it, you could probably partner with a Law Office as one of their paralegals and do the whole thing legitimately.


ktigger2 t1_iujxbvs wrote

Again someone who had a high deductible insurance plan most like doesn’t have a couple hundred around to pay someone to do this. This clientele with money to pay for this service doesn’t exist.


CorporateDroneStrike t1_iuk881z wrote

I’ve read your comments and I can you’ve got a lot of insight into this…

At first, I wanted to argue with you like everyone else but I think you make a good point about the high deductible or uninsured group.

I think there are surprising amount of people who could pay a reasonable fee to (20-40% of savings) to avoid excess spending — but they have lower deductible policies with an out of pocket max.

My deductible is $1500 and my out of pocket max is $4000. I’m fortunate enough to be able to pay the max if I needed to (fingers crossed any accident happens at the beginning of the year) but I don’t have the incentive to fight over billing because insurance will kick in.

I think there are 2 problems: target market and really high specialized labor costs for investigation. I think you could bring down labor costs with a really good tech system (machine learning maybe) but that would require investment.

It’s tough.


Trottedr t1_iuk0wad wrote

Some state agencies offer services like this, at least to find out if the billing is compliant with state regulations and the insurance company has paid the appropriate rates according to the insured's policy.


TheKerui t1_iujs3pi wrote

The answer is to get hires by the insurer to reduce their costs on a much larger scale.


ktigger2 t1_iujwol4 wrote

Insurers already do this for their benefit and when they are stuck with the bill. If it’s a high deductible plan and the patient is liable they aren’t spending their time and money on this. If they are footing the bill it’s another story. I’ve been in this field for more than … !! 30 years, I’ve worked for a hospital, private practice, specialty center and now am on the insurance side.


ChuCHuPALX t1_iuk5r2j wrote

There's money if you threaten to sue and get a settlement.


riptidestone t1_iujy2gp wrote

I notice Labcorp is up to thier usual crap again.i went to my doctor's office and had my blood drawn by HIS nurse to be sent to lab corporate. Lo and behold what was on LabCorp's bill a venipuncture charge for $25.00.


Brando_Calrisian_ t1_iuk2z5r wrote

As a side question, my wife is looking into getting the certs to be a medical coder. Do you think it's worth it?


Kihr t1_iuk6wbl wrote

I'd give you a 20% finders fee


ktigger2 t1_iuk7tjs wrote

And if I do all the investigating and don’t find anything I just wasted a lot of time for zero dollars. Not all billing is nefarious or incorrect. I’ll keep my day job.


Reach_The_Beach t1_iujopdk wrote

In my case at one employer I worked at, we had a benefits coordinator in HR who was worth her weight in gold. So her main job was supposed to be running all the open enrollment and making sure everyone’s insurance needs were taken care of. I’m sure there’s more to it, but it felt like she went above and beyond. She probably spent 30-40 hours a week on the phone with our insurance provider and the hospitals/doctors offices fixing these issue.

I had numerous times where I thought something should have been a co-pay and I got charged $300 or something that should have been like $200 getting charged as $1000. In every instance, she fucking lit into people until the claims were processed properly. She saved me thousands in the few years I worked there. Can’t imagine how much money she’s saved employees there over the 30 years she’s been there.


tx_queer t1_iujyg4f wrote

Same here. Got a surprise bill in the ER. Talked to the hospital, no luck, apparently I signed some paperwork while half way unconscious. Talked to the doctor-helper, no luck, apparently I met him while counting down from 10. But the benefits coordinator went on a 6 week crusade and was able to get me my $4000 back


Reach_The_Beach t1_iujz10a wrote

HR departments typically have a lot of bloat and unnecessary positions, but man oh man the benefits coordinator (assuming it’s a good one) sure ain’t one of them. If I owned a company I’d probably pay them twice the market rate just because I know how important a good one is to my employees.


frankbeans82 t1_iujhyk1 wrote

She spent a whole year on this (obviously not literally) fetching itemized bills and medical records. She only saved $2100 in the end. She'd probably have to sue them to get some kind of damages.


shadow_chance t1_iujrsu3 wrote

It's interesting it took months to even get the CPT codes. In their case, their insurance processed the claim seemingly quick. Their EOB should have had the codes.


sold_snek t1_iujvfka wrote

> lead her to complain to the Illinois attorney general, and discover that the hospital charged nearly $7,000 for a procedure that was never performed.

My question is how is the hospital not being sued or investigated for what sounds like blatant fraud?


blablahblah t1_iujkory wrote

There's two problems:

  1. Insurance is paying most of the cost anyway so you're only saving the client a fraction of what you fight, so a fraction of that isn't going to be especially big compared to the effort you spend and
  2. Insurance plans have a max out of pocket so there's an upper bound on how much you can save any client. And if they hit the cap, you may have to fight thousands of dollars in charges before you can save your client a single penny.

Awhodothey t1_iujnned wrote

Also, most people aren't getting charged for procedures that didn't happen.


ForeverALone_Ranger t1_iujfzuc wrote

I was thinking the same thing. It seems so (unfortunately) obvious that I can't imagine no one does this yet.


it_helper t1_iuk2o4v wrote

Yes kind of. My dad is retired and works part time for a company that audits this exact scenario. When there is a delta between what insurance thinks should have been charged and what the hospital bills for, his company goes in and audits everything. Anything they find that saves their party money, then the company he works for gets a %. You would be surprised how much his company found was incorrectly billed or charted.


shadow_chance t1_iujqygz wrote

I don't know much it actually works, but my employer has this service (I think it's through their insurance broker?) where we can submit bills and a "specialist" is supposed to be able to assist with questions or explain charges. Not sure if they have some inside line to our insurer or not.


upstateduck t1_iujqvgj wrote

the money is on the other side ie teaching hospitals/doctors how to maximize their revenue through coding manipulation


epsdelta74 t1_iuk4l1z wrote

There is. I used to audit Pharmacy insurers and we had some very loyal clientele. Usually the amount we recovered for the client paid for the audit!

Of course, there is a ton of resistance to even getting an auditable contract signed. Truly auditable, not another version of the auditees "correct because they know" report.


luger718 t1_iuk3o32 wrote

My job offers this through Justworks (the payroll/benefits provider) it's called Healthcare Advocate, they help you with understanding health plans and such but also have a service where they negotiate prices and keep a cut of the saved money (I think 25%)


Katelynfinesse t1_iuk4nvu wrote

There is now software that does this for medical practices, I am a sales rep for one of the top ones in this industry. Before I learned about the rev cycle in healthcare I was blown away at how tedious it is, especially the denials and appeals process of medical billing.


Mr_Ted_Stickle t1_iujymav wrote

Look at you thinking about making money off of someone who was incorrectly billed by a hospital. Imagine if hospitals were just honest and billed appropriately. Woooaaahhhh.