2019 Social Security Changes

Based on the increase in the Consumer Price Index from the third quarter of 2017 through the third quarter of 2018, Social Security and Supplemental Security Income (SSI) beneficiaries will receive a 2.8 percent COLA for 2019. Other important 2019 Social Security information can be found here.

* The information contained in this Blog is intended for general information and educational purposes only and does not constitute legal advice or an opinion of counsel.

Managing Medical Bills and Insurance Paperwork: 7 Tips for Maximizing Reimbursement

Do you become frustrated and overwhelmed when managing medical bills and filing health insurance claims? Managing and filing insurance claims can be a complex, frustrating, stressful, confusing and time-consuming process, particularly for families who have children with special needs.  But, given the high cost of health care today, it is critical that claims be filed and managed correctly to ensure you receive all the payments due to you and that you pay only the bills you’re supposed to pay.

Here are some helpful hints on managing medical bills and health insurance claims paperwork from Harvey J. Matoren, MPH, CCAP, who is President/CEO and co-owner/founder of Claims Security of America, a nationwide medical bill management and claims assistance/filing service that helps patients and families manage their medical bills and insurance paperwork.  Matoren’s tips should help get you through the red tape, give you peace of mind and, hopefully, put more money back in your pocket.

  1. Whenever possible, try to have the doctor’s office file your claims and even accept assignment. If your doctor accepts assignment, it means that she agrees to file the claim and to accept, as payment in full, the amount the insurance company approves. Your doctor cannot “balance bill” you for the difference between her charge and the approved amount. In most cases, the insurance company will pay the provider directly when she participates with the insurance program. If the provider accepts assignment or participates with your insurance program, your only obligation usually is the co-payment, as stated in the policy. Many providers will ask for this co-pay at the time of your visit. Try to have them bill you for the co-pay after they have filed the claim and been paid by the insurance company. Many people pay the wrong co-pay. For example, they pay 20 percent of the charged amount instead of 20 percent of the approved amount, and consequently overpay and never get back a refund.
  2. If you have more than one insurance policy, do not assume that the provider will file the claim.If you have to file the claim, be certain to give the insurance company all the information it needs. Incorrect or missing information will only cause a delay in processing the claim. If you need to submit an itemized statement, be certain the following information is included:
  • Diagnosis
  • Description of service
  • Charge for each service
  • Date of each service
  • Location of each service
  • Name of the provider (doctor, hospital) who actually treated you
  • All appropriate insurance numbers
  1. File your claims as soon as possible.Don’t let the bills or receipts pile up — and, certainly, don’t save all your claims until the end of the year. Timely submission of claims is critical in receiving reimbursement.  Even if your provider agrees to file the claim, you should be sure that it is filed within the filing time limits imposed by the insurance company.  Claims filed too late could result in a bill to you from your provider for services that should have been paid by insurance.
  2. Don’t pay any bill unless it is clearly understood that it is a final accounting and you are responsible for it.  Never pay a bill until you have received the explanation of benefits form from your insurance company, which indicates who and how much was paid.  Bills are sent prematurely and many patients pay bills before knowing if the doctor or hospital has received a payment from the insurance company.  Duplicate payments to the provider very often result in refunds that are due to the patient but not returned.  When you do pay a bill, keep records according to the date of payment and check number.  This is necessary if you receive a duplicate bill indicating that payment has not been received, and verification of payment is required.5. Know what’s covered and what isn’t.A lack of knowledge regarding benefits often leads to patients being billed and paying for services that should be reimbursed or written off.  Check your policy to be certain of the covered benefits.

    6. Appeal rejected claims regardless of the reason given. The provider could be helpful, especially if he has not received payment for the service. In addition, appeal all claims that you believe were not paid at the appropriate level.  An insurance company may say that the provider’s charge exceeds the allowed amount (referred to as exceeding the “usual and customary charge”), but this may not be the case.  A Government Accountability Office (GAO) study several years ago indicated that, of the millions of dollars of rejected Medicare claims annually, only about 2 percent are ever appealed.  However, of those 2 percent that are appealed, approximately three-quarters are overturned in favor of the patient.

    7. If you have to file your own claims, make copies of everything you submit. This will make it easier for tracking and follow-up. It will also facilitate resubmitting claims if and when the insurance company tells you it never received the information.

Above all, don’t be intimidated by the system, Matoren says. If you are persistent, aggressive and assertive, you will be able to maximize your reimbursement, minimize your stress and get peace of mind.

* The information contained in this Blog is intended for general information and educational purposes only and does not constitute legal advice or an opinion of counsel.

FRAUD ALERT: Equifax Breach

About half (143 Million)  of  American consumers sensitive personal information was exposed in a data breach at Equifax, one of the nation’s three major credit reporting agencies. According to Equifax, the breach lasted about two and a half months, from mid-May through July. The hackers accessed people’s names, Social Security numbers, birth dates, addresses and, in some instances, driver’s license numbers. They also stole credit card numbers for about 209,000 people and dispute documents with personal identifying information for about 182,000 people.

There are steps to take to help protect your information from being misused.

  1. Visit Equifax’s website.
  2. Find out if your information was exposed. Click on the “Potential Impact” tab and enter your last name and the last six digits of your Social Security number. Your Social Security number is sensitive information, so make sure you’re on a secure computer and an encrypted network connection any time you enter it. The site will tell you if you’ve been affected by this breach.
  3. Whether or not your information was exposed, U.S. consumers can get a year of free credit monitoring and other services. The site will give you a date when you can come back to enroll. Write down the date and come back to the site and click “Enroll” on that date. You have until November 21, 2017 to enroll.
  4. You also can access frequently asked questions at the site.

For additional information and other steps that you can take to protect yourself, visit the website for the Federal Trade Commission.

 

* The information contained in this Blog is intended for general information and educational purposes only and does not constitute legal advice or an opinion of counsel.

Fraud Alert – Medicare Cards

The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, requires Medicare to remove Social Security Numbers (SSNs) from all Medicare cards by April 2019. The new cards will have a new Medicare Beneficiary Identifier (MBI) that will be used for billing and for checking your eligibility and claim status. This will happen automatically. You will not be contacted by anyone asking for any personal information.

If you receive a phone call or email asking you to give or confirm information or make a payment to receive your new card, it is fraudulent.

You can get more information from Centers for Medicare and Medicaid Service or the Federal Trade Commission.

* The information contained in this Blog is intended for general information and educational purposes only and does not constitute legal advice or an opinion of counsel.

New Legislation Passed for Special Needs Trusts

Yesterday, President Obama signed the 21st Century Cures Act.  This includes a subsection known as the Special Needs Trust Fairness Act. Effective immediately, disabled persons with capacity can now establish and sign their own special needs trust. Previously, the law only allowed a parent, grandparent, guardian or court could establish a first party special needs trust. This added a great deal of unnecessary expense to the establishment of these trusts for disabled persons with capacity that did not have a living parent or grandparent, as the only way that a special needs trust could be established for them was through a court order.

* The information contained in this Blog is intended for general information and educational purposes only and does not constitute legal advice or an opinion of counsel.

Gift Ideas for Nursing Home Residents

While this is a repeat of a blog from several years ago, it may be a help to some of you as we enter this holiday season. The best gift that you can give to a nursing home resident is a visit. If you cannot visit or want to do something extra for the holidays or their birthday, the following is an adaptation of a list published by the California Advocates for Nursing Home Reform in the winter of 2011.

  • A new pair of slippers or a robe in a favorite color.
  • A gift certificate for a haircut, massage, or manicure.
  • Recent pictures of family and friends in an album, frames, or a bulletin board.
  • Video record a family event that the resident was unable to attend and enjoy watching it with them.
  • A subscription to a favorite magazine or newspaper.
  • Crossword or word search books. (Perhaps in large print.)
  • A personal television for the resident’s room or wireless headphones for their television.
  • A wireless reading device.
  • Quilt or lap blanket.
  • Regular deliveries of flowers.
  • Plant.
  • Tote bag for walker or wheelchair.
  • Luxury toiletries.

* The information contained in this Blog is intended for general information and educational purposes only and does not constitute legal advice or an opinion of counsel.

Paying Home Health Care Workers

We are frequently asked questions about how to pay home health care workers. Unfortunately, the cash arrangements that many people use to pay caregivers are not legal and we need to discuss the risks and liabilities of this practice.
It can be very confusing for the consumer to distinguish when a home health care worker is a private contractor and when they are an employee. When the worker also lives in the home, there are additional considerations about record keeping and overtime compensation.
There are even some concerns about liability when the home health care worker is hired through an agency of which the consumer needs to be aware. The United States Department of Labor has published a guide to address some of these issues. The following link will direct you to their website to download the guide, “Paying Minimum Wage and Overtime to Home Care Workers: A Guide for Consumers and their Families to the FLSA.
While this publication does not address all of the issues that need to be considered, like insurance and withholdings, it is a good start to understanding how to classify and pay in home health care workers.
* The information contained in this Blog is intended for general information and educational purposes only and does not constitute legal advice or an opinion of counsel.

SCAM ALERT: Fraudulent Family Calls

Have you ever gotten an emergency phone call from someone pretending to be a friend or family member? The caller may claim that they are in jail, in the hospital, have been robbed, or being held hostage. The things that all of these calls have in common is that they are going to ask for money and they are fraudulent. If you get one of these calls, you should follow these guidelines:
1. Do not give the caller any personal information.
2. Hang up and check it out. Contact your family member or friend directly.
3. Never send money to anyone who calls and asks you for it.
4. Go to consumer.FTC.gov and report it.

The Federal Trade Commission has published a short video with more information. Click here to view.

* The information contained in this Blog is intended for general information and educational purposes only and does not constitute legal advice or an opinion of counsel.