The goal is not to reimburse the provider and in turn the patient. So the firsta one is, we lost ur paperwork or you didnt fill it out correctly. Another one p is, youre not covered anyway. Therefore we will not reimburse you. The other is, your doctor did it wrong. So there. Are cereal hurdles, so on each hurdle people get tote next point which is you reimbursement. Gerri we shouldso establish youre a practicing physician. You know what you speak of. Youre in the middle of all of this. Im a parity. Im a wife and mother of four. Yes, im onea both sides. Gerri youre on both sides. You talked about this prtice of coding up, what is that and what disit mean for consumers . Everything is based on the code which is a transaction fee. Think of it as a sku number for what your doctor gave you. It is very specific. The insurers basically dont want to pay, providers and hospals and physicians do want to pay and Patients Want their services covered. However it is fraud to say you gave a service you did not provide. That said there is very much a gray zone. There are degrees for in how to code, if you have two equal, if you have two equal, if a procedure has two explanations. One might be rebill used at higher level than the other so youre told to do it. In fact when i go to professionalig meetings there ae classes to code to your advantage. Gerri code to insure ears advantage, the doctors advantage or the patients advantage . Providers the advantage. We are given class, all legitimate please use this code because you will be reimbursed at a higher level. Behind the scenes i large institutions there are people who are expert figuring out what to do. Gerri i think what youre saying here between the lines a littl bit that insurers are trying to get the lowest price tag assessed to whatever service or test or procedure the patient has, am i right . Yes, maam. Gerri well, thats disturbing. That is the first time i ever heard about coding up. The other thing i think you say that is really interesting, deductible, well it is not the deductible. Im not an accountant. You need to ben accountant. You need to read fine print in your policy. Whatt, happens you might go for 250dollar examination and think 250 is being applied to your deductible. In fact it is usually, depending on your plan, medicare plus 10 . 250 fee might be 8 plus 10. In fact you might not reach the dectible. Plus the. Deductibles are allocated into three buckets. Win is your medications. One is your hospitalbased treatments and three are your providers treatments and there are three different areas. Soon its, very complex and exceedinglyonfusing. Gerri no kidding. So, it sounds like it is vy hard to reach that deductible and in fact you have some experience yourself with this . Yes. If you are in a no deductible plan and only go to doctors within your insuran youre really okay except for the small copays. If, for example, for myself, selfinsured, my son had surgery a endf the year, i thought it was clear that i would be using deductibles. In fact i did not much to my surprise. Thats when i found it out. I didnt know that before. Gerri you can have surgeries and all kind of testing and still being paying outofpoct . Depends on the fine print of your plan. Gerri so what do i do . Who are my allies, a a consumer who can can i turn to . In are a few. If youre in a large institution, find the person in hr theyill run interference with the insurance and cover this w person. If youre individual there is a little more challenging. There are companies and individuals arising who will represent you. In each state the attorney general can be your friend, doctor pamela galin thanks for coming on the show and hope to see you soon. This is very timely. Gerri as you change in age, as Health Insurance companies consolidate the likelihood you have to change your doctor is growing. My next guest says consumers do little Due Diligence choosing a doctor and likely to spend more time pickig out future. We have the ceo of American Institute for pventative medicine. The autr of, healthier at home, your guide to selfcare and wise health consumerism. Glad to have you here, doctor. Tell us why peopleay so little attention to the doctors they choose . I think as you say as consumers we td to spend more time on consumables items. Four hours on buying a computer, hour 1 2 shopping for shoes and only 45 minutes on average selecting your provider. Unfortunately that is not enough time particularly when you talk about somebody that dermines your health and wellbeing and how l long you may live. What are the critical things to do tat will pick a doctor right for you and will do a great job . One, you want to make sure the doctor is accepts your insurance and part of your Insurance Network as that could be very expensive if theyre not. You want to find out about their office hours and is it convenient in terms of their location . Who will be able to see you when the doctor is not there . Have there been any lawsuits that have been brought against the provider . If so, how many . What were the outgrowths of those. That is a matter of Public Record for many people to access. How trained are they . Are they Board Certified or simply board eligible. Board certified means they passessed an exam after their residency. Board eligible meaning they have taken a residency but never passed the exam. Even deciding whether you want an md or do are all different decisions. What is a do. Those are all different decisions to make when people selecting a provider. What is do . Dr. Of as teopathy. Gerri i never even heard of that. I find very critical and important to our viewers, picking a doctor the doctor has to be in network otherwise you pay big bucks every time you see them. You had some astonishing numbers. Medicare payment for average patient is 153. You will see doctors that charge you as much as 6200 . Tell me about that. Yes there is a lot of variation based upon what physicians charge. We recommend consumers even before they select a doctor, find out what various fees are for various types of procedures. Hat gives you more ammunition to actually negotiate with your doctor regarding fees. We try to teach patient to become wiser consumers so they dont simply acce everything wheer it is the fees or what the doctor tells them to do. Research shows that an empowered consumer actually ends up gettng bett care, is more satisfied with their care and has better outcomes. So by arming and being forewarned and forearmed as a consumer we can go a long way improving our wellbeing. Gerri the industry does not make it easy to find about the doctors. There is no American Medical Association annual grade of doctors. I mean you really have t do yo homework if you want to find something other than just the basics. Where did they go to school. That could be pretty easy. You can read the wall in their office. Otherwise finding some data, not easy. Right. I would like to know what sort of grades my doctor got when they were in medical school. If i want them to have surgery i want them to have high honors in surgery classes as opposed to barely passing it. So, yes, there are some website you can go to but theyre biased in nature. One is they may not have a lot of reviews about that doctor. So its a very small sampling. Two, the doctor may have family or friend wtein reviews themselves so theyre quite biased in nature. And then you also have, you know, patients that may be complain about a doctor, not because of the doctors competency because they didnt like the bill they received or had to wait a long time in the office of the so those are criteria you may want to nsider but doesnt really hit home at the top of the physicians themselves. Gerri matters how long you wait. That is not an unimportant consideration given people often wait quite a bit of time and spend very little time with a doctor themselves. You know i think friends and family are a good place too go for suggestions but certainly not the only place. One of the questions people ask me is, look, i could pick a very young doctor and have access to the very latest medical training, or, i could pick an older doctor having access to years and years of experience. Which is the better . Well it depend upon the individual. I actually switched from an established doctor because he had a very poor bedside manner as it relates to a Health Condition i have to a younger doctor, although i did query that docto a lot about his experience, particularly if i might have to have surgery, how often he has done the surgery what his outcomes have been related to that surgery. When you spend time selecting a doctor, it may not only just be looking online about what their criteria are or their experience or credentials but also meeting with the doctor, interviewing the doctor, the same way you might have two or three contractors come out to your house before doing an addition, you want to go around and visit several doctors and feel how it is with them. Are you comfortable . Do you feel like you could discuss anything with the doctor, even sexual concerns . Do they listen to you . The average patient has four questions but only gets 1 1 2 of them answered during a typical doctor visit. Gerri thats so true. Doctor will interrupt a patient 90 seconds after the patient starts talking. That is not a doctor you want. You want somebody you feel you can converse with. You want somebody that will not just tell you what to do but rather take your opinions into account. Theyre not afraid to queion them if they recommend a medication if they recommend a procedure or even recommend surgery. Wh are the alternatives to that . What are your success rates, et cetera . Gerri pardon me, the doctor i choose though i will want them to talk on the telephone with me when i need them. I want them to respond to email. How likely is it that i will find somebody that will be able to communicate at that level . More likely theyre going to call you back, maybe 24 hours later. Only about 17 of doctors are now communicating with their patients through email. That is certainly going to change as more and more doctors become wired and as we move toward Electronic Health records but still doctors tend to be somewhat traditional in nature the ay they communicate with patients. Gerri well, all of that is going to change in the weeks and years ahead. Dr. Powell, thanks for coming on. Great information. I appreciate your time. Thank you, gerri, nice to be here. Gerri and next, our users guide to health care continues as we point out what consumers should look for to make sure their medical bills are correct. Dont go away. Thank you orville and wilbur. Amelia. Neil and buzz for teaching us that you cant create the future. By clinging to the past. And with that youre history. Instead of looking behind. Delta is looking beyond. 80 thousand of us vesting billions. In everything from the best experiences below. To the finest comforts above. Were not simply saluting history. Were making it. Like carpools. Polly wants to know if we can pick her up. Yeah, we can make room. Yeah. [ male announcer ]. Office space. Yes, were loving this communal seating. Its gre. [ male announcer ] the best tng to share . A data plan. At t mobile share for business. One bucket of data for everyone on the plan, unlimited talk and text on smart phones. Now, everyones in the spirit of sharing. Hey, can i borrow your boat this weekend . No. [ male announcer ] share more. Save more. At t mobile share for business. At t mobile share for business. At od, whatever business youre in, thats the business were with Premium Service ke one of the best ontime delivery records and a low claims ratio, we do whatever it takes to make your business our business. Od. Helping the world keep promises. Gerri medical billistakes. It is unbelievable. We continuing our indepth verage how to manage your health car giving awe users guide to your health care and medical bills full of complicated coding and terms the Health Care Industry insiders hope you dont understand. Common mistakes like duplicate billing and typos in medical coding may be costing awe ton of money. Here to explain, martin rosen, executive Vice President and cofounder of health advocate. Martin, thanks for coming in. Thanks so much, gerri. Gerri i want to talk about these bills. Weve been looking at them all week. You sent us to some of them. Seems to me theyre trying to make it impossible to understand what theyre saying, am i right . That is a pretty good interpretation unfortunately. When you look at bills you almost need a microscope to figure o where the information is. Gerri to be clear here you do this for a living. You contest these bills for a living. Who are people responding to these now that theyre so complicated . I think most consumers are baffled, they get t eob, explanation of benefits. Kind of an oxymoron when you think about i it, not explaining very much unfortunately but at the same time it is somportant for the consumer to be aware and understanding this. It is big, big money thats on the table. One of the things i should add is, when they get one of those envelopes open it up, because if they dont act quickly enough they could lose their right of appeal. Gerri what is the deadline . Generally, 45 days. Gerri if you dont open up, 45 days,wh take some action you cod be in trouble. Definitely want to show that. Show you onef the bills. This is blue shield from california, one of the busines you sent to us. There it is right there take a look at that were going to zoom in on the part that might not capture your attention. It is right here. And it is in the notes. Small type. And, martin you tell us, explain, dont read it. Explain what it means . Well, basically what the note is saying that they sent a separate communication to the member, saying that they needed additional information. And, the fact is, is that that they got twopieces of information. In this case the elb which basically said nothing is covered in the fine print. Basically it said you have to respond to this other letter, if you dont, youre responsible. Gerri c i tell what you is crazy about this . The eob says we dont have information we need. Which is an address and that well send you another letter. Why . That is crazy. I want to touch briefly on cpt codes. These are done by the American Medical Association. They make a ton of dough off this. Essentiallyse describes any tes, any kind of procedure you could have and price tag associated with it. When youa pick up your bill you dont see a description of what you got. That doesnt happen. No. Gerri what you see is a number which is another reason people dont understand the bill. Let me give you an example. This is kind of a funny one. There was a bill we worked on for sinus surgery for a child. The cpt code was wrong and it turns o that it was what was the condition, cytus which has to do with organs being in the wrong part of the body. Totally miscoded and, how would you even know that . Your child had a sign news surgery and obviously the second procedure was a lot more money. We, we sort through it all the time. Gerri e you sort through it all the time. But if im an individual what is my next step if i find some kind of anis error . Being educated consumer is the a the heart of this. Pick up the phone. Dont let time go by. Call the insuran compay. They have Customer Service associates to be able to answer those questions. And you have the right of appeal. So, i think whats really important is dont igne this. Were talking about, big, big money. If some cases if it gets really complicated, you might have to turn to a company like us. Gerri martin, thanks for coming on. Greattuff and thanks for explaining it beca it is really complicated. I think you help ad few people out there. Thanks a lot. Gerri coming up your users guide to health care continues with tips how to compare prices before you have procedures done and how to negotiate those overpriced medical business. Any last requests mr. Baldwin . Do you mind grabbing my phone and opening the capital one purchase eraser . I need to redeem some venture miles before my demise. Okay. Its easy to erase any recent travel expense i want. Just pick that flight right there. Mmm hmmm. Give ia few taps, and. Its taken care of. This is pretty easy, and i see it works on hotels too. You bet. Now if you like that, press the red button on top. How did he not see that coming . Whats in your wallet . How did he not see that coming . Nascar is about excitement. But tracking all the action and hearing everything from our marketing partners, the media and millions of fans on social media can be a challenge. Thats why we partnered with hp to build the new nascar fan and mea engagement center. Hps Technology Helps us turn millions of tweets, posts and stories into realtime Business Insights that hp nascar win with our fans. Gerri next as part of our users guide to health care how to cut your medical costs. That is gerri cutting your medical bills. Consumers are intentionally left in the dark when it comes to the pricing of their health care. Whe you go and what you say can literally save you tens o thousands of dollars. Our weeklong users guide to health care continues for important tips to negotiating a fair price on all of your medical bills. Joining me now, dr. Jeff price, Health Care Blue Book and a ceo of medical costs advocate. Both experts in their own right on the issue of costs and reducing costs. Derek, i will sta with you. Ive been looking at this for weeks now and it seems to me the providers, the doctors, hospitals, theyre doing the st they can to hide prices. Am i right . Yes. In fact pricing is very difficult to determine in health care. Theres not a direct relationship the way you would find in other industries in terms of the quantity of health care and how much you pay for it. And, in particular, the quality aspect is, is a lot of tim missing. Typically what well. The way pricing is determined it is based on volume, competitive gerri not in this case. Yes. So what happens is because its very difficult to determine and because there are codes that are involved in creating that, that cost, it is tough for a hospital or a provider to provide an estimate to a customer. Gerri all right. It is tough for that customer to understand what gerri absolutely true. Jeff, right to you. This is an issue youve been deeply involved with. Weve been looking how much costs varies. It is unbelievable. You can pay anything you want to for a procedure for a test. Let me give an example here. For a simple appen deck toe my, you can pay 1500 or can pay 183,000 according to one study. Tell me what you know about this. You are very deep look at costs how theyd vary. What