Question: Need advise for medical bills caused by violent criminal assault against own children. – Medical Bill Survival Guide
The Medical Bill Survival Guide complete book
Available Now: Medical Bill Survival Guide by Nicholas Newsad in print and e-book format at Amazon.com

Second place in the Reader Views Literary Awards, "Health" and "How To" categories

It does not matter how bad your financial situation seems to be, The Medical Bill Survival Guide will provide you with the knowledge to help yourself or your loved one. Medical bill anxiety is caused by miscommunications and misunderstandings. This book teaches easy, effective strategies for working with insurance companies, hospitals, doctors, and other healthcare providers.

Readers will learn and discover:
  • How process problems cause insurance claims to be rejected and denied
  • How to access public insurance programs for the uninsured and unemployed
  • How to access provider-based financial assistance and charity care
  • How to demonstrate financial hardship and
  • How to talk productively to billers and collectors.
The information in this book will benefit:
  • Insured patients who are experiencing difficulty paying the deductibles, co-pays, and coinsurance.
  • Uninsured patients who are unemployed or cannot afford health insurance.
  • Patients and the families of patients who have survived a catastrophic medical episode like cancer, heart attack, or major surgery.
  • Patients with chronic diseases requiring continuous, costly medical care like heart disease, COPD, or diabetes.
Nicholas Newsad, MHSA is a senior analyst at a national healthcare management company. He holds a master's degree in hospital and health service administration from Xavier University. He lives in Westminster, Colorado.He has served as a senior healthcare analyst for six years and has also served as an interim surgery center administrator. He has been quoted and interviewed in the L.A. Times, NY Daily News, MSN Money, and Smart Money, as well as numerous other magazines, newspapers, and radio shows.

Do you have a horror story about your medical bills? Insurance company? Or medical provider? We want to hear about it. at medicalbillsurvivorsguide@gmail.com

Question: Need advise for medical bills caused by violent criminal assault against own children.

0 Comments - Posted by Nick Newsad on November 15, 2012 at 9:59 pm
Kathy O’Keefe from Ohio asks:
On May 6, 2011, a man broke into my daughter’s home. He forever changed all of our lives that day. He hid in the dark early morning hours, and forced his way in. This man attacked my daughter, stabbing her multiple times. Her brother, Danny, heard her screams, and ran to her aid, changing his life forever.
I’d tried all morning to get my daughter, and then my son, by phone, text, and email. It was very unusual not hearing from them. Concerned, I called my husband, who was working at a job site, and told him. I thought I was being paranoid, but he needed to go check on them. He proceeded to pack up his gear. In the mean time, my children’s one year old shepherd had barked for 6 hours straight. This puppy woke my daughter, Kelly. Her barking saved our son’s life. My daughter called me, knowing she was sick and hurt, but not what was wrong. My daughter fought blood loss and multiple injuries to make that call. That call saved both of their lives. My youngest son, Kyle, got home, and I sent him too. He and his dad, Jim, got there right behind each other. I sent them into a nightmare, neither will ever forget. Things like this just don’t happen in real life. It’s too horrid to be real; but it is.
I’ve been told it’s the worst crime scene the police and EMTs had ever seen. My two children laid in pools of their own blood for 6 hours before help arrived. They were stabbed in the brain, chest, neck, and arm. Once I heard from Jim, he told me to go to UC Hospital because my children would be aircared there.
Danny had to be resuscitated at sight. He barely made it to Mercy Fairfield Hospital. Aircare picked him up there. At that time, my daughter was already at UC Hospital, arriving by aircare. I was told she would have brain surgery, and then turned around and was told Danny had arrived and would be having brain surgery. Can you even imagine?
After receiving that news, I had to call my other son, Ryan (a US Army MP). He was stationed in Seattle after being deployed in Iraq for a year and a half. I had to tell him we didn’t know if they would live or not, it didn’t look good, and to get home as fast as he could. Because this was a high profile case, we were told by law enforcement to not talk to anyone, and were placed on lock down. We were asked to maintain our silence. We did. We talked to no one, and just waited to see if our children would live.
Our daughter, Kelly, is an assistant prosecutor for Butler County. She is back to work, working to reclaim her life. We try to shield her from the curious. Because of our silence no one knows how badly our son, Danny, was hurt. Danny was stabbed 19 times in the brain. His right hand had multiple defense wounds. His tendons were severed. He was kicked so hard his spleen was lacerated. Danny’s injuries have been compared to Congress Woman Gabby Gifford. His skull was so crushed it took a year, minus 2 days, to get a skull cap replacement in…
Danny has had 5 surgeries in the last year. Now we’re fighting to get his life back. Danny has aphasia, whichmeans he has trouble talking, reading, and writing, devastating to a young man who had just finished law school. He wanted to be a defense attorney, to make a difference.
Danny used to play the drums, but can no longer use his right arm. Danny walks with a limp, but he walks two miles every day. Danny is our hero. He saved our daughter’s life, but at a great cost. Danny loves sports. He played baseball, football, and soccer. He loved to read, and play the drums. He’s lost it all.
His attacker was trained in the martial art tai chi. He brought a weapon called a skull crusher with him. He was sentenced to 21 years in prison for destroying a life and forever changing our family’s lives
I’m writing to ask for your help. Danny has Anthem insurance. They pay for 30 therapies a year. We got him on Medicaid, and they pay for 20 a year.  We have been told Danny needs more than this  Danny needs intensive speech therapy, occupational therapy, and physical therapy. We have sent  him to the University of Michigan UMAP program for his speech. It’s around $22,000 for four weeks of therapy, and his insurance doesn’t pay for this. His doctors and therapists say he needs to go several times. Room and board for Danny and his caregiver (his dad is with him) is not included in the cost. Neither is the cost of the other ongoing two therapies, physical and occupational.
I’ve never asked anyone for anything. My husband and I have worked since we were young teens, but I’m asking for help now. Can you help my son? We have a face book page “I support the O’Keefe Family”. On the page, there are news articles and a channel 12 video. Donations can be made to the O’Keefe Family Assistance Fund at any Fifth Third Bank. We do have a tax ID we can use with the University of Michigan’s Aphasia Program earmarked for Danny. You can also donate Marriott points, to help with their stay. We also need people in Ann Arbor area that need work on their homes, so my husband can be employed while he is there.
Thank you for taking the time to read this, and if you can offer any help or ideas it will be greatly appreciated.
Response from: Nick Newsad
,Kathy

I’m truly very sorry. I can help you with this if you want me to get involved. It appears to me that you have to deal with three issues. These are
a) Establishing fair self-pay pricing for the University of Michigan Hospital speech therapy services
b) The ongoing coverage limits of Danny’s insurance for therapy visits (ST, PT, OT)
c) Substantiating the “Medical Necessity” of the need for the service in spite of the coverage limits
Regarding (a), for his immediate needs I have some additional questions.
(i) Are Danny’s covered visits exhausted for 2012? Does re-enrollment (and benefit resets) occur January 1, 2013?
(ii) Is he enrolled in Anthem, Ohio Medicaid, or both? Are you saying the University of Michigan speech therapy is not covered by Anthem or not covered by Ohio Medicaid? Are they saying this is not covered for being out-of-state, above the visit limit, or not “medically necessary?
(iii) Does he have a local speech therapist and physical therapist he has been seeing in Cincinnati? Please described the significance of the 4-week program in Michigan relative to his ongoing treatment.
(iv) Is the $22,000 before or after the application of self-pay discounts and/or uninsured discounts?

Pending responses to these questions, I highly suspect the $22,000 price tag you mentioned for the UofM program is their high “gross charge” sticker price that they maintain for auto insurance patients whose plans have no negotiated prices and pay 100% of the bill. I was working with a PT/ST clinic in Ohio just this summer and their average payments from normal health insurance companies for therapy visits is about $70-$90 for physical therapy evaluations (code 97001), $110-$130 for speech/hearing evaluations (CPT 92506), and $20-$50 for the various exercises and therapeutic services (CPTs 97110, 97140, 92507). At these rates, Danny could have 200-400 therapy sessions for $22,000.

If I am correct that this is the “gross charge”, common health insurers like United, Cigna, Anthem, and similar have negotiated “discounts” for the UofM program that brings the price down 50% to 75% or more from the gross charges. Please respond to the questions above and I will put you in contact with the Director of Revenue Cycle Management and the CFO of the University of Michigan Hospital to get an self-pay discount. I coached an elderly man with COPD to get a $17,000 write-off from the University of Michigan Hospital last March under similar circumstances.
Regarding (b), I’m a little unclear on whether he is currently covered by Anthem, Ohio Medicaid, or both. Regardless, the visit limit coverage for Anthem and Ohio Medicaid are going to be pretty firm. Ohio Medicaid will probably not grant exceptions. You will have to check you Anthem benefit plan (not the short benefit summary, the big one) to see if exceptions are granted on the basis of “Medical Necessity”, which I will describe further.

Another option you may consider, that will not provide immediate benefits but could definitely help over the long term, is federal SSA disability and Medicare. If a physician declares that Danny has a permanent disability, 24 months from the time he is enrolled in the federal SSA disability program, he will have the option to enroll in Medicare (the federal health insurance program for the elderly and permanently disabled). SSA disability enrollment qualifications are unique for young persons (http://www.ssa.gov/dibplan/dqualify.htm).

I bring this up because Medicare currently has a base annual speech and physical therapy benefit of $3,700, but you can get additional therapy visits by using their exception process for “Medical Necessity”. Basically your physician just has to put in writing that the additional visits are medically necessary.

Medicare therapy exception info:
http://www.asha.org/practice/reimbursement/medicare/overview_exception
http://www.apta.org/Medicare/TherapyCap/FAQ
Regarding (c), if your Anthem health plan has an exception policy, you can go through the same appeal process as I described above for Medicare to demonstrate “Medical Necessity” with the assistance of Danny’s physician. You’ll need to check your benefit plan documents.

Sincerely

Nick Newsad

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