Showing posts with label Gov. Show all posts
Showing posts with label Gov. Show all posts

Fighting Fraudulent and Inflated Medical Bills - Federal and State Websites Help Patients Fight Dishonest Charges

Latest update: August 29, 2022. Page URL indicates original publication date; meanwhile, times change and the updates continue.

These websites will actually help you when a medical entity victimizes you with inflated or outright fraudulent medical bills and/or denied insurance claims.

This includes hospitals, general doctors, specialists, X-ray places, CT scan or PET scan centers, blood test places, and pretty much any other medical facility or entity that engages in illegal or unethical conduct. Emphasis is on illegal, unethical contracts and on illegal, unethical billing practices. Also includes resources regarding insurance company misconduct or for when a Medicare, Medicaid, or Medi-Cal case worker makes a mistake or acts in bad faith. Sooner or later, you will need the information on this page.

Medical Federal and California (and other) State Government Websites That Will Help You When an Insurance Company or Service Provider Victimizes You – Also Some Worthwhile Additional Information

Ways to Deal With Our Country's Corrupt Private Sector Medical Industry


Patients Rights and Financial Help Resource List

A list of resources regarding the rights patients are legally supposed to have. Many provide complaint forms and will actually help you. All listed websites are government or other well-known, reputable resources. All links go directly to the website's patients rights page and/or patients help page. Needless to say, all are free.
  • MedlinePlus, from the U.S. Library of National Medicine.
  • HealthCare.gov, your rights under the Affordable Care Act.
  • Medicare.gov, your Medicare rights.
  • The Medicare Beneficiary Ombudsman. , a resource for filing complaints, grievances, appeals, etc.; in other words, a place to rat out medical service providers. The page also promises to provide information, help, assistance, and other services. The page is apparently also the starting point for when you need to deal with Medicare's own shenanigans.
  • CMS.gov, Centers for Medicare & Medicaid Services. The particular link I provided has to do with Consumer Information & Insurance Oversight. The page may not especially look it, but these guys are your friend. Sometimes, out of the blue and without any action on your part, they will send you notices a particular medical bill from a medical service provider or insurance entity is not valid and that you don't have to pay it. This website is definitely worth prowling around when you have the time.
  • California Department of Public Health (CDPH), the go-to page for filing medical complaints in California.
  • Office of the Patient Advocate (OPA), another go-to page for filing medical complaints in California.
  • CDSS is another California site that may be able to help you, especially as applies to local office Medicaid (Medi-Cal) obstructions.
  • Bing. For folks not in California looking for their state websites, simply do a search for:
    "YourStateNameHere patients rights help site:.gov" (without the quotes and be sure to include the exact "site:.gov" syntax).
If a link suddenly stops working, it means the website moved that particular page. Let me know in the comments section and I'll find and post the new location.

Some Tips for When Dealing with the Medical Bureaucracy

(being involved with an insurance plan network limits some of these tips)

  • The Medicare 1-800-633-4227 number is open 24/7. They have always been friendly, professional, and helpful. Do give them a break and check their website first. You might not only find the answer to your question(s), but also discover other worthwhile information relating to your situation.
  • Referring doctors make paperwork mistakes all the time. Whenever possible make sure the medical treatment specifications match what the Medicare white book says. This is mostly applicable to preventive services. Not kidding here, make sure the doctor's instructions exactly match what the Medicare website and yearly white book specifies. I've personally saved myself one financial disaster already by doing this.
  • Never walk into a medical service provider's diagnostic center without the proper Medicare COPD 5-digit code included on the referral paperwork. 
  • Referring doctors make paperwork mistakes all the time (did I mention that already?). Always verify the accuracy of the Medicare code on the paperwork before going to the specialist's or medical service provider's office. Confirm with Medicare that the Medicare code number is valid for your circumstances and procedure(s) and that Medicare will approve and pay for the procedure.
  • When referred to a specialist, sometimes a COPD code isn't provided; the specialist adds the code after the fact. Your only defense against this is having diagnostic information showing the necessity of the visit to the specialist, e.g., CAT scan shows potential malignancies in lungs, thus being referred to a pulmonologist makes medical sense. If the specialists uses the wrong code(s) after the fact and the claim is denied, don't just give up. Work with Medicare and the specialist to get the mistake straightened out and resubmit the claim.
  • If not involved with an insurance plan network, the referring doctor does not not always know if the referred specialist or medical service provider takes Medicare, Medicaid, Medi-Cal, etc. When you walk into that referred specialist's office or medical service center for the first time and have identified yourself, always ask first:
  1. Does Medicare accept you and do you accept Medicare as full payment, secondary insurance covering remaining balance?
  2. Does Medicaid//Medi-Cal/Etc. accept you and do you accept Medicaid, Medi-Cal, etc. or whatever other supporting insurance applicable in your situation as full payment?
If any part of their answer is no, leave immediately. As a Medicare beneficiary, you have the right to go to any Medicare specialist or service provider center you wish, unless you are on an insurance plan where one must stay within the plan's network. Either way, tell your primary, referring doctor what happened and they should be able to take care of it.

An important note. If a medical entity financially victimizes you or is trying to victimize you happens to be a referral from your doctor, first check with Medicare via their website and/or phone calls and find out exactly what is going on. If that doesn't clarify or fix the situation, then tell your doctor's office all about it. They might be able to fix the problem with just one phone call to the offending medical entity; not so surprisingly, your doctor's office will often be quite successful at this.

A personal note. That medical contract you are always forced to sign is basically a blank check allowing the medical entity to do whatever they want. You've given them the right to do anything and everything their little hearts desire and then to bill you for whatever insurance doesn't cover. For that reason, I always print directly above my signature the following in caps:

"ONLY PROVIDE INSURANCE COVERED SERVICES ONLY"

If the medical service provider then refuses you as a patient, immediately inform your primary physician that referred you. If that doesn't solve the problem, i.e., your doctor being able to find a different service provider in the area; I'd personally let Medicare, Medicaid/Medi-Cal, and any other involved insurance/government entity know all about it. I would think they would all want to know about a medical service provider that turns away patients simply because that patient only wants those services that are covered by insurance. Who knows? They might even be able to help you.

An update (Medical Hack(?)). Someone sent me this. I do not know if it is true or not. It sure would be interesting to find out:

Medical Life Hack?

I'm continuing to look for other government medical websites that help patients when it comes to money issues. If you happen to know of one, please mention it in comments. I'll be happy to include it on the list. Federal sites are preferred, but sites specific to your state are also welcome.

Here's an article from CNBC about fighting a fraudulent medical bill: More than 30% of Americans have medical debt: What you need to know about negotiating a medical bill.

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A 100% Meritocracy Is Flawed. How It Relates to Society, Capitalism, Darwinism

Latest update: February 1, 2022. Page URL indicates original publication date; meanwhile, times change and the updates continue.

Meritocracy - Society - Politics


The Sociological Definition and Results of a 100% Meritocracy, i.e., Societal Darwinism

Why a 100% meritocratic society can never work as a standalone system; the pros and cons. For democrats, republicans, liberals, conservatives, and anyone else who is interested. A blended meritocracy is what seems to work best.

Darwinism - Another Word for Meritocracy


A Meritocratic Society

Meritocracy is a good thing. In addition to rewarding those who can compete, it generates lots of extra money that can be used to help those who cannot. Unfortunately, meritocracy can never work as a standalone system. This is due to the fundamental nature of meritocracy and, of all things, the basic laws of mathematics.

What is a meritocracy? For the purposes of this article, meritocracy is defined as one's survival and success being solely contingent upon one's ability to compete and contribute to society in such a way as to prosper.

Meritocracy and capitalism have a lot in common. In a "perfect" system, the concept of money could be defined as the method used to quantify one's success.

The Scenario – What would happen if a society were to convert to a 100% meritocracy? The sociological implications...

In a meritocracy there will always be winners and losers. In many cases the loser worked just as hard as the winner, but the winner was just a little bit better at it. The winner thus gets more and the loser gets less. So far, no problem. And the loser can always try again.

However, resources are finite. For the bottom 10%, there will always not be enough. There will not be enough shelter. There will not be enough food. There will not be enough health care. There will not be enough of a lot of things. It is inevitable, due to the lack of even the basic necessities of life, the "losers" will sooner or later lose the ability to compete. Now what with this being a 100% meritocratic scenario, what happens to them?

It is already abundantly demonstrated in our present society one of two alternatives will occur...

Alternative One – The Person Dies

In our present society, homeless people unnecessarily die all the time. Everyone knows living on the streets will eventually destroy most people through attrition: a continual decline of health, the eventual and inevitable being a victim of successive crimes, and finally the loss of ability to defend or survive, and then death.

However, we are not talking about our current society. We are discussing a 100% meritocratic society. Therefore: there are no free job-training programs; there are no homeless shelters; there are no food banks or food programs; there is no affordable health care; there is no type of charity or handout whatsoever.

Needless to say, this greatly accelerates the attrition, leading to death or the second alternative.

Alternative Two – A New Criminal Is Born

Steal, rob, kill; or die. That pretty much sums it up.

Of course the number of criminals will continually be reduced for the usual reasons: competition among same; attrition through street-living; "eradication" by society via imprisonment, etc.

As the number of criminals are reduced, others will take their place.

The Brutal Mathematics

What happens when the bottom 10% gradually dies; whether it be through Alternative One or Alternative Two? The answer is simple; they will gradually be replaced by a new 10%. It is a brutal mathematical fact; there will always be a bottom 10%.

Recursion comes into play. As the bottom 10% shrink through death, new lowest 10%'ers will take their place. Along with an expanding criminal element and a shrinking population; riots and other civil unrest could very well become commonplace. 100% meritocracy is equivalent to 100% Darwinism. Both are good, but not at the 100% implementation level.

Conclusion

A 100% meritocracy is not only brutal and full of misery, it is destined to fail.

An 80% to 90% meritocracy, however, could be a good thing. We pretty much have that now. We just need to get better at it.

It should also be noted that a meritocracy below 80% will more than likely lead to a country's bankruptcy. This apparently is already happening in some European countries.

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Here is an interesting, related article from Vox: The problem with America’s semi-rich. It also relates to meritocracy and society.

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Best Medical Website List of Resources

Latest update: January 4, 2022. Page URL indicates original publication date; meanwhile, times change and the updates continue.

The CDC is a good first resource for the latest pandemic information. The rest of this page, though certainly pandemic applicable, is more about our American, day-to-day medical situations.

And do note the final resource listed under the $100 bills. You will be glad you did. Federal and state agencies can often be a patient's best friend.

Medical Website Resources

Resource Description
Fighting Patient Financial Abuse Patients Forced to Sign SWAG Medical Contracts Under Duress. Includes additional resources to fight back.
...nih.gov/... Patient rights, and much more.
consumer.gov/... Patient rights, and much more.
calpatientguide California patient rights, and much more.
CMS.HHS.gov Centers for Medicare/Medicaid Services. Includes nursing home ratings.
Medicare Medicare Information.
Physicians Physician Comparison and Ratings by Medicare.
Hospitals Hospital Comparison and Ratings by Medicare.
amdcanada Macular Degeneration. Amsler Grid.

Resource Description
MayoClinic Seems to have it all.
Merck The Merck Manual. The medical standard.
WebMD This and that, more...
pparx Prescription cost assistance directory.
HealthWorld Health answers, medline, more.
HealthLibray Stanford Health Library.
HealthAnswer Health/Medical answers.
InteliHealth Health/Medical answers.
MedExpert Has every medical link on the planet, more....
healthgrades Research hospitals/physicians/more. Free & fee.
QualityCheck Hospital ratings, more.
nhcaa National Health Care Anti-Fraud Association.
FDA Food and Drug Administration.
NLM Federal National Library of Medicine.
alz.org Alzheimer's info.

Resource Information About Specific Doctors
A.M.A. The American Medical Association. Basic background info and a whole bunch of other stuff.
Reserved
Admin. in Med. Misconduct, malpractice, criminal data.
A.D.A. American Dental Association.
doctoroogle The Good Dentist Guide - By Patients for Patients.

This Has to Stop

Last, but not least, here is a page dedicated exclusively to dealing with patient financial victimization: Medical Federal and California State Government Websites That Will Actually Help Patients When a Medical Service Provider Victimizes You – Plus Some Important Tips


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Best USA Federal Government Websites List - Most Popular or Frequently Used

Latest update: January 19, 2023. Page URL indicates original publication date; meanwhile, times change and the updates continue.

This is one of my personal bookmarks pages I made; I figured why not let others use it as well. For 90% of visitors, you will find your federal link here. Also makes for interesting browsing. If one wants any additional federal websites listed, simply post its URL in the comments section. More than likely I'll include it in the next update.


Resource Description
NIST Time Time
USPS US Post Office
IRS Internal Revenue Service
IRS Advocate IRS help
FTC Federal Trade Commission
FDA Food and Drug Administration
SSA Social Security Administration
CMS.HHS.gov Centers for Medicare/Medicaid Services. Includes nursing home ratings
Medicare Medicare information
GovBenefits Official benefits site
Census Census Bureau
BLS Department of Labor, Bureau of Labor Statistics
US Mint US Mint
GSA General Services Administration
FPDS Federal Procurement Data System
SAM Federal System Award Management
FBO Daily FedBizOpps (FBO)
HUD Housing and Urban Development
State Dept. State Department
State Dept. State Department. How to get passport.
CIA CIA. Includes world fact book.
FBI FBI
GAO General Accounting Office
FDIC Federal Deposit Insurance Corporation
NHTSA National Highway Traffic Safety Administration
CIC Consumer Information Catalog
Grants Central source for organization grants
CDC Center for Disease Control
Congressional Information Legislative Information Service
NASA NASA Hubble telescope
NASA Gallery NASA Hubble telescope images
USGS USGS earthquake site
FuelEconomy.gov EPA mileage data and info
SEC Securities and Exchange Commission

Nat'l Libraries Description
LOC Library of Congress
NLM National Library of Medicine
NLE National Library of Education
NAL National Agricultural Library

Directories Description
USA U.S. government's official web portal.
Fed World Links, more....

American flag in cupola of International Space Station with Earth visible. - NASA

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