Valley man fights $36,000 medical bill

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PHOENIX - Many people out there face problems with insurance claims, so 3 On Your Side found one family in Phoenix who fought through the red tape and won.

“Late last year, I started having back pain. I’ve never had that before,” Chris Zachar explained when 3 On Your Side sat down with him at his Phoenix home.

This father of three said he tried just about everything but his herniated disc kept getting worse. Finally he couldn’t take it anymore.

Doctors at Barrow Neurosurgical Associates recommended surgery and he thought the procedure was covered by insurance.

“Barrow Neurological is in St. Joe’s Hospital," Zachar said. "We have good insurance. St. Joe’s is a very well respected hospital. I didn’t think about it.”

That’s a mistake many people make. They don’t double check that a procedure will be covered and, in Arizona, that responsibility falls with the consumer.
 
Zachar, who is a personal injury attorney and has experience dealing with insurance companies, said he learned that the hard way when his insurance company told him that St. Joe’s is not a listed provider on his health plan.

“It was about a month later, I get a bill for $36,000 and I said, okay, this has to be a mistake.”
 
Not long after that, his wife, Michelle had an MRI – fully covered. But the following month when she needed another one, at the very same facility, the insurance company denied her claim because the films were given to a radiologist who is not a listed provider.

“It’s happened twice in a year, it’s got to be happening hundreds if not thousands of times a day – just in Phoenix,” Zachar said.
 
“There are so many problems of this kind because our information systems are not good,” says Dr. William Yasnoff, M.D., Ph.D. and a former Senior Advisor at the Health and Human Services Department in Washington.

3 On Your Side sat down with him in Phoenix to find out what consumers can do to fight back. Dr. Yasnoff answered that question by saying, “It’s the right of every consumer to have copies of all of your medical records.”   
 
He said patients are at a huge disadvantage when it comes to fighting for coverage because there are no comprehensive medical records available -- so different doctors treating you are not always on the same page. And, often times, it’s hard to make your case to the insurance company.
 
Dr. Yasnoff founded a company called eHealthTrust (www.ehealthtrust.com) which, for a fee, will store your medical records electronically.

He said it’s a step in the right direction – however, even with your medical records in-tact; patients still need to ask questions.

“As a consumer you want to ask questions as to why things are needed and if you’re concerned whether something is covered by insurance, typically the institution is just as anxious,” he said.
 
The Zachars no longer face upwards of $40,000 in out-of-pocket medical expenses. With help from their Insurance Broker, Cheryl Hawker from Pacific Reserve Inc. (www.PacificReserve.com ), Chris was able to able to get his health insurer to cover his claim as “out of network”, and get St. Joe’s to accept payment in full.

Michelle was successful in her fight as well.

They said that they learned what could have been a very costly lesson.

“The rules are no matter what they tell you or what they don’t tell you,” said Chris, “it’s incumbent on you to make sure that is a provider in your network and whatever you are having done is going to be covered.” Michelle adds, “We just want people to be aware.”
 
3 On Your Side received this information from Insurance Broker, Cheryl Hawker:
 
Most medical insurance plans today have benefits In Network and Out of Network.
Policies pay more when In Network providers are used.   That includes the doctor, hospital, surgical facility, lab, x-ray facility, and pharmacy - all providers impacting medical care.

3 tips for Mindful Utilization can save you money:
1. Always check the On Line provider listing to be certain the providers of services are “Contracted” with your insurance PPO Network.
2. Double check by asking the office manager of your doctor’s office to confirm that anyone involved in your care is “Contracted” with your insurance company’s PPO Network.
3.  If having surgery or any extensive medical care, confirm with the admitting department that the facility and anyone involved with your care is “Contracted” with your insurance company’s PPO Network.
 
PPO Network contact information is typically located on the insurance ID card.
PPO Network telephone operators are very helpful in assisting callers wanting to confirm a provider is Contracted.
The provider list changes frequently so best to verify the list often.

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