How long does a hospital have to bill a patient for an out-patient procedure?

March 10, 2015 16:07 by Consumer Ed

Dear Consumer Ed:

How long does a hospital have to send me a bill for an out-patient procedure?  It has been four months since the procedure, and it is hard to know how to budget for this expense. In addition, it may be too late by the time I get the bill to claim it as part of my medical expenses on my taxes.

Consumer Ed says: 

First of all, it may be helpful to make sure you are actually an outpatient.  Your hospital status, i.e. whether the hospital considers you an “inpatient” or “outpatient,” affects how much you pay for hospital services (like X-rays, drugs, and lab tests).  For example,

  • You are an inpatient when you are formally admitted to a hospital with a doctor’s order. The day before you’re discharged is your last inpatient day.
  • You are an outpatient if you are getting emergency department services, observation services, outpatient surgery, lab tests, X-rays, or any other hospital services, and the doctor hasn’t written an order to admit you to a hospital as an inpatient. In these cases, you’re an outpatient even if you spend the night at the hospital.


Your hospital status also affects whether the law clearly mandates a timeline for hospitals to provide you with a bill.  If you were an inpatient, Georgia’s Fair Business Practices Act requires a hospital or long-term care facility to provide you an itemized statement of all charges for which you are being billed within six business days after you have been released from its care. It does not contain a similar deadline for hospitals to issue a bill for outpatient services or procedures.  However, there are several steps you can take to speed up the process.

First, you should contact the hospital’s billing department and inquire into the status of your bill. Hospitals generally have specific billing timelines, and processes to follow. The Georgia Administrative Code mandates that hospitals should develop, implement and enforce policies and procedures to ensure that each patient is provided an itemized statement of all charges for which the patient is being billed.  Hospitals are also required to provide, upon your request, a written summary of hospital charge rates per service to allow the patients to assess the charges and make cost effective decisions in the purchase of hospital services.  The American Hospital Association issued similar guidelines to encourage hospitals to respond promptly to patients’ questions about their bills and to use a clear and patient-friendly billing process.

Under Georgia law, patients have the right to inquire as to the estimated charges for a routine office visit, routine treatments, and lab tests prior to receiving such treatment.  It’s still the patient’s responsibility to determine the insurance coverage, but you can always ask the hospital about the costs associated with routine office visits, routine treatments, and lab tests.

There may also be a timely filing requirement for hospitals, depending on what type of medical insurance plan you have:

  • If you have Medicare, the Medicare claims must be filed no later than 12 months (or 1 full calendar year) after the date when the services were provided.
  • If you have Medicaid, the provider must file the claim three months following the month the service is provided.  If you have Medicaid and a third-party insurance plan, in general, your provider will bill the third-party insurance plan first, and then to Medicaid for consideration of payment not to exceed the sum of the deductible, copayment, and coinsurance.  If you have Medicaid and a third-party insurance plan, effective July 1, 2011, Medicaid must receive the claim after the third-party insurance, but within 12 months of the date of the month of service.
  • If you have private health insurance, the insurance company may only accept claims submitted by health care professionals within a specific period of time.  For example, Cigna only considers in-network claims submitted within 3 months after the date of service.  This timeline may be longer if the treating physician is out-of-network.  You should read your insurance company’s Explanation of Benefits (EOB) to see if it has a similar timely filing requirement. You can also contact your insurance company to find out whether your hospital has already provided it with your medical bills.

Additional questions about this? Here’s who to contact:

  • What is covered by my insurance?   
    Contact the insurance company directly. For Medicare, go to www.Medicare.gov. For Medicaid, visit www.Medicaid.gov.
  • Claiming tax exemptions for medical expenses
    Contact the IRS - www.irs.gov
  • A Georgia hospital did not provide an itemized statement of the charges you are being billed for.
    Contact the Georgia Department of Community Health - www.dch.georgia.gov
  • A Georgia hospital or long-term care facility did not provide a detailed bill for in-patient hospital stay within 6 business days.
    Contact the Georgia Department of Law’s Consumer Protection Unit – www.consumer.ga.gov
  • Filing a complaint against a health insurance provider   
    Contact the Office of Insurance and Safety Fire Commissioner - www.oci.ga.gov

 

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Are stores allowed to sell expired food products?

January 26, 2015 14:25 by Consumer Ed

Dear Consumer Ed:

In Georgia are there laws that prohibit service stations and convenience stores from selling out-of-date food products?

Consumer Ed says: 

For the answer to this question, we consulted the Georgia Department of Agriculture.

The Georgia Food Act gives the Georgia Department of Agriculture the authority to put in place rules and regulations that businesses must follow regarding the sale of certain food products with expiration dates. According to the rules, “Expiration Date” means the same thing as “Pull Date”, “Best-By Date”, “Best Before Date”, “Use-By Date”, and “Sell-By Date” and they all refer to the last date on which certain products can be sold at retail or wholesale. In Georgia, it is considered unlawful to sell the following perishable food items past the expiration date stated on the label:

 

  • Milk
  • Eggs
  • Pre-packed sandwiches and other ready-to-eat products
  • Infant formula
  • Fresh shellfish (including oysters, clams and mussels)
  • Any potentially hazardous foods (meaning foods with time and/or temperature controls for the safety of the product) that are labeled “Keep Refrigerated”


For food products outside the list above – especially dry, shelf-stable products like potato chips or rice –the rules do not preclude the sale of products that are past the expiration date indicated on the label. Rather, the date is considered a “guideline” for freshness and quality.  If a food product has reached its expiration date, it will most likely be an issue of food quality, not food safety, and does not necessarily need to be disposed of immediately.  If the product has been stored properly and appears to be visually wholesome and fit for consumption, it can still be consumed after the expiration date with little to no threat of food safety concerns.

Keep in mind that a principle of American food law is that foods sold in the U.S. must be wholesome and fit for consumption.  An expiration date does not free a company who produces food or health products from such a responsibility.  A product that is dangerous to consumers would be subject to potential action by the Food and Drug Administration (FDA) to remove it from sale regardless of any date printed on a label.

To better protect yourself, always confirm the expiration dates on foods and beverages before you buy them. Nearly all food products on retail shelves include an expiration date on the product packaging these days.  If the item you're holding has an expiration or "best if used by" date that's already passed, pick another item. If you see expired items on a store shelf, there are several things you can do, such as:

  • Tell the store manager and follow it up with a letter. Send a copy to corporate headquarters as well.
  • Contact the Georgia Department of Agriculture Consumer Complaint line at 404-656-3621.
  • Contact your local Better Business Bureau (bbb.org)
  • Contact the Georgia Department of Law’s Consumer Protection Unit (consumer.ga.gov)
  • File a complaint with the Attorney General (law.ga.gov)
  • File a complaint with the Food and Drug Administration (fda.gov).

 

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Finding a reputable nursing home in Georgia

November 5, 2014 19:45 by Consumer Ed

Dear Consumer Ed:

I want to find a good, reputable nursing home for my grandmother, who lives in West Georgia. What are some resources I can use?

Consumer Ed says: 

Finding a quality nursing home for a loved one is a serious and formidable task.  However, it can be made less intimidating when using a number of online resources to help guide your search.  But, before you make any decisions about long-term care, first gather as much information as possible about places in your desired area and what help your loved one may need.  A nursing home may not be your only, or even your best, choice. Whether you decide on home health, assisted living, a nursing home, or one of many other options, there are community and state agencies and organizations that can help you make your long-term care decision-making process more comfortable.

A great starting point for your research is LongTermCare.gov, a website developed by the U.S. Department of Health and Human Services to inform Americans about the long-term care options available in their communities.  Along with general information about long-term care, the website provides links to tools like the “Eldercare Locator," a website and call center that connects you to state and local agencies on aging, as well as community-based organizations that serve older adults. Specifically, this site provides information about your local Area Agency on Aging, which is designated by the State to address the needs and concerns of all older persons at regional and local levels.

Another valuable resource is the “Nursing Home Compare” tool on Medicare.gov, which can also be found as a link on the LongTermCare.gov site.  “Nursing Home Compare” has detailed information about every Medicare and Medicaid-certified nursing home in the country.  It provides a tool to help consumers compare nursing homes with links to a ratings system, contains complaints against certain nursing homes, links to local health advocates, and offers a comprehensive guide to choosing a nursing home.

Your local long-term care ombudsman can be a significant resource in your research as well.  Long-term care ombudsmen are advocates for residents of nursing homes, board and care homes, and assisted living facilities.  Your local ombudsman can provide information about how to find a facility and what to do to get quality care.  You can find the contact information for your local long-term care ombudsman by visiting www.georgiaombudsman.org.

The State Bar of Georgia also provides information regarding legal rights and contact information about state resources at: www.gabar.org/newsandpublications/consumerpamphlets/nursinghomerights.cfm. The site explains what you need to know before signing a nursing home admissions agreement, and what your loved one’s rights are as a nursing home resident.  It also provides a list of agencies to contact for assistance or with any questions or concerns you may have.

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