Insurance Claims – Industry Problem or Provider Calamity (Part 1)

Have you spent time reviewing your medical bills, insurance claim forms (like the explanations of benefits), or insurance contracts to know if you are really getting what you pay for? With the Affordable Healthcare Act (“Obamacare”) passage in 2010 and implementation in 2013, reports show more Americans are using health insurance than ever before. With an uninsured percent of less than 10% of Americans, the number of claims submitted to insurance companies has increased as well. Wouldn’t it be wise then,  as consumers as well as patients, to make sure that in a paperwork and electronic tangle of co-payments, deductibles, covered services, co-insurances and maximum out of pocket expenses, that we make sure nothing slips through the cracks? I mean, the AHA has more than 2000 pages, and I’m pretty sure my health insurance plan does too! Recently I experienced a billing and insurance claim nightmare I’d like to share in an effort to encourage once again, for each of you to always be your best healthcare advocate.

The Story Begins…

As a divorced parent, insurance claims can be a bit more complicated. My children have coverage from their father and their stepmother. While dual insurance has been a tremendous benefit through the years of braces, bronchitis and broken bones; sports accidents and “boys will be boys” injuries, it also adds a layer of confusion. Which is primary? What percentage gets paid? Which contracted rate (assuming a payer contract was signed) and allowable amount apply to the services provided? It’s overwhelming at best. Suffice it to say, however, that with the kids nearly grown and almost a decade of experience, we have gotten a pretty good handle on this aspect of co-parenting.

One thing insurance companies may provide is online access to benefits; most even offer a “pre-authorization” estimate for your out of pocket costs. On the day of the procedures, November 7th, I was quoted an out of pocket amount due to the provider and promptly paid that amount (over $1,500.00).  When the children’s father learned the amount, he questioned it; based on his research on the insurance portals, our out of pocket should not have exceeded $250.00. We were informed that only one of the available insurances would be billed and that was why the amount was so high. Without hesitation we agreed to file the secondary claim ourselves. Providers are given certain information for the purpose of submitting claims not available to patients. Four days after the procedures, my former spouse went to the office, with the completed paperwork, to get their signature and other information. After some questions about the billing process, the conversation became less than amicable. The surgeon intervened and offered for his office to complete the billing for both. This seemed to be a good idea and it was left with them to handle.

Life Lessons

This is a good place to push pause. Trusting the professionals is a lesson many of us were provided by parents and well-meaning mentors at a young age, but this might not always be the best advice. I’ve learned to follow a slightly different method – trust, but verify. On November 11th, we agreed to trust the professional. More than sixty days later, I am still not financially whole, we’ve traveled down a less than pleasant road with our children’s healthcare provider, and now I’m faced with the dilemma of trusting my gut or trusting the professional. All because I have chosen to trust, but verify.

First I’d like to offer my take on where I fell short in this process. First, I should have been prepared with my own copies of the estimated benefits. Knowledge really is power and in this particular instance, the knowledge was available to me and I was not prepared with it. Second, I should have asked the provider to provide me the information they received estimating benefits payable that was used to calculate my estimated out of pocket. This is when I would have learned about the difference in the amount billed to me, the amount submitted to the insurance company (-nies) and the negotiated and allowed amounts. Then I would have been prepared to negotiate what I was made to pay up front. Less money out of pocket may have made this extended timeframe without reimbursement much more palatable.

Next time

In my next installment, you’ll learn about balance billing, incomplete or inaccurate claim submissions and insurance denials. If you or someone you know has been injured as a result of someone else’s neglect or you believe you are a victim of insurance fraud or questionable medical billing practices, we may be able to help. Call our office immediately at 941-748-2916 for a free attorney analysis of your case.


Cars of Tomorrow and the Tesla Autopilot Crash

In this day and age, technology is ever evolving. We can accomplish nearly anything from the convenience of our smartphone or tablet. People are inventing ways to make things more efficient and safer every day. In regard to driving and vehicles, there is a potentially groundbreaking technology being developed. Just like an airline pilot, the everyday driver may soon have the luxury of autopilot. It is thought that this could make roads much safer by putting much of a driver’s normal responsibilities on the vehicle. However, this hope that an autopilot feature will be more effective than a human driver may be misguided.

Tesla’s highly anticipated Autopilot feature seemingly promises to change the world of motor vehicle safety and technology. Unfortunately, the recent death of Joshua Brown has shown the dangers of this new technology. Mr. Brown was behind the wheel of his Tesla Model S when he collided with the trailer of a semi-truck turning left through an intersection. Neither autopilot nor Mr. Brown applied the brakes before the collision.

The autopilot’s failure to apply the brakes raises many suspicions regarding the effectiveness and safety of this technology. In an article published on Tesla’s website they state that autopilot comes disabled by default until drivers have been made aware that “it is an assist feature that requires you to keep your hands on the steering wheel at all times.” Tesla stated that their vehicles audibly warn drivers to remain alert while using the feature if the car does not detect hands on the wheel. But what happens in the event someone is asleep with a hand on the wheel? This seems potentially counterintuitive for technology referred to as “autopilot.”

Despite the warnings, individuals utilizing their autopilot successfully could very well come under the impression that the vehicle is in fact capable of handling itself without their help. But as we saw in the case of Mr. Brown, autopilot is susceptible to making errors just like humans. In a statement, Tesla claimed that the white semi-trailer combined with a brightly lit sky allowed the semi-truck to go completely unnoticed by autopilot.

In defense to the serious criticism Tesla has received, the company cited some very interesting statistics. Although Tesla’s autopilot has made fatal and serious mistakes, statistically it sees less fatalities than per mile (with autopilot activated) than all cars in the U.S and worldwide. Mr. Brown was the first fatality in 130 million miles of active autopilot driving. Tesla claimed that the scenario was a very rare and unfortunate event and that they were continually working to perfect the technology to stop deadly occurrences such as this. With that being said, it may be some time before we can conclude if autopilot is safer than the average driver. Drive safe and always remain alert behind the wheel, even with autopilot activated!


Who’s Ready For Something More Football and Less Politics?

Are you a Seminoles fan looking for new show to watch? Showtime may be able to perfectly suit your needs. This year the Showtime original series, A Season With, will feature Coach Jimbo Fisher and his Florida State Seminoles. The show’s previous season followed Notre Dame and has now made its way to the sunshine state for the 2016 season.

Classroom to Gridiron

A Season With Florida State Football or (A Season With for short) gives a behind the scenes perspective of the Seminoles from the classroom to the gridiron. The show follows the Seminoles week by week depicting the preparation and hard work of players and coaches leading up to every game. Locker room speeches from Jameis Winston and sideline conversations between players and coaches put viewers in the midst of the action.

a-season-with-photoProviding in-depth scenes of practice and preparation for coaches and players is only one aspect of the show. A Season With also focuses on the personal lives of everyone involved with Florida State football.

The first episode tells of the would-be starting quarterback, Sean Maguire and his broken foot. As a redshirt senior, Maguire’s time to take charge was finally here until his injury put him behind Francois. A Season With gives viewers a personal perspective that allows them to gain a deeper sense of what college athletes overcome and how they handle adversity.

Aside from football, the show includes what players and coaches are doing off the field. Florida State wide receiver, Travis Rudolph, is followed by Showtime to a local Tallahassee school to have lunch with an Autistic child named Bo. Rudolph and Bo quickly hit it off in the first episode and become even closer friends as the weeks go on.

The difference players are making in the community is not normally a high priority for sports broadcasters, but Showtime has created an outlet for viewers to see what an impact FSU and other featured college football programs have off the field.  A Season With covers almost every aspect of the Seminole’s football program. From overcoming adversity to making a difference in a child’s life, this show is definitely a worthwhile watch. New episodes A Season with can be seen on Showtime every Tuesday at 10 p.m. ET and previous episodes can be seen online.


KTM Motorcycle Recall

As advocates of motorcycle safety, we encourage anyone riding on a motorcycle to take all proper precautions to avoid the risk of serious injury. This includes going above and beyond just wearing a helmet. Making sure all equipment is up to industry standards is another essential precaution to take.

Recently, KTM North America recalled their Motocross Competition Off-Road motorcycle due to a crash hazard. According to the Consumer Product Safety Commission, the connecting rod in the crankshaft assembly can break. This hazard can cause the operator to lose control and crash.

Being the outdoor oriented Floridians we are, riding off-road motorcycles is a very common activity or hobby for many. Being informed as to whether or not your equipment is up to industry standards and regulations is crucial for minimizing the risk of serious injury.

Per the CPSC, this recall includes “model year 2016 KTM and Husqvarna Motorcycles brand motocross off-road motorcycles with 250cc, 4 cycle engines.” The recalled KTM models, KTM 250 SX-F and KTM 250 SX-F Factory Edition, are described as orange and black and orange and blue, respectively. The recalled Husqvarna FC 250 models are described as being white with blue and yellow markings.

If you currently own one of these bikes you should immediately stop using the product and contact an authorized KTM or Husqvarna dealer to schedule a repair. Both dealers are offering free repairs for defective models. Currently, only 5 reports of this defect have been reported with no injury.

Despite no reported injuries, this recall still poses a serious threat to owners of the motorcycles. KTM and Husqvarna are brand names in the market of off-road motorcycles and their defective products were sold nationwide for approximately six months.

The CPSC reports that around 920 units were sold before the defect was addressed. This number may be relatively small, but it is important to help avoid every case where a life could be lost.

If you or someone you know owns any of these products, make sure yourself and others are aware of the dangerous crankshaft defect and have it repaired immediately. As always, if you have questions pertaining to any of these products or other recalled products contact the offices of Heintz & Becker at (941) 748-2916 .

 

Sources: http://www.cpsc.gov/en/Recalls/2016/KTM-North-America-Recalls-Motocross-Competition-Off-Road-Motorcycles/#remedy


E-Cig Explosions

A young girl recently suffered severe burn injuries as a result of an electronic cigarette or “e-cig” exploding while on a ride at Universal Studios in Orlando, FL.

According to police, a man’s e-cig exploded during the ride and shot what was described as a “fireball” at the teenage girl behind him. She sustained burns to her face, arm, and leg and was taken to the hospital for immediate medical attention.

This is not the first instance of these cigarette substitutes harming individuals. This alternative to traditional cigarettes has caused multiple incidents similar to this explosion. The incidents are thought to be caused by overheating of the battery, normally while the device is being charged.

The U.S. Fire Administration, a division of FEMA, estimates that around 80% of the explosions occur during charging.  With boil and auto-ignition points getting as high as 500 degrees Fahrenheit, it is easy to see how the traditional e-cig that most closely resembles a tobacco cigarette, with its weak ends, could have flames or objects propelled in the event of an explosion.

So What is an Electronic Cigarette?

So what comprises an e-cig? Generally speaking, electronic cigarettes consist of a cartridge that contains the liquid nicotine, an atomizer, and a battery.  Using a different charger than what was supplied at the time of purchase is what researchers believe is causing many of the explosions; however, this does not explain the explosions that take place while the device is in the users pocket or during use.

FEMA speculates that the lithium batteries may play a role in these types of malfunctions. Many other products such as phones use these same lithium batteries and have experienced similar malfunctions.  When combined with a serious heating element, like an e-cig’s atomizer, fires involving lithium batteries become a much larger threat.

Diagram of an e-cigarrette

 

 

 

 

(Photo courtesy of IEC)

Despite generating billions of dollars each year, the e-cig industry has yet to create a solution to this problem. There are, however, versions of e-cigarettes that may be of lower risk. An electronic cigarette researcher, IEC, believes that devices with detachable batteries are much less prone to overheating or exploding than those that charge with an atomizer still attached. This is because a detachable battery must be unscrewed from the atomizer and then plugged in to charge. Devices that charge while the atomizer, where the heating element is located, is still attached to the battery have been found to create the majority of malfunctions.

If an E-Cig Explosion Causes Burns or Injuries, We Can Help!

The burn injury attorneys at Heintz & Becker work hard to provide our readers with useful information you can use in your everyday life. Concerning the use of electronic cigarettes, and any other battery powered devices, we would encourage you to always follow the manufacturer’s recommendations for use. If you or a loved one suffered an injury as a result of an e-cig malfunction or other lithium battery malfunction, call the office today at (941) 748-2916 for a free consultation with one of our board certified civil trial lawyers.


6 Questions To Ask A Lawyer [Infographic]

We don’t have to tell you that there are plenty of law firms in the Bradenton and Sarasota areas that want you to be their client.  That’s why we’ve listed some  important questions you should ask and tips on choosing the best attorney for you.

We’ve compiled 6 more questions you should ask a lawyer before hiring them for your personal injury or car accident claim. Feel free to download and share this infographic. And if you have questions, do not hesitate to contact our law firm. Continue reading


U.S. Government Issues Regulations for Self-Driving Vehicles

We have previously talked about the new autopilot technology being developed by many car manufacturers. Massive companies such as Google, Tesla, and Uber are all in the process of perfecting the first self-driving or “autonomous vehicle.” Although fatal accidents have occurred due to the still developing technology, it may have a very promising future. The U.S. Department of Transportation’s National Highway Traffic Safety Administration (NHTSA) has recently issued guidelines for companies racing to put their self-driving vehicles on the road.

Every year thousands of people are killed in car accidents and the NHTSA has recognized this as a growing problem. The idea of autonomous cars has developed into a practical solution to reduce the number of fatalities and injury on the road. Obviously, there is risk associated with putting lives in the hands of a developing technology; however, down the road this technology could save numerous lives and money once all flaws are worked out. According to the NHTSA, approximately 94% of crashes are the result of human error. With that being said, a car capable of avoiding those errors would be hugely beneficial to society.

The new guidelines issued by NHTSA encompass four specific sections and aim to minimize the risks of using self-driving vehicles and regulating their production. The first section addresses a 15-point safety inspection. This aspect sets standards  for companies to consider their autonomous vehicle safe for use. For example, how the vehicle responds in life threatening situations as well as crash precautions. The other 3 sections address the power the government will have over companies manufacturing these vehicles and how the federal regulations will work with the varying state laws regarding autonomous driving.

The Federal Government appears to be very interested in this technology and is carefully monitoring the progression. The new guidelines, although not officially law, portray the legitimacy and practicality of cars driving themselves. It can be implied that if perfected, autonomous vehicles may revolutionize how we use the roads. Even beyond improving highway safety, this technology could give people that are disabled, or otherwise unable to drive, access to the roadways.

 


The Wells Fargo Scandal Explained

In one of the most shocking events in the financial world, Wells Fargo was recently fined by multiple regulators for creating fake bank and credit accounts for their customers and charging fees associated with the fraudulent accounts. These fines have amounted to hundreds of millions of dollars and resulted in the termination of thousands of Wells Fargo employees.

It has come to light that the employees of the company were given unrealistic sales quotas and pushed to use highly unethical policies for obtaining them. Whenever an enormous scandal occurs in the financial world the first instinct is that a few high ranking officials were the perpetrators. However, the crimes committed in this instance were by a plethora of lower ranking employees.

The unrealistic quotas were met by the opening of additional accounts for current customers without their consent. Fees were then charged to customers that unknowingly had their funds relocated to the fraudulent accounts. According to the Consumer Financial Protection Bureau (CFPB), these practices were considered “widespread” throughout the company. The bank was charged the biggest fine since the CFPB came into existence, amounting to $185 million dollars. The company is also facing a lawsuit where plaintiffs seek to recover over $2 billion dollars.

The pressure to reach the sales quotas at Wells Fargo appear to be the motivating factor behind the creation of the millions of fake bank and credit card accounts. Low level employees may have been given incentive to resort to these illegal methods for the fear of losing their jobs. Wells Fargo employees indicated that failing to reach quotas or refusing to adopt the unethical tactics normally resulted in being terminated for minute reasons unrelated to sales quotas.

It is terrifying that a company as large as Wells Fargo would condone stealing money from its own customers. The banking and financial worlds are complex and very difficult to fully understand for most. The lesson learned from this scandal is that as a customer of any banking or financial institution, you must be aware of all account activity and question all suspicious charges or fees. Take some time to familiarize yourself with the basic concepts of how your money is handled and avoid being the victim of financial crimes.


Choosing the Best Attorney

Anywhere you turn today, our world appears to be inundated with injury law firm or attorney photos. From billboards to pop-up ads, firms find a way to reach the public from every angle possible. Typically, larger firms with the means to market themselves on a large scale dominate the landscape. Many of these ads can lead people to think they are choosing the best representation, when quite possibly, it is far from meeting their needs. In this culture of mass marketing and billboard law, knowing the reasons for choosing the right lawyer when seeking justice or compensation, particularly in the event of an accident or injury, is critical.

After someone is involved in an accident where another party is at fault, they have a lot to consider. This is especially true when they begin to seek the services of an attorney. Before making a choice based on size or a large marketing campaign, consider these factors:

First is the overall caseload of a firm. This has a direct impact on the ability to communicate with the client. In some instances, a client may never meet or even speak with their attorney throughout the entirety of the claim. This should be unacceptable to the accident victim. Not only should an attorney readily meet with their clients as needed and be able to keep clients informed about their case status, a good firm will have policy in place that keeps lines of communication between the client and the firm open and active. Is this attorney dealing with a large number of cases while working on yours? If so, they may also lack the time necessary to achieve the highest settlement possible. Smaller firms generally have a better ability to meet with the client and to work much more personally and aggressively on each case in the office. What a wonderful advantage when you have suffered due to someone else’s negligence!

Also, the attorney’s willingness and readiness to go to trial is of utmost importance. Do not rely on an advertisement that merely portrays an attorney in a courtroom or shows a single settlement figure. In order to determine if your lawyer is prepared to fight in trial to obtain the best settlement possible, ask if they are a Board Certified Trial Lawyer. If they aren’t, ask why. Many times a case will be settled for much less than it is worth due to scared or lazy representation. A Board Certification is a great indicator of an attorney’s ability and desire to succeed at trial when the opponents refuse to cooperate fairly.

Lastly, communication and credentials matter, but does your attorney consider what is best for you? Many times on the surface, a case seems cut and dry. Elements of personal injury law can be muddled, but when concepts like liability and damages are in your favor, the work seems to do itself. Easy settlements happen daily but is an easy settlement the best settlement? A wise attorney will explore all potential avenues of recovery and fully discuss settlement options with you. Your concerns should be heard and taken into account before settlement is reached.

In conclusion, remember to ask questions before hiring a lawyer. Communication, credentials and consideration are three very important factors to consider before you hire an attorney. The best representation will be capable of taking on any defendant in trial, no matter how big. They will also have the time to personally meet and talk with their clients as needed. To get a good idea of the services you may employ, do not forget to ask if your lawyer is a Board Certified Trial Lawyer. Don’t make a decision based on mass marketing and legal advertisements alone; know if you are choosing an attorney who is prepared to take every measure needed to get the compensation to which you are entitled.


Surfing… in The Gulf of Mexico?

When most people think of the Gulf of Mexico, surfing probably never crosses their mind. However, the gulf is more than capable of producing quality surf. The gulf waves are influenced by tropical weather, such as hurricanes and cold fronts, often producing much higher quality surf that most would expect.

Hurricanes and Cold Fronts – A Gulf Coast Surfer’s Best Friends

For those in the know, it is during hurricane season that gulf coast surfers have the highest hope for quality surf. Most named storms tend to track up the eastern coast of the United States, leaving Gulf residents in the clear. While the thought of a hurricane is certainly bittersweet, many local surfers are willing to risk the potential dangers if it means they can hit the waves. Prior to this week’s Hurricane and Tropical Storm watches and warnings, 2013 was the last time we saw enough activity to warrant weather alerts and it was Hurricanes Ike and Gustav in 2008 that created the last serious swell in the Gulf.

The most consistent time of year for surfing in the Gulf is winter. The storms brought about by cold fronts can produce great surf. Despite cooler air and water temperatures, you can see many surfers along the gulf beaches when a cold front arrives. These winter swells generally begin with strong south winds and choppy surf.  As the cold front moves across the state, the winds will switch to a west or north-west direction that can lead to some great waves and cold weather. Make no mistake, surfers in the gulf take advantage of any opportunity to catch a wave. This year, surfers benefited greatly from the El Nino weather pattern. Many days of favorable surf were enjoyed. Just a small disclaimer, if you’re a true Floridian the gulf temperatures can get cold! Take along a wetsuit if you want to give surfing a cold front a shot.

It Really Is a Possibility

If you are a local gulf coast resident or just simply vacationing, know that surfing is a definite possibility in the Gulf of Mexico. Although fickle, the gulf can offer some fun waves along the entire coast whether you are just earning or are an experienced surfer. There are multiple websites that offer daily updated surf reports such as Gulfster.com and Aurasurf.com. These are great resources to use for checking the surf forecast. Check out the photo below for a glimpse of what the Gulf of Mexico can offer for anyone wanting to catch some waves.

rolling surf


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