How has your company helped uninsured/underinsured women?
What does the 200,000 number represent - what services did you provide to those women?
How did you help 35,000 women reduce the cost of pregnancy? What does that milestone mean to you?
What problems do underinsured/uninsured women face? Why do they face these problems?
Do insurance companies exacerbate the hospital billing issues? How so?
Do insurance companies exacerbate the hospital billing issues? How so?
Q: How has your company helped uninsured/underinsured women?
Our company has identified the holes in the healthcare system, specifically as it relates to prenatal care and delivery. By relaying our expertise to uninsured and underinsured women, we have imparted a wealth of knowledge on how to take cost-containment into their own hands, and when that is not enough, we have stepped in with auditing systems, negotiators, doctors and nurses to help them along the way.
Q: How does the non-profit help uninsured/underinsured women?
MaternityHealth.org helps uninsured and underinsured pregnant women by providing education information on their pregnancy options, on the importance of prenatal care, and ultimately by seeking out ways to make their pregnancies affordable without undue burden on their family and society. MaternityHealth.org awards financial assistance funded through the donations of large and small contributors alike.
Q: What does the 200,000 number represent - what services did you provide to those women?
200,000 women have contacted the organizations seeking financial help for their pregnancy. The representatives they spoke with directed them to an appropriate organization for assistance such as: Option Line, MedicaidApplication.org, MaternityHealth.org, American Maternity Association, Bethany Christian Services, and Maternity Advocates.
Q: How did you help 35,000 women reduce the cost of pregnancy? What does that milestone mean to you?
It is so important that women take control of their medical bills because (with the exceptions of organizations like ours) no one else will. Medical billing companies are generally expansive, systemized, out-dated and beaurucratic. To them, the pregnant mother is simply a patient account number. The systems are usually designed to inflate the costs of the charges because they are constantly struggling with the insurance companies and vice versa. The uninsured and underinsured get caught in the crossfire and become the unassuming victim. Sometimes they just make plain, old-fashioned billing errors! Consumers are savvy these days and as healthcare costs rise they are beginning to look at ways to save. However, patients are generally unaware when they are overcharged for medical services, or even charged for services they never received. As a society we generally trust our physicians and this trust may flow over to automatically believing the charges we receive from them are correct. Doctors, hospitals, and their billing companies are not one and the same. .
Q: How do hospitals and insurance companies inflate medical bills for underinsured/uninsured women? How did you discover this, and how did this and other factors influence your decision to found your company and non-profit?
Only a few states have Cost Transparency laws on the books. The difficulty in ascertaining what a cost will be when calling a physician or facility makes it abundantly clear that the pricing for services is, at best, vague. Do you have insurance? Then it will be this price. Do you have insurance but it doesn’t cover this service? Then it will be this price. Are you completely uninsured? Then this is the price and we need it in full before you leave the office. The uninsured price may be the same price as the full cost that an insurance company pays. The insurance company, however, gets a break on their payment. It wasn’t fair that the insurance company was getting a break and many times, an uninsured patient paying cash was paying more or the same as they were. The real shock was when we found that if a patient did not have the ability to pay for an expensive procedure (like delivery of a baby) up front, the billing companies very often inflated the price they would have paid up front by 400% or more. When we hired nurse auditors to go over the bills and began using an auditing system based on UCR (Usual and Customary Rates: What is FAIR & REASONABLE) by region we found that this was common practice on all billing for medical services. 90% of all hospital bills are inflated and/or contain errors. Even worse, when we called the billing company or facility to dispute the charges, we faced resistance. How much more stress would the patient herself experience? We had women call us sobbing that the hospital was going to sue them, they were going to lose their home because of the medical bills, and they could not return to the hospital if they didn’t pay in full (sometimes 40-50K for a normal delivery!)… That is when we stepped up our auditing systems, staff of professional medical advisors, negotiators and created the non-profit to help fund the cost that still remained after the bill was reduced to a fair rate.
Q: What problems do underinsured/uninsured women face? Why do they face these problems? How can women get help handling these problems?
The first problem underinsured and uninsured women face is getting into their initial doctor’s appointment when they discover they are pregnant. As soon as the doctor’s office discovers that insurance will not pay for their services, the patient may be treated rudely, completely denied an appointment, or told they need to pay the full global fee for prenatal care up front at the first visit (2-3k). Newly pregnant moms can spend hours on the phone trying to locate a doctor who will see them. The American Maternity Association can provide information on what doctors will see new patients, self-pay (uninsured) patients, and expected costs. The American Maternity Association can also schedule the initial doctor’s appointments, eliminating the stress of time and questioning that comes as a result of not having that “magic” insurance card. Lastly, at the end of the day, the uninsured or underinsured pregnant mother has to pay the bills. Every pregnancy is unique. Because the full costs of the pregnancy and delivery of a new baby is unknown until the baby has been delivered and released from the hospital, total charges for a new baby to a cash-paying, uninsured family can range anywhere from $6000.00 to $60,000.00. Cesareans greatly increase the cost. When a baby is rushed to NICU because he or she is born premature (often due to little or no prenatal care), costs skyrocket. Coming up with this kind of money is rarely ever easy, and sometimes, impossible. Even for the hardworking mom who is contributing society and doing her best not to “live off the system.”
Q: What is the single most important thing women need to know before they go to the hospital or write that first check out to the hospital after a pregnancy? ?
o “Get It In Writing.” The first thing they need to know before they write out that check is what the charges are for and if they will be billed for anything else. Every patient has the right to an itemized billing statement. What patients often don’t know is that even if they can come up with the check amount right now, they may be billed for even more, for the same or other charges, later. Additionally, when figuring out how much they can pay immediately, they need to realize that if they had any other doctor come into the hospital to perform a procedure, like a second surgeon for an emergency Cesarean, or even an anesthesiologist to provide an epidural; they will be billed for this separately later, usually from another billing company.
Q: Do insurance companies exacerbate the hospital billing issues? How so?
Certainly. Although insurance companies are paid to pay claims for their customers, their actual job is to deny claims. Because hospitals spend so much of their time and resources trying to get insurance companies to pay the claims, instead of deny them, billing coding has become one way to bundle charges so that they pass through the insurance review. Additionally, hospitals inflate charges so that if the claim is not paid by insurance or the patient, the facility receives more money when they sell the bad debt off to collections.
Q: How many women would you estimate are uninsured? Underinsured? If they're underinsured, what important benefits are they missing?
According to the Census Bureau in January 2008, there were approximately 47 million Americans that were uninsured. That number rises every day. The American Pregnancy Association estimates that 13% of uninsured women become pregnant each year. At an average of 6 million births each year, that’s an estimated 780,000 uninsured pregnancies every year. Out of over 1 million abortions every year, two-thirds of women state it was because they could not afford the cost involved.
http://www.accessmylibrary.com/coms2/summary_0286-217854_ITM)
Many women have abortions when they find out they cannot afford to pay the doctor for their visits. MaternityHealth.org was founded to help women like this find options to make their pregnancy affordable.
Q: Who are your clients, and who does the non-profit help? Define 'Moms in the Middle'. Also, are there other demographics that can benefit from your services?
The Mom in the Middle is the pregnant mom who wants to meet the financial obligations for their prenatal care, but does not have insurance to cover their maternity costs and they do not meet the income requirements (some are barely above the poverty line) to receive Medicaid benefits. These moms are stuck in the middle: self-employed, lost job after becoming pregnant and therefore lost insurance coverage, unplanned pregnancy with no maternity coverage, has very limited maternity coverage that may only cover $1-2k of the fees and sometimes only in the case of an emergency, working where no benefits are provided, and so on…
Q: At the end of the day, how does it feel to be able to help your clients?
Sometimes you forget to take a deep breath and realize what it is you’re doing. We’re on the phone all day, listening to horror stories from these women – they’re crying, yelling, just so frustrated with their circumstances and the system. Between their stories and our own struggles with medical providers for them, it can be overwhelming. At the end of the day, when you take step back from it all, it’s quite remarkable to be able to provide a shoulder, a kind word, and a service to help these women who are struggling to get through what was once such a natural part of life that has become increasingly difficult because of cost. These women are having the children of our future. It’s wonderful to be able to help them now. Especially knowing that women who do not get prenatal care and their children are more likely to die in childbirth… It is so important that we, as a society, come together to help these women get the prenatal care that they need. That is why we formed the non-profit MaternityHealth.org and why we get up and go to work every day.
Q: What is your service area for both the company and non-profit? Texas, nationwide, etc....
Nationwide. One of the reasons that we can help you and other moms is through our strong network of women who are Paying It Forward. We’re committed to helping mothers meet their financial commitments for prenatal care. Every mom we help makes us a stronger organization to help other moms, like you, in the future. You also play an important role in uniting people to help shoulder the burden of the high cost of prenatal care for a mom in need. Scholarships are awarded only to mothers who give back or “Pay It Forward…”
