This article originally appeared on MySanAntonio.com. Portions © 2005 San Antonio Express-News. All rights reserved.
Modern medicine stopped the growth of cancer in Amy Lewis’ husband, but that medicine had a nasty side effect: a chronic case of bad credit.
The Lewises said they paid every bill on time, but they had trouble getting loans for their Boerne-based home-building business because of a 3-foot-high stack of paperwork and $100,000 in bills.
That’s when they called a San Antonio medical claims advocate, Tamara Apgar.
“It was really a matter of getting help to understand,” Lewis said. “I hired her to help me resolve it and to understand it. Tamara ran into the same roadblocks, but she knew how to handle them and never gave up.”
Many people who don’t get help find themselves filing for bankruptcy to protect themselves from creditors.
An estimated 77 million people, or two of every five adults in the U.S. over the age of 19, have difficulty paying medical bills, have built up medical debt or both, according to a recent Commonwealth Fund study.
A Harvard University study earlier this year found that half of the people interviewed — all going through bankruptcy — said illness or medical bills sent them to federal bankruptcy courts for protection against creditors.
Harvard researchers also found three of four of those who filed bankruptcy after an illness had health insurance. Since the study was published, U.S. bankruptcy law has become even tougher for debtors.
Consumer Credit Counseling Services of San Antonio has seen more of its clients bringing major medical bills as part of their debt, said Cynthia Hayes, the organization’s manager of marketing and education.
“People don’t have much time, things are more expensive and diseases are more prevalent,” said Janie Paschal, a medical claims advocate with San Antonio-based Claims Resolutions. “The paperwork is just crazier.”
Sometimes, people get in over their heads because they don’t know how to interpret the bills and insurance benefits information.
“You can very quickly fill up a grocery bag with paperwork, and when you’re dealing with illness, that’s not a high priority,” Apgar said. “When people don’t understand a bill, they don’t want to pay the bill.”
To iron out their problems, the Lewises turned to Apgar’s Your Medical Claims Expert, one of a small but growing number of such advocates around the nation as the health care system becomes more tangled.
It took about $1,500 in hourly fees, but in the end, the Lewises’ good credit was restored and nearly $100,000 in medical bill disputes with providers and the family’s insurance company were resolved.
In another case, a 60-year-old client of Apgar’s had no health insurance and was stuck with a $35,000 hospital bill. Apgar said she had the bill reduced to $10,000 by negotiating a discounted rate similar to those paid by insurance companies.
Apgar, who has worked as an educator, financial planner and advocate for people with developmental disabilities, said a claims assistance professional often can get results when patients or family members can’t. That’s because a sick or emotional caller isn’t as effective.
“Because I am not the patient, it seems like their ears perk up a little more,” Apgar said of dealing with insurance firms, medical billing offices and collection agencies.
Insurers and medical providers have used claims experts for years, but it’s only recently that a cottage industry has sprung up to help consumers.
Apgar said she already is getting requests to help with the latest confusing twist in the health coverage system: Medicare Part D drug coverage for senior citizens. There are nearly 50 drug plans available in Texas for seniors to choose from through May.
Paschal of Claims Resolutions began dealing with the maze of medical debt and paperwork in 1998.
That’s when a 14-month hospitalization for her mother racked up $950,000 in bills rife with billing errors and insurance company denials. She organized the bills and systematically solved the problems.
Now, she has taken what she learned and made it her profession.
For skeptical consumers, there are do-it-yourself cost management tools.
Lisa Rogers, health care group product manager for financial software firm Intuit Inc., said her company’s Quicken Medical Expense Manager was designed to help people manage bills and keep consumers from being overwhelmed.
The Quicken product has been on the market for a year, and a new version comes out next year. Users can enter insurance policy information and medical data.
That helps determine whether the insurance company made the appropriate payments and also keeps track of payment data