Last week I took a look at the Farid Fata case. He is the (former) oncologist who sentenced 553 people to their death or a lifetime of illness or financial bust by lying to them – telling them they had cancer they did not have, then treating them with chemo they didn’t need and ruining their lives. The 45 years he’ll spend in prison were not for the heinous crimes of destroying their health, instilling fear, breaking their hearts and stealing their hard-earned money. Rather he was penalized for defrauding Medicare and insurance.
Beyond the obvious disturbing and distressful aspects of this case, beyond my personal bias about misdiagnosis, and certainly beyond my real sympathy for the victims, is a big concern I have for advocates. Misdiagnosis, whether intentional or not, is happening with more frequency as doctors are spending less time with their patients. It is no stretch to see the responsibility for determination of a correct diagnosis as falling more squarely on the shoulders of advocates.
Despite the fact that we are not doctors or diagnosticians, our role in making sure clients get the right answers will become even more prominent as time goes on. For many reasons we can NOT afford to get it wrong!
Last week’s post was about the steps private advocates would have taken that would have prevented their clients from falling for these intentionally imposed misdiagnoses. Four steps.Four services advocates know to perform. Each by itself could have stopped a client-patient from being misdiagnosed.
But the bone I can’t let go of actually stems from a comment made by one of the post’s readers, Cindi, in reaction to one step – seeking a second opinion.
“Fata was many patients’ second opinion. He offered a better solution…. To assume none of his patients sought a second opinion is insulting…”
For one thing, it never occurred to me that Fata would have been the second opinion oncologist, and would have ended up treating people who had already received an opinion. It should have, but it had not.
But secondly, the more I think about it, that very fact proves that
…a second opinion is no longer good enough.
I think we need a new regard for the second opinion, a more defined best practice, a higher standard of advocacy care. When a second opinion is called for, we must insist our clients seek an objective, second confirming opinion.
Let’s break it down:
One thing we know is that doctors are human beings who, like all human beings, have friends and colleagues and professional regard for each other. Ask any doctor and he or she will tell you that “other doctors” (because they don’t consider themselves fallible enough to do this themselves) will rarely contradict their friends or colleagues.
Further, there is confirmation bias. That is, that the suggestion of an answer or solution cements that same answer or solution in a second person’s mind. This is further affected by how much respect (or fear) doctor #2 has for doctor #1, or even how lazy doctor #2 is, or how much of a hurry he or she is in.
(I can also tell you from personal experience that this takes place even in labs. In my own story, the specimen (a lump) removed from my torso was sent from lab #1 to lab #2 for a “second opinion.” Lab #2 simply regurgitated the wrong answers from lab #1’s paperwork.)
We have to wonder how many of Fata’s misdiagnosed patients actually went to a second oncologist and were given the same information, the same misdiagnosis, because the second oncologist was either a friend or colleague, or found it just easier for whatever reason to confirm that misdiagnosis?
This points out the need for objectivity in a second opinion – finding a second opinion professional who has no relationship whatsoever to the first opinion professional. In appropriate cases (potential cancer, or lifelong debilitating diagnoses, or recommendations for surgery, etc) as advocates, we must be sure that our clients see an objective second person for an opinion – a doctor who lives and works in another location, who doesn’t practice within the same health system, whose kids don’t play on the same school teams or who don’t go to the same church or temple or mosque. If that means we must find a doctor in another city, or on the other side of the state – or the country – then – we must.
Because not insisting on that objectivity is at least a waste of our clients’ time, and possibly money. At worst, it may be limiting them to wrong answers which will lead to wrong treatment, which can have a harmful effect on their quality and quantity of life, harm that could have been prevented.
Knowing those 553 people didn’t have cancer, no matter whether Fata’s misdiagnosis was the first or second opinion – his opinion must have been a different opinion.
(Or was it? See “objective” above.)
In the perfect world, a patient would see two unrelated (objective) doctors and get identical answers about diagnosis and treatment options; confirming information that would allow him to make the right decisions for himself based on that now-confirmed information. If testing was involved, then the tests would be accurate, and their results would be easily viewable, too.
If a second opinion is that cut and dried and was known to be as objective as possible, then the advocate’s second opinion support job is done.The diagnosis is confirmed.
But we don’t live in a perfect world and rarely is it that simple.
A second opinion that is not the same as the first one calls the question “which one is correct?” And since there is no second, confirming opinion, the job is not done. The correct answer hasn’t been achieved. The patient-client needs to get a third opinion, in hopes of confirming one of the first two. And it needs to be sought from someone who is professionally and personally removed from the first two to be sure it’s objective.
Still not confirmed after three opinions? Then it’s time to look for a fourth. Because no one can know which of the first three is the right one. The patient can’t simply choose the one he or she likes the best!
The patient may need multitudes of opinions. But only two of them need to agree. THAT is the second, confirming, opinion.
The New Gold Standard
This is the new gold standard in advocacy: helping our patient-clients find objective, second confirming opinions.
To be clear, it’s not that I’m trying to prevent a redux of this Fata case. I can’t imagine in my lifetime a second Farid Fata anymore than I can imagine a second Ted Bundy or John Wayne Gacy.
No. This is about understanding what it’s like to be misdiagnosed and have one’s life totally upended because of it. It’s about making sure misdiagnosis, one of the most preventable of medical errors, is routinely uncovered so patients-clients get what they really need.
What do you think? As advocates, are we willing to begin promoting, and overseeing a new standard of diagnostic determination?
Are you willing to say that for all appropriate clients, you will insist on helping them seek an objective, second confirming opinion?
I think you must. Because to do any less puts their lives – and our profession – in jeopardy.
This article was written by a connection of mine from LinkedIn, Anne Llewellyn, RN-BC, MS, BHSA, CCM, CRRN on her blog "Nurse Advocate.
Tackling Medical Bills
In this week’s post, I would like to share my experience with paying the hospital bills that accumulated during my illness. This is an important post especially for consumers as most have to pay a portion of their bills and the amounts can be staggering.
Paying healthcare bills is not like paying your electric bill or your Macy’s bill. Healthcare bills are complicated partly because most consumers are not familiar with medical billing and it is so different from the bills we pay on a routine basis.
In doing research for this article, it was learned that bankruptcies resulting from unpaid medical bills will affect nearly 2 million people —making health care the No. 1 cause of such filings outpacing bankruptcies due to credit-card bills or unpaid mortgages is another serious issue, according to new data from Nerdwallet. Paying healthcare bills is challenging as most of the services charged on the bill may not be recognizable, thus hard for the consumer to evaluate. I hope this post will help consumers of healthcare better understand how to tackle this challenging task.
Like most of us, I am not sure I ever really appreciated the healthcare insurance benefit I received from my employer until recently. Many times when I saw the deduction taken from my paycheck for health care insurance, I would say to myself: “I am healthy and I never use this insurance…why do I have to pay for this every two weeks when I don’t use it? I wished so many times that I could just pay for health insurance when I need it.” Today, most people realize that having healthcare insurance is an important way to protect ourselves and offset costs when a healthcare event impacts our lives.
My healthcare event occurred on November 24, 2014, when I was diagnosed with a Central Nervous System Brain Tumor. I was never so glad to have health insurance as I was at that moment. My insurance allowed me to see the physicians that were able to diagnosis me, treat me, and enable me begin to recuperate from what could have been a terminal event. Today, I am improving thanks to the treatment I received at Sylvester Cancer Center, a leading cancer center in Miami Fl. I am not 100%, but I am alive and continue to work to overcome the deficits that I have as a result of the chemotherapy that eradicated the brain tumor.
The cost of my care was in the hundreds of thousands of dollars and most of it was paid for through my healthcare insurance policy. I consider myself very lucky and thankful to my former employer for taking the time to put together a comprehensive health insurance plan that covered most of the services needed to treat my condition.
Paying the Bills
One of the responsibilities that comes with having health care insurance is making sure that the services provided were appropriate. As I was the only constant person on my team, I was able to help by reviewing the bills to make sure what was charged was actually provided. I felt that this was a responsibility that I had as mistakes can happen. Also, as we were responsible for a portion of the bills, we wanted to make sure that we did not pay for services that were not provided.
So my husband and I took the time to review each bill as they came into our home and make sure (as far as we could tell) that what was billed was correct. This was easier said than done as reading medical bills is a skill that even I, an experienced healthcare professional, was not prepared for. Some of the challenges we found were:
- Many bills were not clear as to what had been done so reviewing them was a challange
- Understanding who the providers were was a difficult because many times we did not recognize provider’s names or had never met them as they were behind the scenes.
- Some bills had only the amount to pay with no explanation as to what services were provided.
- Bills that did have explanations on them many times had multiple charges for what seemed to be the same service so deciding if they were duplication was hard
- It was sometimes hard to know when to pay a bill as we could not tell if the insurance company had paid or we were responsible for the charge
- In addition, as I was in a weakened state, having the stamina to review the number of bills coming in was at times overwhelming
It is important to remember that bills should not be paid until they are reviewed and paid for by your insurance company. Many people think they have to pay a bill when it comes as you would with other bills, but this is not correct. You should wait for an explanation of benefits from the insurance company, so you know what they paid off the bill and inform you what portion of the bill you are responsible.
My husband took the time to sift through the mountain of bills that came in via the mail as well as through the two internet portals that Sylvester Cancer Center and our insurance carrier had in place. He put the bills into two piles. One pile was for bills that had all of the information included. The second pile contained bills that did not have all of the information or needed follow-up.
The bills we had questions on required us to make calls to the providers to ask them to resend the bill with an explanation of all of the charges. This took time for them to resend so it could be reviewed. Once the full bill was received, we reviewed it to see that the services provided were accurate. Then we had to wait for the Insurance Company to send the explanation of benefits so we knew the amount they paid and what we had to pay.
It was interesting to see what was billed, what was paid, and how the services were explained. Every bill format was different and this made the process very tedious.
In many cases, if there was a balance to be paid I made a call to the provider to see if they would accept what the insurance company paid. Many providers had programs that could help offset some of the cost, but it required more paperwork to be filled out to see if we qualified for the exemption. If your income is impacted by your illness and money is tight, this is an import option to consider, although it does add extra work.
I did have out-of-pocket costs in the beginning as I had not reached my out-of-pocket requirements specific to my insurance policy. This meant that I did have payments for many of the bills that came in early. Once my deductibles and out of pocket requirements were met, we were not responsible to pay; as the insurance company paid their negotiated rate which was a relief.
Matching up the bill with what the insurance statements showed what was paid which is an important part of managing the bills. Please remember not to pay anything till you get notice of what your insurance company paid. Doing so can result in duplicate payments which is a nightmare to resolve.
On occasion, we did have questions about payment of certain bills, so we made a call to the provider. Getting to the right person was not always easy and took persistence. Writing down the date, the time, who we talked to, and what they said was important so that we had a record of who said what. A few times, I was able to get items taken off the bill as they were not appropriate or mistakenly billed, but overall most of the bills were correct, especially after the detailed explanation of services was received.
If there was a large payment expected I would call my case manager at the insurance company and he could check to see if the insurance company had paid their portion of the bill. This was helpful when it came to knowing what our responsibility was. Again, documenting the information received over the phone was very important.
As an FYI, I was on a traditional commercial insurance plan but if I had been on Medicare, it would have been important to make sure that Medicare, as the primary payer, had received the bill and paid what they were responsible for. Once they paid their portion, the bill would be sent to the secondary insurance company. Secondary insurance will usually pay what Medicare does not pay, so again, keeping track of all of this is important.
Communication is critical
Communication with providers and the insurance company is important when reviewing hospital bills. Both organizations hold information that can help you understand the billing process and what your responsibility is. Don’t be afraid to ask questions.
Also, if you have a balance to pay and do not have the funds, ask the provider if they will accept what the insurance has paid. Sometimes they will do this if you can prove paying is a hardship. If they will not, then you can ask if they will allow you to pay the amount due on a payment schedule which could be as low as $5.00 a month. Again, don’t be afraid to ask for these options. If you find charges that you think were not appropriate on the bill, let your insurance company know. They can check this out for you.
Resources that Can Help
In this section, I wanted to include some resources that might help you better understand the medical billing process. Here are a few you can review:
Understanding your Medical Bills: This article will assist you in understanding your medical bills. Click here to read.
Professional Healthcare Billing Advocate Can Help: Patients who have had complex care can rack up millions of dollars in medical bills which can in turn cause financial hardship. So if you are having trouble reviewing your bills, are too sick to handle this task, are getting called by bill collectors, have questions regarding how much you have to pay, or need financial aid there are professionals who can help you. They are known as Healthcare Billing Advocates. Click here to read an article on how a billing advocate can assist you.
Insurance Handbook: Your insurance handbook has a lot of good information about your policy. Take time to read your insurance handbook so that you understand your policy what is covered and what your responsibilities are. Many insurance companies are not printing these books but place them online for your review. Take time to read your handbook and if you have questions, you can call the insurance company or talk to your human resource department
Understanding and Recognizing Healthcare Fraud: Health care fraud costs you, payers and providers, millions of dollars. This article can help to combat this unnecessary expense by understanding what health care fraud is, how to recognize it and what you can do to prevent it. Click here to read.
Human Resource Department: If you have healthcare insurance through your employer, your Human Resource Department can assist you with questions you have or refer you to someone who can help you. Again, do not be afraid to ask for help. Paying medical bills is a complex task that most people find it distressing. Asking questions and getting clear information is important.
Individual Policies: If you have an individual policy that you pay for privately, you can call your insurance company and ask them questions. Most have good customer service departments who have access to all of the policies and can find answers to your questions. If you have a clinical question, they may refer you to a Nurse Case Manager who can assist you. Usually, there is no charge for this as these people work for the insurance company.
Web Portals: Today many Hospitals or Health Systems have electronic portals that you can access once you register. The systems contain hospital and provider bills, hospital records, lab, and diagnostic tests. In addition, the Portals allow you to make appointments and even communicate with your healthcare team if you have questions. These systems are usually easy to navigate, but you have to register and have internet access. If you need help, the health care system will usually have technicians who can help you set up your portal and show you how it works. This allows all of your information to be kept in one place.
Your insurance company may also have a web portal that you can access to see what bills have been paid, and what bills need to be paid. This is where you will also find a copy of your Member Handbook. Again, you need to register and have internet service to access these portals. If you have questions they have technicians who can assist you.
Insurance Commissioner: Every State has an Insurance Commissioner who can be a resource for you if you have questions on health care bills or a complaint against your insurance carrier. Here is the link to find help in the Insurance Commissioner in your State https://eapps.naic.org/cis/fileComplaintMap.do
I hope this information helps you better understand your role in paying your healthcare bills. As a last bit of advice if you can keep up to date paying your medical bills that is better than letting them go unpaid and piling up. If you have trouble keeping up with your medical bills due to your healthcare challenges the most important thing is to let the various providers know who sent you the bills so they know you are not ignoring their request for payments. There are professionals that can help you sort out your medical bills.
Please email me if you have questions or comments. You can reach me via email at firstname.lastname@example.org
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