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Elephant in the Room of Health Care

There has been little mention of collections, scheduled fee controls, debt write-offs and other important factors in the debates about repealing and replacing of the Affordable Health Care Act. Adjusting these items can drastically change healthcare costs in the United States.

The Good Samaritan

Laced in the American hospital system is a notion of the Good Samaritan. Americans do not leave its citizens on the streets to die when in need of medical care. There are many charitable hospitals and medical facilities all over our nation. Some are religious, and others are facilities of mercy provided by the generous donations of our citizenry.

Title XVI

Title XVI of the Social Security Act offers specific protections for aged, blind, and disabled persons. American citizens frequently fall through the safety net and become inpatients in medical centers without visible evidence of medical insurance, or possess an insurance policy whereby an insurance company has refused to pay the medical bill as a result of the patient having a preexisting condition. An extraordinary amount of revenue is spent in this one area alone.

Most individuals that have serious medical conditions rely on Title XVI medical coverage when their medical insurance policies rejects coverage due to preexisting conditions. Most of these individuals qualify for Title XVI coverage as they are either expected to be permanently disabled, or are expected to live less than one year.

Bogus Insurance Policies?

It is of little concern from whence a medical insurance policy comes if the policyholder possesses a preexisting condition.

I know that there is a whole lot of talk about preexisting conditions in medical insurance policies, but there is little information available how a preexisting condition affects an insurance policy holder.

Let's make it simple. For patients admitted into medical facilities through E.R.; time is very important! Who thinks about insurance when a patient is in helpless peril? Doctors go to work immediately. On many occasions, relatives are unavailable to provide insurance information. Some patients have medical insurance cards in their possession; others have no visible means of paying the medical facility.

Most patients once stabilized, are admitted into to the medical facility dependent upon his or her condition. The patient then provides information regarding bill payment, if available.

If the patient possesses a medical insurance policy, the hospital requests a "treatment authorization" for present and future services. If this request for treatment is denied and, if the patient possesses no visible means of making payment to the medical facility, this account becomes a collection account.

If the medical facility is a charitable hospital, then it would be prudent for the medical center to transfer the patient to a government funded facility unless there are mitigating circumstances.

If the insurance company denies coverage for a presented "treatment authorization request", and there are many reasons to deny a bill, then on most occasions the patient is later dunned by the in-house collection department of the medical facility for payment. If the insurance company does not pay this medical bill, or the patient does not pay within a stipulated period, the medical bill will be eligible for a write-off. This period is normally for about 90 days.

Follow The Money

Once the hospital writes off a bill, this is one justification for later increasing medical costs. Medical facilities also make assignments to collection agencies for a great portion of the medical bill once it is determined that the medical account will become uncompensated.

Later clever medical collectors and consultants track down the patient, assist the patient in becoming eligible for a governmental benefits programs, or other charity programs that pays the medical bills for patients that fall through the cracks. Then these collectors and consultants bill these items to the government for the medical facilities and later identify these items on hospital "remittance advice's" from the payers of these medical accounts once a payment has been established.

The lions share of the government's payment of the bill goes to the collection agency. Believe it or not, a huge amount of money is paid by the government for these medical bills that are hospital write-offs, a black hole where our hospital dollars are going.


It will be much cheaper to pay medical bills for all citizens. Free doctors and outpatient care will reduce expensive E.R. admissions thereby reducing costs measurably.

The process is clear, but what is happening presently is most important for the patient, and for all Americans to understand. I will show you where your hospital dollars are going if you will read my free newsletter reports.

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