Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: THURSDAY, April 13, 1995 TAG: 9504200026
SECTION: NEIGHBORS PAGE: S-22 EDITION: METRO
SOURCE: STEWART MacINNIS SPECIAL TO THE ROANOKE TIMES & WORLD-NEWS
DATELINE: LENGTH: Long
``There just aren't enough hours in the day,'' she says from her storefront office in Salem. ``I'm at a point where I'm not sure what to do.''
All she wanted was a small business she could run out of her home, providing a needed service to clients she could work with personally. That was why she set up Medical Recovery Service Inc. a little more than a year ago.
She now has clients in 23 states. And she has heard from 61 people in 29 states who want to get in on the ground floor of the business by opening offices.
It all began 12 years ago when her father complained that his insurance company wouldn't pay for many of his medical expenses. She reviewed his bill and found $400 in errors. Over the years, more and more people asked her to look at their bills, and the errors she pointed out helped them get hundreds of dollars in refunds.
In February 1994 she set up her business as a part-time affair run out of her home. In the summer she went at it full time, and by December she had outgrown her home office and moved to her current location. Her office is in the same building where her brother operates a glass shop she once managed.
Palmer stumbled into a wide-open field. Insurance companies generally don't scrutinize hospital and doctors' bills of under $10,000. Most people accept a notice from an insurance company that a procedure or an expense isn't covered by their insurance, or they think the health care industry is just too big to tangle with.
Only two of the first 22 cases Palmer reviewed after opening her business had no errors. In the remaining cases she uncovered errors that ultimately resulted in $15,000 being recovered. Palmer doesn't charge a fee from reviewing records, but she keeps a percentage of the amount recovered.
Lewis-Gale Hospital will audit a patient's bill on request at no cost, says Terri Rush, the hospital's marketing director. ``We certainly strive for a very accurate billing system. Our business office representatives are available whenever a patient has a question about his bill. We want people to call us when they think they have a problem. We want satisfied customers.''
Surveys of patients upon their discharge from the hospital show a very high level of satisfaction, Rush points out. More than 97 percent of the patients say they would return to Lewis-Gale if they need additional hospitalization, she says.
The auditing at Lewis-Gale is done by a nurse-auditor with a strong background in health care, auditing and quality review, Rush says.
Palmer says that among the cases she has reviewed were four that had been reviewed by a hospital's auditor. She later found errors in all of them that resulted refunds to the patients.
``A lot of errors are just plain errors,'' she says. ``But when it comes to duplicate charges, someone has to know what is going on.''
Among the items she has found on bills are charges for surgical packages and then separate charges for the component of the packages. She has found the same drug listed repeatedly under different trade names. And on one bill, there was a charge for several hundred dollars itemized simply as ``unknown.''
``A lot of this stuff is ridiculous,'' she says. One woman told her of her father's hospitalization for a heart ailment. The daughter discovered he had been charged $850 for a delivery room.
It isn't anticipation of the almost inevitable tussle with the business office of a hospital that animates Palmer. She's motivated, rather, by what she views as the injustice of a system that often penalizes people who can barely afford insurance payments, much less pay for services they never received.
She tells of an elderly woman who had a $1,738 doctor's bill. The woman decided she could no longer afford to go to the doctor. Palmer found that the woman actually owed just $218.
In Palmer's view, insurance companies are being victimized just as are patients. ``I guess they don't have time to question everything on a bill,''she says. ``If a charge pertains to an illness, they OK it. My philosophy is, if I didn't get it I'm not going to pay for it.''
Her philosophy and her efforts have touched a chord she didn't expect. Her story was featured nationally by The Associated Press and is the subject of an upcoming feature by the Cable News Network.
The unwelcome result of the positive media coverage has been a crush of new cases and pressure to expand her business much more quickly than she had expected.
``When I started this that day in February last year, I never dreamed things were as bad as they are,'' she says. ``It has built up to be a major problem. If we don't put a stop to it, the insurance firms will have to raise rates and then no one will be able to afford health insurance.
``I'm just one person and there is a whole nation needing this service.''
Medical Recovery Service Inc. is at 1876 Apperson Drive in Salem. Additional information is available at 387-2119.
by CNB