ROANOKE TIMES
Copyright (c) 1997, Roanoke Times
DATE: Sunday, January 12, 1997 TAG: 9701110015
SECTION: BUSINESS PAGE: 1 EDITION: METRO
COLUMN: Health Care
SOURCE: SANDRA BROWN KELLY
Considering reactions by the area's biggest health care providers, Pat Palmer is the pea under the mattress, the eggshell in the omelet and the wrinkle in their shorts.
The former Blue Cross-Blue Shield claims processor went into business in February 1994 to get paid for what she'd been doing for friends for free - scrutinizing medical bills for errors. Her business is Medical Recovery Services Inc.
By the end of 1994, she'd moved from her home office to a building on Apperson Drive where she shares quarters with a brother's glass shop.
Palmer now has eight full-time and part-time employees, a branch in Lynchburg, and this month, she opened a division in Tazewell.
Palmer says she's saved customers $223,000 since she went into business. But while clients have been satisfied, health care providers have started to chafe. They don't see why Palmer should make money doing what they will do for free - audit patient bills. The health care providers are trying to make it harder and more expensive for Palmer to get the information she needs.
People come to her, Palmer said, when they haven't been able to solve their disagreement with the medical facility or when they don't have time or don't feel capable of dealing personally with a questionable bill.
One older customer was a widow who for two years was erroneously billed $140,000 for her late husband's care. Each bill reminded her of her loss, and Palmer said the woman was crying when she came in for help in getting the bills stopped.
Many customers are senior citizens intimidated by bills sent to them before Medicare or their private insurance company has had time to pay, Palmer said. Many of these patients pay the bill resulting in a credit on the account when the insurance company pays.
And then, sometimes getting a refund on the overpayment isn't easy. One client still is trying to get a Roanoke Valley chiropractic office to return a $120 overpayment made in December 1994.
Medical Recovery Services' fee is set at 50 percent of the amount it saves a client, but if the savings are high - several thousand dollars - then her fee goes down, Palmer said. Sometimes she gets fired up enough over a case to do the work for free, she said.
But after having a laissez faire attitude toward Palmer's business, the medical billing offices are making her less and less welcome.
The medical businesses have begun to "throw up barriers," she said.
Columbia Lewis-Gale Medical Center has been the most gentle, but it refuses to give written answers to questions about a bill and instead requires a patient to come in for the explanation. At one point, the hospital wanted the patient to pay a $250 third-party auditor fee if a Medical Recovery Services employee came along, but it hasn't enforced that policy. The Medical Recovery Services employee isn't allowed to ask questions at the audit, however, Palmer said.
Hospital spokeswoman Terri Reynolds said patients are asked to come in for a explanation because written comments sometimes can be misinterpreted. She also said the hospital has no problem with Palmer's involvement.
Lewis-Gale Clinic is a different story. After cooperating with Palmer's office for two years, in November Lewis-Gale informed Palmer it would no longer take questions by phone from Medical Recovery Services. All requests have to be in writing accompanied by an original signed release that is no more than three months old, the clinic said.
The clinic promised to respond to requests within five business days, but Palmer said that is not always happening.
"It's ludicrous. It doesn't matter if you pick up the phone or write, the questions still have to be answered," she said.
Carilion Health System also recently informed Palmer that it considered her business in the category of insurance companies and lawyers, who must pay fees of up to $500 to have a patient bill audited.
Palmer disagrees with the designation, however. She said her company does not request the itemized bill, the patient does. Medical Recovery Services just helps a patient understand the bill.
The relationship with Carilion is "at a standstill as far as us not being allowed to review any hospital bills without paying a fee," Palmer said.
In the past, Palmer and her staff would review a bill and then suggest adjustments to Carilion.
Now, unless Medical Recovery Services wants to pay an audit fee, Carilion will work only with the patient, said Jodie Caplan, director of internal audits. No adjustments are considered unless Carilion auditors are asked to do the review.
To get an audit, a patient must complete an authorization form. Then, a Carilion auditor compares the patient's medical record against the bill, sends the patient an itemized bill and calls the patient to discuss any adjustments, Caplan said.
Caplan said she considers the Carilion auditors to be as much the patient's advocates as Palmer can be.
"Our concern is that they're paying for a service that we will do for free, and we can't understand why," she said.
Carilion did recently change its audit request form to make it friendlier, she said.
The previous form warned that audits "frequently revealed" charges left off the bill.
Caplan said it was changed after a patient wrote to point out that the language was enough to scare some people away from requesting an audit.
The statement that undercharges could be found is still there but "it isn't the first thing that hits you over the head," Caplan said.
Caplan also said she has no problem with a patient requesting an itemized bill and then seeking Palmer's help, but that no adjustments are made just because Palmer's office requests them.
Palmer still believes that the hospitals and the clinic are trying to make it harder for a consumer. Third party auditors who pay fees aren't usually working for a consumer; an insurance company auditor is looking out for itself, she said.
The reception Palmer is getting is nothing new, according to Todd Larsen of Consumers for Quality Care in Santa Monica, Calif. Palmer explained what was happening with her company in a personal letter to consumer activist Ralph Nader, and Nader turned the letter over to Larsen.
It has gone into Larsen's files about billing problems with all types of businesses.
What's happening to Palmer - hospital's attempts to charge fees and make access to records difficult - has been happening for years to companies trying to do what Medical Recovery Services is doing, Larsen said.
However, Palmer said she's not going to quit fighting back because the medical places' reactions don't make sense to her. Many of the errors her office finds are miscoded charges, she said. Once codes are corrected, the insurance company will pay.
Although she was talking about Lewis-Gale Clinic when she said the following, Palmer thinks it applies across the board.
"We're getting them thousands of dollars and now we're not allowed to speak to them," Palmer said.
LENGTH: Long : 125 lines ILLUSTRATION: PHOTO: headshot - Palmer colorby CNB