Jennifer Witt

Jennifer Witt

If you are tuned into current events, you recently heard mention of efforts to require more transparency in healthcare costs. One of the challenges that consumers face is not understanding how medical facilities code their services for billing. Additionally, there is very little consistency in the coding—even within the same facility.

Why Are There Multipe ER Bills?

 

For starters, a visit to your local emergency room will typically produce two or three bills. The first bill will be a facility bill. This bill will list a charge of level I up to level V based on the complexity of your visit. Level V is the most complex and, therefore, the most expensive. Most often, another bill will be sent to you for the emergency room physician’s services. In our experience, these collection services tend to be the most aggressive and the least flexible. Finally, if you had any X-rays or a CT scan done while at the hospital, you will likely receive a separate imaging bill. Any lab work performed can also be billed separately but, depending on the facility, might be included in your facility bill as a separate line item. That’s a lot of billing!

Of the bills generated by an Emergency Department, the one most ripe for review is your facility bill. The reason is that there are no exact standards for assessing the complexity of your visit. Basically, there is a lot of gray area in facility coding. For example, if two individuals seek care for chest pains, one emergency department patient might be billed level III and the other at level IV or V. One of the patients might be older and the symptoms might look like a potential heart attack so many more resources and testing is necessary. A young healthy patient might have a history of heartburn and the doctor provides a prescription level medication for the discomfort without performing an EKG or labs.

How Are My Bills Coded? And What Does That Mean?

 

While there are no hard and fast rules about coding your visit, there are some general rules that the provider uses to properly bill you for services. First, there is a valuation of resources. This means the provider is looking at how a patient with your symptoms or presentation uses resources such as nursing, staff, ER room, and even the cost to create a medical record and bill you. Second, the number of diagnostic tests used to determine your diagnosis or rule out more serious concerns is a factor in cost. Finally, the level of complexity of your presentation is a big factor in determining the proper level of coding. For example, if you are brought to the ER unconscious with no guidance on how or why you are unconscious, there will be many doctors, nurses, lab technicians and specialists trying to quickly determine whether you are in a life or death situation. Your presentation to the facility has pulled so many resources for only one patient that the bill will reflect that “draw” on resources.

Can You Really Afford To Go To The Emergency Room?

 

The problem for the average consumer is that, when you have to use the emergency department because the urgent care is closed, how can you decide whether you can afford to treat your strep throat tonight or whether you should manage until tomorrow? Honestly, the bill might kill you so it’s worth thinking about! The difference in receiving antibiotics via pills versus intravenous treatment can cause the facility bill to go from level II to level IV, which can be a difference of more than a thousand dollars. There are many factors to consider when your medical issue is not really an emergency. If you are paying the balance, it is important to know what you could be charged.

To illustrate, we randomly pulled 5 personal injury files and reviewed the billing for emergency department visits.

The first four clients were treated at facilities on the Kitsap Peninsula:

1) ER level IV bill = $2,773.00
ER physician’s bill = $953.00

2) ER level III = $1,793.00
ER physician’s bill = $1,057.00

3) ER level IV = $2,641.00
ER physician’s bill = $1,407.00

4) ER level IV = $2,773.00
ER physician’s bill = $603.00

Client treated on the Olympic Peninsula:

5) ER level IV = $727.50
ER physician’s bill = $169.50

 

As you can see, the difference of a level IV facility bill on the two peninsulas was a difference of nearly two thousand dollars!

Can An Urgent Care Handle Your Needs?

 

If you know that an urgent care can handle your needs, it is important to consider that your out of pocket expenses are likely to be far lower. Additionally, if you do not have insurance, there is no “allowed amount” reduction as is done for those who have private insurance or Medicare. In fact, CMS has greatly reduced allowed amounts so the patient will never be forced to pay $2,700.00 for a facility charge. Additionally, the Center for Medicare Services has been reviewing these charges with more scrutiny and refusing to pay bills where hospitals are “upcoding” a patient’s visit. This is good news for those using Medicare or Medicaid. However, for the rest of consumers, there is more to be done to avoid a financially devastating bill.

Hopefully, the medical transparency bill will lead to better outcomes. Part of the equation to improving outcomes means taking some responsibility as the patient. If you are not in a life-threatening situation, you might consider driving to a less convenient location for a greatly reduced bill. A high level trauma center, with the high cost of running such a facility, might not be the hospital you want to visit. The facility bill for a level I trauma center is likely to be five or ten times higher than an urgent care. Without transparency in the billing by these facilities, it becomes impossible for the patient to make informed and cost-saving decisions.

Why Do We Care About Your Billing?

 

So why would a personal injury firm care about all of this billing? After all, won’t the insurance companies pick up the tab? Yes and no.

The explanation regarding subrogation could cover 10 blogs but, in a nutshell, if you “over spend” when treating a soft tissue injury (whiplash) your “pay back” to your medical insurance provider could mean there is nothing left in your pocket for pain and suffering. For example, our clients with straight forward “whiplash” cases often visit the emergency room immediately following the accident, follow up with a primary care doctor, and seek chiropractic treatment or physical therapy. If the hospital visit included a CT scan and other X-rays, you can assume that the imaging bill will be somewhere between $3,000 and $5,000, a level IV facility bill of nearly $2,000, an ER doctor bill of approximately $1,000 in addition to the $3,000-$5,000 for chiropractic or physical therapy. If none of those bills are reduced, the injured person who has no medical insurance or poor coverage is looking at a potentially terrible situation.

Despite the “injury calculators” all over the internet (the ones that say you will get 5x medical expenses), soft tissue cases have a ceiling. The insurance companies know what juries will award in every jurisdiction and they aren’t about to hand out extra money in settlements because the injured person is stuck with a massive ER bill. The insurance adjuster is considering whether the care is reasonable and related to the accident but the patient or her attorney has to keep in mind that the cost of the treatment should also be reasonable and fall within an average settlement award for those injuries.

Speak With An Auto Accident Lawyer As Soon As Possible!

 

If you have been injured in an accident, it is important to talk with a lawyer as soon as possible. Occasionally, we have been able to help clients qualify for insurance that has retroactively covered an emergency visit. Knowing how to handle accident cases and get the best outcome for an injured person often means having an advocate immediately following your injury. A delay in legal advice can mean the difference in getting stuck with your medical bills due to someone else’s negligence or actually being able to treat your injuries and also receive compensation for your pain.

If you have been injured and have questions about your case, we offer free consultations. You can visit one of our offices in Gig Harbor, Bremerton, or Poulsbo. However, if it is more convenient, we can also handle everything over the phone.

For some of you, this may seem like a silly question. However, there are a lot of people who have never stepped foot in a courthouse or are young and have never heard of “business casual.” Never feel too embarrassed to ask your lawyer about courtroom protocol because putting your best foot forward can only help your case. Being appropriately dressed and groomed is helpful but there are a few other suggestions we would like to make:

 

1.  Confirm with your lawyer that you know the date, time, and courtroom where you are required to be. Do NOT do this an hour before court. If you have an experienced criminal defense attorney, it is likely that she has been in three courtrooms before you have even parked your car. The attorney is rarely able to answer phone calls on the morning of court. Call the office the week before your court date. Make sure to provide a good phone number (one that you will answer on the morning of your expected court date). If plans change, the attorney or office can reach you to give you updates.


2.  Always plan to arrive to court 15 minutes early. Depending on the court location, parking can be a hassle. For example, you might need to walk a fairly long distance in Pierce County.


3.  Be prepared for security. If you carry a lot of “trinkets” in your purse or pockets that might set off the scanner, it is probably best to leave those at home. Go into the courthouse with the bare minimum so you can get through security quickly.


4.  TURN OFF YOUR PHONE. This should probably be #1 on the list. It looks incredibly rude to have your phone go off in court. Some judges will make that mistake a VERY memorable occasion for you. Trust us on this one!


5.  Remember any paperwork that you may need.


6.  If asked to address the Court, the correct response to the judge is “Your Honor.”


7.  As far as appearance, wear clothes that are appropriate for a job interview. If you don’t have slacks, a button up shirt, or a simple dress, then wear something that does not draw attention. For example, no funny t-shirts, no beer/weed references, or inappropriate language. Not everyone owns “fancy” clothes and that is understandable. However, if that is your situation, do your best to have clean, neatly pressed, non-torn up clothing. Remember, your appearance says something to the Prosecutor. Does it say that you are taking this situation seriously?

 

As a side note, try not to panic. Often, the stress of mentally and physically preparing for court can cause unintended side-effects. Your demeanor may change in a negative way and it might appear that you are being disrespectful or dismissive. If you have never been to court before, let your attorney know so that you have a basic understanding of what will be happening. For an Arraignment, people often think something “big” is happening. Generally, that is not the case. In fact, an Arraignment is quite uneventful and, unless you are waiting for in-custody defendants, you will be in and out of court fairly quickly.

 

While knowing what to wear is important, the best thing you can do for yourself is be prepared mentally. Most clients want the process to “hurry up and go away” so life can get back to normal. Unfortunately, it is rarely a quick process.

 

Keep an open dialogue with your lawyer about your concerns but also trust that he or she is working behind the scenes to find defenses and negotiate a positive outcome in your case. Nearly all of the work a defense attorney does on your behalf is done outside of the courtroom. Your court appearance is simply a formality and the negotiation happens over the phone, by email, and even in the courthouse hallways as defense attorneys try to catch busy prosecutors racing from one courtroom to the next.

 

The criminal justice system is somewhat like controlled chaos. That is hard for most people to understand. It is messy but things are happening in the “order” they should. Follow the suggestions above and you will help your defense attorney by being present, on time, and respectful of the process.

 

If you have searched the internet to find a value for your injuries, you have likely noticed a big difference in estimates. In part, this is due to the fact that “whiplash” injuries (sometimes called minor impact soft tissue injuries or MIST) vary so much in their physical damage to the vehicle, emergency response at the time of the accident, medical treatment, follow-up care, loss of income, as well as pain and suffering. Additionally, depending on the state you are located in and even the specific county in which a jury would be empaneled, your odds of a jury finding in the plaintiff’s favor can vary widely.

 

Victims always want a nice calculation such as three times medical expenses. However, that is simply never the case. If you “under-treated” “over-treated” or were inconsistent in making your medical appointments, be prepared for a fight from the insurance company. If you’re handling your case without a lawyer, be prepared for the adjuster to spring this on you at the end of your treatment period.

 

Despite the inconsistent settlement amounts and jury verdicts, there are some truths for soft tissue injury victims. First, because your injury is not visible to a jury, it is important to have your injury documented by a medical professional. Second, because juries tend to be skeptical about injuries they can not see, make sure your treatment behavior is consistent with someone claiming to be truly hurt. For example, do not plan to successfully assert that you have been in so much pain that you can’t get out of bed but, at the same time, you never went to see a doctor. This can be tricky for a person without insurance but, if you talk with an experienced personal injury lawyer, he or she will typically know of service providers who will hold your bill until the case settles. Third, do not exaggerate your claim. Sometimes, people get bad advice from friends that if you “rack up your medical bills, you will get more money.” This could not be further from the truth. Reasonable care is the key. If you “over-treat” be prepared to get stuck with some of the medical bills and no money in your pocket for pain and suffering.

 

The moral of the story is that you need to seek legal advice from an injury lawyer in your area. If you were injured in Bremerton but seek advice from a lawyer who practiced in Los Angeles, be prepared for quite a shock when it is time to settle your case. Geographical differences in personal injury cases are quite substantial. The insurance companies are well-versed in the jury verdicts of every county in the country. They know the range in value of your case and they are rarely going to venture outside of the range.

 

If you want accurate information, make sure you keep all of these factors in mind. Contact a local personal injury lawyer so you are prepared. Let the attorney know if law enforcement did a report (determining who was at fault), whether you were transported to the hospital, who responded to the accident, and any treatment providers you have seen since the date of the accident. Your lawyer will confirm whether the at-fault driver had insurance and whether the policy will be large enough to cover your treatment.

 

For more information about valuing your injuries from an auto, pedestrian or bike accident, contact Witt Law Group for a free consultation. Do not seek legal advice about your accident, injury treatment, or how to value your case from random “injury calculators” or generic non-local websites. On top of your physical injuries, you will likely injure your case!

There are many reasons a person can benefit from having a private attorney on the case before the arraignment. If you have been arrested, received a summons to appear, or you are trying to help a loved one through the process, here are several reasons to consider seeking legal advice before your first appearance:

1) If you are arrested and in custody, a lawyer can help explain the bail process and get you connected with someone who can get you released before court. Studies show that defendants who are in jail throughout the criminal justice process have worse outcomes.

2) If you have received a summons to appear, you likely need some guidance on what that means and how to best proceed. Receiving a summons can be frustrating to the accused because they are often mailed many months after an incident took place when memories are fading or perhaps the defendant had no idea she was being investigated. Defendants are often very confused when a summons arrives in the mail. It helps to investigate and discuss the criminal charge being alleged before you walk blindly into court.

3) Many people have difficulty getting time off of work on short notice to appear in court. If you make contact with a criminal defense attorney earlier enough, he can typically waive the arraignment, which excuses your presence.

4) In some situations, the case can be resolved before your arraignment! If there is enough time, we can work on a Compromise of Misdemeanor or a Pretrial Diversion Agreement. These options apply to certain criminal charges and, if the State is amenable, we can have an arrangement prepared before your arraignment.

5) If the case does not resolve before arraignment, we can usually get the conditions of release to be more favorable. For example, if the Prosecutor is requesting an ignition interlock, we will have our clients get an alcohol evaluation prior to the arraignment. This allows the Judge to better determine whether that condition should actually apply and gives you a better chance of avoiding these costly conditions of release.

6) Hiring a private attorney allows you to speak with your counsel and get legal advice before walking into court for the first time. This does not happen when you are waiting to be assigned a public defender. You have to wait until after an arraignment to schedule a meeting with a public defender. Depending on how much time you allow, your private defense attorney might be able to develop a comprehensive strategy before the arraignment.

7) As an added bonus, a good private attorney will keep you apprised of all court dates. It is important to never miss court! Failing to Appear (FTA) negatively impacts your attorney’s negotiating power and potential positive resolutions for your case. However, do not expect a public defender to email or call you to remind you of a court date. They have far too many cases to add that to their “to do” list. That is not the case with private counsel—expect to get regular reminders.

There are many more reasons to seek counsel before arraignment but, basically, everything runs more smoothly if you are prepared. If you are unsure whether you need counsel, it is best to seek a free consultation and discuss your concerns. We are available 7 days a week and can handle everything over the phone. If you prefer to meet in person, we have offices in Bremerton, Poulsbo, and Gig Harbor.

There is a lot to deal with following a car accident. Most injured victims will deal with pain, healing, medical bills, stress and even anxiety about the accident. However, many of our clients are unpleasantly surprised to find that their insurance rates will be raised even when the accident was not their fault. Talk about adding insult to injury!

 

In the State of Washington, approximately 20% of drivers on the road are uninsured. If you are hit by one of them, your UIM/UM and PIP coverage can help. It’s never great to have to use your own insurance when injured due to someone else’s negligence but it is better than nothing. Make sure you have that coverage! 

Will My Premiums Increase?

While your own insurance can help in this situation, there might be a financial consequence—your premiums increase. We have been asked in the past to “do something” about the unfair practice but our hands are tied. In most states, insurance companies are permitted to raise your rates. You can complain but it will rarely make a difference.

 

What is particularly troubling about this practice is that it is often the poorest in our community who get hit with the greatest premium increase. The study done by Consumer Federation of America found that the insurance companies added a greater premium hike to people who were deemed less educated and lower income. Hopefully, the lawmakers of Washington will crack down on this practice. 

Insurance Company Decisions Are Tied To Profits

As we have said in the past, insurance companies are tied to profits. The bottom line dictates most of their responses. Whether it is “low balling” the settlement offer or raising rates on innocent accident victims, get prepared. The State of Washington does not prohibit “not-at-fault premium penalties.” However, since not every company does this, find a knowledgable insurance agent to help you navigate this issue. Drop the unfair company and find one that will truly stand by you!

 

If you have been injured and need help navigating all of the insurance challenges, we are here for you. We truly enjoy getting accident victims the settlement they deserve. Our consultations are free and, if you are too injured to come into one of our offices, we can handle everything over the phone or come to you. Don’t delay. Personal injury cases have a statute of limitations and you can be barred from bringing a case if you wait too long.

 

December 22, 2019

Designated Drivers Beware

 

Are you planning to attend holiday parties as the designated driver? Good for you! Just remember that there is some risk in taking on that role if you also use marijuana.

 

Many recreational users of marijuana don’t understand that THC levels remain high enough to be cited for DUI days after their last use. The levels of THC will certainly depend on how often you use, how active you are, how long you have regularly used marijuana as well as other physiological factors. However, it is very important that you understand there is always a risk for prosecution. Even smoking the day before you are pulled over can pose a risk of being charged with a crime—we have seen it.

 

Additionally, don’t think that “just one drink” will keep you free from prosecution. We have represented people arrested by law enforcement for DUI with blows as low as .03 and the State did not drop the DUI charge. This year alone, we have represented more than a dozen clients charged with DUI with blood alcohol at or below .06 under the “affected by” prong of the statute. The State prosecutes these charges just as aggressively as an .08 or above. While the DOL jurisdiction for suspending your license occurs when you blow an .08 or above, the prosecuting attorney will still seek criminal remedies that impact your driving and cost you in terms of fines, restitution, emergency response restitution to the law enforcement agency, and legal fees.

 

The moral of the story—if you use marijuana, you should consider using Uber for your designated driver. Also, the “one drink” plan is not a risk-free plan. The safest plan in terms of avoiding a criminal charge and getting home safely is to stay off the road if you use any marijuana or plan to indulge in alcoholic beverages.

 

Have a safe and crime-free holiday season! We want the Christmas tree to be the only twinkling lights you see.

 

If an issue does arise, do not hesitate to contact our office. While we handle auto accidents all over the State of Washington, we primarily handle criminal matters in Kitsap County and Pierce County as well as all cities in between. We have office in Bremerton, Poulsbo, and Gig Harbor for your convenience and offer free consultations. Over the holidays, we will have the office phone forwarded to our cell phones so do not delay in seeking legal advice if you or a friend need help.

If you have been injured in an accident and have been told by your treating physician that you will likely need future care, it is important that you understand what that means for your personal injury case. For those victims who are on Medicare, will be a Medicare beneficiary within 30 months, or have a “realistic expectation” of becoming a Medicare beneficiary due to Disability Benefits, it is important that you keep in mind the concept of a Medicare Set-Aside Arrangement (MSA).

 

The purpose of a MSA is to avoid shifting the financial burden to Medicare if you are being compensated for future care in your personal injury case. For example, if part of your $300,000 settlement is in consideration for medical care you need in the future, Medicare should not be on the hook later to pay for that care. The Centers for Medicare and Medicaid expect that you have placed some portion of your settlement into a specially designed Trust for future medical care.

 

Things To Consider For An MSA

 

When determining whether your case might fall within the conditions for a MSA, here are some criteria to consider:

Are you a Medicare beneficiary (due to age or disability benefits) and your total settlement value is greater than $25,000?


Is there a “reasonable expectation” that you will become a Medicare beneficiary within 30 months of the settlement date and the anticipated settlement amount for future medical expenses, disability, and lost wages is expected to be greater than $250,000.


A “reasonable expectation” occurs when:


a) you have applied for Social Security Disability

b) you have been denied Social Security Disability Benefits but plan to appeal

c) you are in the process of appealing a denial of Disability Benefits or re-filing for Disability Benefits

d) you are 62 years and 6 months old

e) you have End-Stage Renal Disease (ESRD) but do not yet qualify for Medicare based on ESRD.

 

Things To Consider For An WCMSA

 

If you are settling a Workers’ Compensation case and a portion of the settlement is to pay for future medical services related to the workers’ compensation injury, you will need to do a separate analysis to determine if a Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) is necessary. 

 

These issues can be complicated but the purpose is simple. The Centers for Medicare and Medicaid Services (CMS) want to make sure the victim is not burden shifting future medical payments to CMS. If you receive money for future medical care, that money may need to be put in a special Trust to ensure that future care is paid for with this money rather than CMS money. To avoid future penalties, being denied future benefits, or facing other civil actions taken against you, contact our office for a free consultation to determine if you need an experienced attorney to assist with your case. Most personal injury victims have a much better financial outcome if they have legal representation and hiring an attorney can be critical for someone who is receiving benefits from Medicaid or Medicare.

 

Witt Law Group is a personal injury / auto accident law firm based out of Kitsap County Washington. We have offices in Bremerton, Poulsbo and Gig Harbor for your convenience. If you have any questions about an MSA, please give our personal injury lawyers a call. 

For various reasons, people leave the State of Washington with unresolved legal issues. More often than not, a person is under investigation for a crime but not yet charged when they move. By the time the prosecutor’s office charges the case, the mailing address provided months or years earlier is no longer valid.

Delays In The State Bringing Charges 

 

In recent months, we have experienced in increase in cases where DUI cases have been charged a year after the person was originally arrested and released. When the toxicology lab returned the blood result, the accused person had been living in another state for many months. Often, the only reason the person knows they have been charged with a crime is that notice of a warrant appears on a background check for a new job.

 

If you have unresolved criminal charges or have been notified that a warrant has been issued for your arrest, it is critical that you contact an experienced criminal defense attorney. Hiring private defense counsel will cost money but it can help get you back to “normal” much faster and, hopefully, allow you to keep your job.

 

How the Witt Law Group can help:

 

1.  We will determine if charges have been filed or a record has been created. Additionally, we will determine whether a warrant has been issued.

 

2.  We will determine if there are any critical timelines that you may have missed and whether there is a way to remedy the missed deadline.


3.  We will determine the jurisdiction of your matters or matters. This means we need to figure out where you were charged—city, state or federal charges.


4.  We will determine whether you left the state “pre-resolution” of your case—meaning the case is unresolved. If you were arrested and left before your arraignment, you will likely need to appear in court with an attorney to help quash your warrant before we begin negotiation of your case. If you left post-resolution of your case, we will facilitate bringing your case back to a status of compliance.

Every Case Is Unique

 

Criminal charges are common but the facts of every criminal case is different and the challenge in resolving the case is always unique. To really understand the path that your unresolved case could take, it is best to contact an experienced lawyer right away. Discuss the unique details of your case so you know how to move forward. Delaying will only cause more unintended negative consequences. If you found this article interesting, CLICK HERE to see all of our blog posts. 

If you were recently arrested or received a summons in the mail to appear on a criminal charge, it is important that you deal with your legal issues promptly. Around the holidays, many people want to put off dealing with the cost and the stress of the criminal justice system until later in the new year. This can be a very bad decision that leads to more negative consequences than anticipated.

 Reasons To Hire A Criminal Defense Attorney

 

There are many reasons to contact an experienced criminal defense attorney immediately but here are just a few:

1. Evidence can be more difficult to collect the longer you wait. For example, if a video of the incident would be helpful to your case, be aware that videos are often deleted or destroyed after weeks or months. Additionally, witnesses are harder to track down over time and their memories are less clear. Therefore, your exculpatory evidence could be gone by the time your attorney requests it.
2. There are criminal and civil timelines that absolutely inflexible. For example, if you miss your DOL deadline on a DUI, you will be suspended.
3. Appearing with an attorney can help a person be released on their personal recognizance. If you fail to appear at a hearing, it is likely that a judge or a prosecutor will believe you are a flight risk and your conditions of release will be much tougher when you finally appear.
4. Proactive measures need to start immediately. The time between your arraignment and your pretrial is valuable time! Your attorney can help you by creating a roadmap of proactive steps that facilitate a more positive resolution of your case.

If You Are Unsure About Hiring A Defense Attorney

 

If you are unsure of how to handle your criminal case and need to consult with an attorney, give our office a call. We can help inform you of the risks you could be facing if you delay. Our consultations are free and we have offices in Poulsbo, Bremerton and Gig Harbor. If you are interested in more articles on the law or criminal defense, CLICK HERE to read our blog.

Choose your insurance coverage wisely 

Recently, we were dealing with a first party agent regarding a car accident case. We were commiserating about the difficulty of dealing with the agent of a certain company. This person mentioned that everyone in the industry knows this company is intentionally difficult. They are terrible as third party but also terrible with their own insured as first party. She stated that, “Everyone in the industry knows they are impossible to deal with!” Even if you just need a rental car, they will make it so difficult that you give up. We would probably have to second that sentiment (although there might be a tie with another company). 

When you are choosing auto insurance, be sure to check the reviews of any company you’re considering. Saving a few bucks on your premiums may not be worth it. Check reviews online, ask around, and contact insurance agents. Make sure you make an informed decision. There can be a big difference in customer service among the various companies. Your premium might be higher for a certain company but your stress after an accident could be much lower!