Posted Thursday --- February 21, 2008 -- 10:00pm

Have you ever had to choose between your next trip to the grocery store and a checkup at the doctor's office?

More and more people are getting *Buried* under health care *bills* ... and we're not just talking about the poor or uninsured.

The health care system is getting more expensive - but in some cases the back and forth between your doctor and the health insurance company can cost you more than you actually owe.

NBC-15's Sarah Carlson was inspired by her own story - feeling buried under bills - after routine procedures and checkups.

A "benefits explanation" -- 13 pages long, took hours to sort through.

We found one local woman who took on the system - and won - and hopes to help others learn from her experience.

Karen Lee Weidig went for a routine checkup when she turned 50.

But a coding error in the billing process turned that routine checkup into months of phone calls and emails.

Weidig says, "I feel fed up a lot of the time."

Despite getting approval from the insurance company ahead of time... she was *later told it wasn't covered.

"Once it went through to the insurance company... hours and hours and hours -- on my cellphone by the way, during my business hours, were spent with the insurance company."

From the beginning of last October through the end of December, Karen Lee made phone call after phone call and email after email.

They told her she owed $500.

"There is a strong fear factor. What if I get taken to court. What if I get dropped by my insurance company? "

While Karen Lee feels like her doctor was caring and as helpful as she could be - she was discouraged by the system.

Weidig says, "I think people are getting abused and it's not necessary."

But the good news is -- she did the right thing.

"Stay in the game. Don't just hate the bills."

Meg Gaines is the director of the Center for Patient Partnerships.

It's her job to help patients navigate the health care system - especially those who've become overwhelmed.

Gaines says, "Never leave it and just say I can't pay this so I'm not going to respond. That's the worst because then you're in collections and all bets are off."

Her most important piece of advice is to stay in touch with the people billing you.

And be sure to keep solid, written records.

Gaines says, "Keep track of the date. Keep track of the words they used and the things they said. Don't be afraid to talk to people's supervisors."

Also be aware of the fact that EVERY hospital and clinic has a billing system for people who can't afford to pay.

It's often called charity or community care.

UW Health Hospitals and clinics has worked to make that information more accessible to patients, by putting information online.

But no matter where you're treated - *just call* if you can't afford the bill.

Gaines says, "This is a business in this country. And so when consumers go in and consume health care they need to understand -- that it's not unrelated. And I don't mean individual doctors and nurses aren't kind and caring and so forth, I think they are tremendously committed health care professionals, who hate the system as much as rest of us do."

Karen Lee is discouraged by her experience with the system.

"Once correctly handled, the insurance company was responsible for the whole thing."

To fix the mistake, her health insurance company had Karen Lee start over with a new visit and the correct billing code.

Her advice is simple:

Weidig says, "Being a pain in the butt isn't always a bad thing. A lot of people are victimized by saying 'oh I shouldn't bother them, I'll just pay it.' Where if more of us were standing up on our hind legs, maybe this wouldn't be happening."

It's important to point out that every hospital and clinic encourages patients to STAY IN TOUCH. Don't be afraid to contact the financial assistance department for help.

If you or someone you know can't afford your medical bill -- Here is information on policies and guidelines from all of Madison's hospitals and clinics.

CLICK HERE to Read Federal Poverty Guidelines from UW Health

CLICK HERE for St. Mary's Charity Cares Numbers

CLICK HERE for Help with Medical Bills from UW Health

CLICK HERE for Information about Meriter Hospital’s Financial Assistance for Health Care Program

Click HERE for Meriter Billing Information

CLICK HERE for University of Wisconsin Hospitals and Clinics Community Care policy

CLICK HERE for Center for Patient Partnerships

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BILLING POLICIES FOR THE POOR, UNINSURED OR UNDER INSURED
MADISON HOSPITALS AND CLINICS

MERITER HOSPITAL:

Anyone who is below 300% of the federal poverty level is encouraged to apply for financial assistance. But there are some circumstances that could make a person over that level eligible as well. Patients with concerns are asked to contact Meriter Hospital and fill out the application.
In addition, patients who are categorized as self-pay (do not have insurance or coverage by a government program) receive an automatic 20% discount on their bill.

DEAN HEALTH:
The Dean Community Care Program is a health benefits counseling program designed to assist uninsured and under served patients in determining eligibility and applying for medical assistance programs.
Financial assistance to uninsured and under insured patients is also provided to low income patients. Community Care may write off Dean Health System charges based on a sliding scale. Anyone who is below 300% of poverty level is encouraged to apply for financial assistance. Adjustment amounts are dependent on household income as compared to the federal poverty level.

ST. MARY'S HOSPITAL:

St. Mary’s Hospital has a financial assistance program in place for patients who are not able to pay for the medical care they received. These individuals are encouraged to contact the hospital’s financial counselor at 608-229-7600. Those with income at or below 400 percent of the federal poverty level are eligible for a financial discount. In addition, St. Mary’s recognizes in some unique situations, medical bills can be catastrophic, regardless of income. The hospital will evaluate what individuals can reasonably expect to pay within four years and only require payment of that amount.

In addition, patients who are categorized as self-pay (do not have insurance or coverage by a government program) receive an automatic 20% discount on their bill.
Please see separate file attachment on specific guidelines.

UNIVERSITY OF WISCONSIN HOSPITAL AND CLINICS:

U.W. Health's Community Care program is designed to help patients who are unable to pay for the medical care they receive. Community Care staff use the following guidelines to determine patient qualification: The patient has no assets that could be appropriately used to pay medical debt, the patient is ineligible for aid under county, state and federal programs, the patient lives in Dane County or the surrounding counties, the care is medically necessary, UW Health is the appropriate provider for the level of care required by the patient, the patient's family income level is at or below 500 percent of the federal poverty guidelines, the patient's medical debt is more than 50 percent of the annual household income.

Please see separate file attachment on specific guidelines.