| Author | Message | ||
     Whistler |
My son broke his hand six weeks ago and now the medical bills that the insurance company did not pay are beginning to come in. My favorite so far is from the Emergency Room Doctor, a total invoice of $2,856 of which the insurance company paid $1999.20. The Doc is hitting us up for the remaining $856.80. This is not for the hospital or any staff or x-rays or anything else, just the ER Doctor. I asked my son what this Doctor did during the visit and he said the Doctor said hello, looked at the x-ray, and made a referral to another doctor that specializes in hand injuries, five minutes tops. Hoping someone has made a mistake I called the out of state billing service, waited on hold for thirty minutes and finally gave up the idea of speaking to anyone this afternoon. Wow. | ||
| Whitetrashxb |
well, if the provider is in your insurance's network, there is a non-allowed/discount amount, but since your insurance paid 70% of billed charges, it would seem that provider is out-of-network. I'd double check tho James | ||
| Whatever |
Typical b*llshit... insurance companies and health care providers want you to bend over... and then bend over some more... | ||
| Whatever |
I would put in a call to your state insurance commisioner... file a complaint with them and the insurance company usually straighten it out... | ||
| 86129squids |
Wow- the scale of things gets REALLY wild if you have insurance... which, unfortunately, I do not. Apparently without insurance, they will only charge you about half what they would if you did have coverage... If my math is right, that's $34,272 an hour based on that charge, for 5 minutes. I had a similar experience last year, when I laid my Shovelhead down on my left leg in wet grass... below is the letter I wrote to the hospital's administrators. I'd talked with my sis beforehand, who works as a hospital chaplain- she said what they'd charged me was ludicrous. What you've described is systematic, routine behavior involving graft on a Bernie Madoff scale- but perpetuated by thousands of individuals over the years... DON'T GET SICK!! ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~ To whom it may concern: I was recently a patient at the ER facility there at Blount Memorial- I had sustained an injury to my left leg after a motorcycle accident at home. I received fairly prompt and adequate care- my concern was that I had broken my ankle, X-rays showed that I had no broken bones after all. Long story short, I had "smooshed" my leg pretty badly, but no severe injury indicated at the time. At this writing I am still recovering, in light to moderate pain, working on recovering my full flexibility and mobility. The reason I am contacting you is to question the billing for services rendered- I have received 3 separate bills: 1 from Blount Memorial, 1 from SE Emergency Physicians, and 1 from LeConte Radiology. My first question is to the SE Emergency Physicians bill... There is a $334 charge for the ER visit from either Dr. Davis or Dr. Lewis, which I do not question, but I do ask for further explanation for the second charge, $234 for "application lower leg splint"- seriously? To my best observance, the "application" was done by an ER intern/nurse, and simply strapping on a velcro/foam/plastic ankle brace to my leg is NOT worth an additional $234 charge! At least your billing department should combine the doctor's visit and charge for this- however, as I stated, AN INTERN actually brought the brace and put it on my leg. Secondly, on the bill from Blount Memorial- I was charged $43 for what I was told was an "elastic bandage", which I do not at all remember having, and $366 for the "prosthetic device". Upon reading this bill and the charge for the prosthetic, I spent 5 minutes doing an Internet search for the same product, and found it "on sale" for $39.95!! Can this be explained? I have been charged over TEN times the market price for the prosthetic, and an additional $234 JUST to have it put on my leg by an intern. That's an even $600 for products/services that, at best, should command $100. I work as a bartender, and I pay my bills one dollar at a time. I can and will pay what I owe to all three bills over time- I must ask that someone please further enlighten me as to how, at all, these two billing entries are fair and reasonable. Thank you in advance for your time and attention- I look forward to your reply. Sincerely, | ||
| 86129squids |
Oh, and BTW, I finally figured out the $43 charged for "elastic bandage" was just a good old fashioned "ACE" bandage... prolly $2 at the Dollar General...   | ||
| 2008xb12scg |
I have Kaiser for our eye coverage. I just bought my daughter glasses at Sears with no insurance cheaper than they would've been at Kaiser with insurance. And Sears wasn't even the cheapest just needed to put them on a card for a few weeks.. Makes ya wonder. | ||
| Hughlysses |
Way back in the 70's (when this was a LOT of money), my Dad once had a charge for $450.00 for "supplies" for an overnight stay after cataract surgery. He questioned the hospital on it as he was checking out, and they said it looked completely reasonable to them and would take hours to track down. He said "I'll wait". 5 minutes later, the girl came back with an invoice that listed bandages and stuff totaling $45.00. They were SO sorry for the mistake. | ||
| Reepicheep |
It's a mess. The hospitals overbill people with money and that do pay, to cover people they have to help without money or that don't pay. The insurance companies are trying to just pay for their insurees, not everyone else, so they try and dicker the hospitals back down. The hospitals are worried about frivolous lawsuits, and do everything and anything to cover their behinds if things go to court (meaning a lot of potentially unnecessary stuff). When I was talking to a lawyer regarding an injury sustained by an aggressively careless driver, he told me not to pay any of the medical bills, rather I should turn them over to him. He would be able to negotiate with the hospitals as a "lump sum cash transaction" and pay less... as he was in effect acting as their collection agency against the at fault drivers insurance company (which, as goofy as it sounds, is a reasonable position). Most of the problems are rooted in the fact that the medical transaction is not just directly between the patient wanting service and the medical professional providing service. The law of unintended consequences... the more you add layers and parties to "fix it", the worse it seems to get. | ||
| Jb2 |
Reep - Things are bound to get better with all the government layers Obama just added to the equation. Come on peoples... where is all that progressive optimism?  | ||
| Azxb9r |
Bend Over Here It Comes Again | ||
| Danger_dave |
Bummer. Emergency medical treatment is 'free' here. Everyone pays a tax levy. | ||
| Hybridmomentspass |
This is an outrageous thread, and a sad one. It truly is crazy what they charge us for medical assistance. Its sad that people without insurance (myself currently included) get better rates than the people who pay in to insurance each month. 86129 - mind if I asked if they responded to your or not? And what their reply was? | ||
| Cityxslicker |
Welcome to my world. This is indeed what I do all damn day long. I play the heavy between the insurance company, the provider, the patient, and if need be collections and lawyers. The fees you quoted are right in line with industry standards and billing practices. NOBODY is going to balk, your Insurance Commissioner is not going to do anything but send you a polite form letter - It is not fraud, it is not tortious, it is not a scam against industry, state, or fed agency guidelines. Luckily for you, all the codes and billing is national. So what they do in your area... is practiced with similar zeal across the country. BHO did 'create' a new job - the HealthCare Hitman' that he mentioned in his February 2010 speech is EXACTLY what I do. When people refuse to play nice and live up to their portion of the the requirements of POLICY, Compliance, Billing, and Remittance - I am the sledge hammer that POUNDS shiate flat. (I of course charge exorbitant rates for my services ! ) However, for your case, and as a BadWebber- feel free to contact me with scanned copies of the bills, and a copy of your insurance dec page, your network area, and your contact information; I would be happy to take a look. No guarantees - but industry standard is that 75-82% of medical billing contains at least one error - sometimes administrative, sometimes clinical, sometimes treatment, sometimes lethal. Normally I only take bills in excess of 50K; because it is where the money and the lawyers are (guess who makes out bigger than your Dr? yep!) | ||
| Ourdee |
I went to the ER in 2000. I stayed for 3 days. The room alone was $63,000.00. | ||
| Cityxslicker |
ER/ICU/Critical Care with BLS (basic life services - maybe a respirator, EEG, Heart stat monitor, and a on-call staff) yep. six ways to Sunday - and depending on the actual treatment done - that service today would be in excess of 117,000. Just did one two weeks ago with an airlift for ER admit after a car crash, resultant of a DUI - 125K in facility room fees. And they are totally screwed. As it was a car accident - your work healthcare insurance is by contract writ off the hook (read your policy, most will exclude MVA - motorvehicle accidents) Next in filing against the auto policy for the medical portion.... they are denying the claim because the patient was in violation of the policy by driving drunk - and are not paying anything..... And when they get out of the hospital, the have a judge waiting for them for the resultant of garnishment of wages for the airlift, response, and HazMat clean up. They will loose their house, probably their job, and that is the upside. as much as you pay for 'insurance' it is indeed worthless. | ||
| 86129squids |
Hybrid- I never heard from the hospital. If anyone is still human there, they probably can't afford to care about me. Or, more likely, they have been instructed NOT to talk with anyone for any reason UNLESS it's from a lawyer and verifiable. Carrion eaters. Vultures. DON'T GET SICK. | ||
| 86129squids |
City- thanks for your frankness. I wish you the best in your future. Believe it or not, just finished watching "Dr. Strangelove"... somehow I think you like this movie.... Seriously, thanks, keep posting and enlightening, and keepin on. | ||
| Cityxslicker |
You know, I have never actually seen that movie. It, along with Dr Frankenstein, always came on in the middle of the late nite when I was a kid, and I could never make it through. Its raining here this weekend - again, I think I will fire up the net flicks. Ax you have been censured! because you are mucking about in places where truthiness is not appreciated. I am not a lawyer, nor am I a healthcare provider, I am NO longer an insurance agent/broker - but I know the tricks that they all play ! and it is always so much fun to trap them in their own contract language | ||
| Lastcyclone |
This thread is pretty good proof for the need for health care reform in the US. We spend more for health care than any other advanced nation in the world, but the care is not as good as most of them. How can every hospital expect thousands from a person just to walk through the door? Do they realistically expect people to pay it? Why does every doctor expect to be a millionaire? How many people or families are bankrupted each year due to lack of medical coverage? As long as health care is profit driven by mega conglomerates this is what you should expect. These giant companies are are about the bottom line, the more they pay for you and your injury or illness they less they make. Any it gets worse every year. I, like many, do have medical coverage (through my job). The payroll deduction goes up, the co-pays go up, the amount that is covered goes down. It's easy to see where the equation is headed. With four kids and regular trips to urgent care, I have bills of all sorts. None very large fortunately, but in total they amount to several thousand. As Cityxslicker points out with his insight from experience, that is not where the real money is. So after some advice from others and like many others in a simular situation I have decided to not pay any of the remaining balances. The bills keep comming or have gone to collections. This has gone on for over two years. From what I can tell it has had no impact on my credit. They can send all the notices they want, I could not care less. Junkmail. Time to take a stand folks. If something doesn't give and soon, it may bring us all down. I know there aren't many Micheal Moore fans here but if you have 90 minutes,here you go. http://topdocumentaryfilms.com/sicko/ (Message edited by lastcyclone on July 16, 2011) (Message edited by lastcyclone on July 16, 2011) | ||
| 86129squids |
Still thinking about Dr. Strangelove... Kubrick truly had a warped sense of humor, and Peter Sellers HAD to have been one of his best buddies. The other actors in it are priceless, too... BTW, Netflix sent me the movie, but I'm not sure you can stream it to your 'puter... just order it anyway. I've found that insurance is necessary for my vehicles, and just safe/smart living gets me by otherwise- I'll be riding as safely as possible given that I've been reading this thread... | ||
| Big_red_79 |
when i hit a deer with my bike, i was taken to an ER by ambulance, the ambulance crew were good, didnt mind paying the bill for them, the ER staff was good, but the DR sent me a bill for 800 bucks, i called them up told them that the DR walked in, said hi, and looked at my road rash, told the other people in there to put some stuff on it, and then left, after i voiced my concern over an 800 dollar bill, they called me back and it was knocked down to 99 bucks, and i gladly paid that, i mean after all i did sit on the paper on the exam table, and i know they used some gauze on me. | ||
| Cityxslicker |
"This thread is pretty good proof for the need for health care reform in the US. " Pity that is NOT what that last bill was. the last bill changes nothing in the game, It EXPANDS Medicaid -already a failed system It CUTS incentives for private insurance...you may think that is a good idea- until they leave the market entirely and you have nothing to turn to but MEDICAID. It continues the underpayment ratios on the fed programs, and even strips away cost of inflation upgrads... wages, premiums, and service cost will be frozen for five years. Again you may think that is a good idea- until it applies to you ie How many years would you stay in the same job with a guaranteed no raise line item that lasts minimally five years ?..... I know I wouldnt even apply for it. Those that like this 'reform' havent read it. Have no insurance background. And are entirely and wholey in the pockets of Lawyer Pacs and OBH's home town academia. Its a bad law -.... but I am going to rape it for every penny it is worth  | ||
| Whistler |
Here's an amusing update. After four phone calls and over an hour and a half on hold, I was finally able to speak to someone concerning the ER Doc's charges of $2856.00. I was first able to confirm that the amount charged is for the Doctor's services and authority only, nothing else. I told the billing service employee the Doctor's charges were excessive and outrageous. She said the charges had been calculated according to AMA guidelines and if I liked I could take a look at those guidelines on the AMA website (there's some interesting stuff on that site). I told her I thought it remarkable that doctors use their own association to validate their billing practices. She said I could send them a written protest of the invoice and they would review the charges to see if the guidelines were followed correctly. She also said she could allow an extra 30 days for my payment since it may be under review. And of course I'm still irritated my insurance company paid their portion of 70% without even blinking an eye. I'm a rookie with all this so I think it best to take a little time to mull over a game plan. At this point the one thing I know I will do is ride the CR with enthusiasm later this afternoon. That bike seems to ride much better when I'm just a little put out. | ||
| Fast1075 |
Last year I got "nearly dead" sick. I actually did TWO stays in the hospital back to back....first doctor tried to outright kill me with incompetence...the second fought to get me well again. Point is, I was taking routine medication for blood pressure and cholesterol...I had the required meds in my tote bag by my bed. The hospital would not allow me to use my own medicine...the charge for the normal maintenance medicines they administered was in excess of $3,000.00  I did stand my ground and refuse to pay for the "treatment" from the first doctor. My lawyer convinced the hospital that it would not be a good idea to try to force me to pay . If you find a good doctor, keep up with him or her...it is damn hard today to find one that sees past the chart and the accounts receivable ledger. A year after being released, I sent a pound of genuine Kona beans to the doctor, and a pound of fine Kenyan beans to the nurse staff that took care of me....they took me from death's door to healthy enough to risk dragging knee... | ||
| Bads1 |
To many people without coverage= we have to pay for them. People having welfare children,people walking into the emergency room's with nothing more then a sniffle. Also walkin clinics. The list goes on and on. | ||
| Cityxslicker |
oh it is worse than that. the AMA 'OWNS' the CPT, HCPC, DME codes in the same since that a singer 'owns' the song, lyrics, and riffs to a song that is down loaded via say iTunes. And try and do a preemptive price search, when there are twelve to twenty different codes, modifiers and outliners for say 'appendectomy' and the rates are different by locale, contract, and payor. it is its own language. And they are holding the dictionaries hostage. the own the training to learn to code, and the software to do the billing for the codes too. | ||
| Court |
>>>>>.... but I am going to rape it for every penny it is worth And you are not alone . . . GAME ON. When you put that much money out that folks loose interest in anything to do with health care and focus on those $$$. Nephew is making just shy of $500K/yr covering the asses of Apple, Cisco and some airline. Follow the money . . . | ||
| Reepicheep |
That's the fire, the gasoline thrown on it is that the transaction is less and less between the person getting a service and the person giving a service. Adding a federal bureaucracy in the mix makes it exponentially worse. It's a guaranteed path to the an expensive and low quality experience, and will you pay for a lot of people that are completely uninvolved in making you better. (Message edited by reepicheep on July 20, 2011) | ||
| Whistler |
Well we finally reached a conclusion with the Emergency Room doctor's invoice. After receipt of my protest letter they waved the remainder of the fee. Meanwhile, I had also been sent a new invoice for two assistant doctors who supposedly helped during the surgery. This was news to me as the surgeon never mentioned anything about needing or using assistant doctors during the operation. My insurance company denied the claim so they came after me for the money, about $3800. I told them to go fish and suggested they talk to my insurance company. They sent me a letter reminding me of my legal obligation to pay. I never had a chance to reply but a few days later I received an adjusted invoice. They reduced the charges from $3800 down to $100. I think it interesting they made that reduction but still invoiced me for $100. Unless they can prove they were in the operating room and actually helped the surgeon I doubt I will send them the $100 either. It's all such a game. |
