Being a patient in a hospital is punishment enough. Trying to sort through 47 pages of billing is worse. The hospital billing department likes to send bills with demands to pay whatever sum they assume you owe. A good portion of the time the bill was never sent to the secondary payer or was coded incorrectly. I am fortunate in that I work within the health care field, but pity others who must wade through this mess. I can see why folks of means hire someone to sort through the bills, deal with the hospital billing department and reluctant third party payers. I would be interested in hearing from others regarding their experiences.

As a physician, I agree that this the process is convoluted, confusing and requires great effort to untangle. I really have no idea how older folks in particular avoid overpaying or getting sent to collections, because they do not understand the bills they receive nor do they have access to appropriate resources to help them sort thru the process. No real answers on my part, although many times the patient's insurance carrier will provide ombudsman type help and usually the hospital offers such services as well - but only if they are approached for same. On a similar vein, our whole tax system is another morass that needs to be cleaned up. Requiring accountants or tax services to help fill out a tax form means that the system is to complicated.....

Handled a case where my client was sued for about $10,000.00. Again, a mess of a bill.

After reviewing everything, took the case before the Judge. It didn't take long after I showed the Court that they were asking $20.00 for one Tylenol pill(mid-90s). One out of many. The Judge requested an explanation and none was given. The plaintiff requested a continuance to consider settlement.

Settled the case for about $200.00.

That was some angry Judge, if I ever saw one. Literally, went bipolar on the plaintiff.

and it's not just a single bill for the hospital. No, you're getting a separate bill for every doctor who even stuck his head in the door of your room, even if you don't remember seeing them.

What kills me is how they can’t tell you how much something will cost before they do it.

Now I get that some stuff can be complicated but my wife went to get an MRI a couple years ago and was told that we owed $750. She was told that when she booked it and when she went for the procedure, where she paid the $750. A few months later we get a bill for $250. Why? Oh, well it seems that this office also does some other shit that allows them to classify themselves as a hospital so they can charge more for the MRI than a normal MRI place. Somehow they didn’t know that when they told us it was going to be $750. But of course they still expect us to pay.

If she’d drove a mile down the road it would have been $750.

quote:

Now I get that some stuff can be complicated but my wife went to get an MRI a couple years ago and was told that we owed $750. She was told that when she booked it and when she went for the procedure, where she paid the $750. A few months later we get a bill for $250. Why? Oh, well it seems that this office also does some other shit that allows them to classify themselves as a hospital so they can charge more for the MRI than a normal MRI place. Somehow they didn’t know that when they told us it was going to be $750. But of course they still expect us to pay

Thank Medicare for that one. It allows doctors who use an office supplied by the hospital to charge an additional "facility fee". It has had the effect of making it very hard for independent physicians to get by, since they are not allowed to bill that fee. The whole billing process is deliberately kept obscure.

quote:

Originally posted by zoom6zoom:
and it's not just a single bill for the hospital. No, you're getting a separate bill for every doctor who even stuck his head in the door of your room, even if you don't remember seeing them.

To make things even a bit more complicated other than what you mentioned. I was in the hospital a few years back for a couple of months and having been kept sedated a portion of the time, there were instances I had foggy memories of several visits from folks as you mentioned dropping in a glancing at my chart, mumbling a few things, and many visits from doctors I had no recollection of them at all and not consistently on my particular case. Luckily I did have an excellent corporate insurance plan that paid mostly everything to include a $12,000 chopper ride, and thank my lucky stars that I had good insurance for some of the reasons mentioned above.

Ugh, I don’t want to know how bad I got screwed last year when my appendix decided to shit the bed on me. I had just moved to another state 5 days prior, insurance only covered part of my expenses. The sum of 4-5 bills added up to just under $32k for a simple procedure. I was left owing ~$12k after the dust settled. Got nowhere with my insurance carrier, hospital gave me some forms to fill out to see if I would qualify for a reduced settlement. In their eyes I earn too much, glad somebody thinks I do. Ended up paying the balance owed, kitchen remodel setback a year...

I often wonder if there was more I could have done or still could do to recover some money, but the time and effort may not be worth it.

To further obfuscate things, with insurance there is in and out of plan, approvals and coverage (or not) for doctors, hospitals, procedures, medications, medical equipment, etc. Then there are premiums, deductibles, copays, out of pocket expenses, maximums, etc.

It has become nearly impossible to shop for insurance because you can't tell what a plan will cover. The care provider has to submit a bill before you can know how much your insurance will pay.

Then there's the amount the provider charged, what the provider and insurance company agreed it's worth, what the insurance paid, and what you pay.

My prostate cancer has returned, evidently radiation did not get it all. Urology doc and I are discussing treatment options. Two of the possibilities are covered by my insurance.

The third option, HIFU (High Intensity Focused Ultrasound) is partially covered and my copayment could be anywhere up to maybe ten large. Doc told me this in very vague terms. I have asked his clerical staff to have their billing department touch base with the insurance carrier to give me a firm quote. You think they will do this? Hah! All I get is "maybe," "it depends," and various other run-around crap. Basically, doc's office wants me to sign a financial responsibility form stating that I will pay for anything that the insurance does not cover, but they will not nail down the cost of a procedure that they offer.

I am guessing this is what your Doc wants you to sign:

An Advance Beneficiary Notice (ABN), also known as a waiver of liability, is a notice a provider should give you before you receive a service if, based on Medicare coverage rules, your provider has reason to believe Medicare will not pay for the service.

For what its worth, I did see that standard Medicare, not Medicare Advantage will help cover the procedure. I have copied and pasted an article which may be of help. The article is here below:


New Reimbursement Code Makes HIFU for Prostate Cancer More Affordable and Accessible to Patients and Draws New Interest From Physicians
Posted on: September 1, 2017
The first Medicare patients to be treated with HIFU for prostate cancer since The Centers For Medicare And Medicaid Services (CMS) issued reimbursement code for non-invasive HIFU treatment.

CHARLOTTE, N.C., Aug. 24, 2017 (GLOBE NEWSWIRE) — HIFU Prostate Services, LLC (HPS), the leading provider of HIFU technology to physician practices in the United States, is excited to announce that physicians in their network will treat five patients this week under their new Medicare program. This is a significant milestone as it means that HIFU as a treatment for localized prostate cancer is becoming more accessible to men in the US and to physicians interested in providing their patients with non-invasive treatment options.

“We feel this is a very meaningful announcement that will go a long way in moving HIFU as a treatment for prostate cancer more into the mainstream within the medical community,” said John Linn, chief executive office, HIFU Prostate Services. “Within the first month of the announcement of the code, we saw a substantial increase in inquiries about HIFU and already have a waiting list of Medicare patients.”

The patients this week will be treated by John Jurige, MD in Louisville, Ky. and by Dr. Michael Lazar, MD in San Francisco, Calif. HPS has plans to treat additional Medicare patients later in the year, including at hospitals in N.C. in early September and additional hospitals in the near term.

Jurige and Lazar have both been performing HIFU for more than 10 years so they are especially encouraged to see the treatment become more accessible to men with prostate cancer.

“We are pleased to offer Sonablate HIFU, with its advantages of precise prostate cancer ablation and minimal side effects, to a larger group of patients with Medicare coverage,” said Jurige. “Medicare and other payers are beginning to recognize the benefits and ultimate cost savings of this highly advanced therapy option.”

“At last, after more than 10 years, Medicare has issued a facility billing code which will cover most of the expense of HIFU,” said Lazar. “This remarkable technology will now be available to Medicare beneficiaries with prostate cancer at a fraction of the cost.”

The Centers for Medicare and Medicaid Services (CMS) issued the C-code C9747 in July for HIFU ablation of the prostate. A C-code is a part of the CMS standard coding system, called the Healthcare Common Procedure Coding System or HCPCS. C-codes are unique temporary codes that are only valid for Medicare claims for procedures performed in a hospital outpatient facility or ambulatory surgery center. This means the reimbursement code does not apply to procedures completed in an office setting or to services provided by a physician. The code only provides reimbursement to the hospital or ambulatory surgery center.

At this time, the code does not apply to commercial insurers; therefore, patients not covered by Medicare seeking to pursue HIFU should expect to pay treatment expenses out of pocket. For more information on reimbursement and coding visit https://www.hifuprostateservices.com/reimbursement/.

“In the near future, we anticipate making HIFU available at up to 25 more facilities throughout the country,” said Linn. “We see it as an important step towards bringing the revolutionary prostate cancer treatment to more men facing a prostate cancer diagnosis.”

About HIFU Prostate Services, LLC
HIFU Prostate Services (HPS) was founded to provide men access to a less invasive treatment option for prostate cancer that has the ability to eliminate cancer and preserve patient quality of life. Our mission is to deliver the highest quality of care, support, and technology to the patient and to the urology community for the treatment of localized prostate cancer using Sonablate® HIFU. The company is headquartered in Charlotte, NC and with locations in 12 cities throughout the US. Learn more at http://www.hifuprostateservices.com.

Hope this helps.

It should be illegal for a business to sell products or services that they can not price up front. Period.

Towing companies used to catch a lot of flak over just presenting a bill (usually outrageous) after towing a car. Laws were then passed that mandated a fee schedule be available so that somebody could view and/or negotiate the charges prior to accepting service.

What makes the medical community any different?

quote:

Originally posted by ZSMICHAEL:
"has issued a facility billing code which will cover most of the expense of HIFU"

This is exactly what my problem is. I can not get a straight answer to my questions about

1. Total cost of the procedure,
   
   
2. How much of the total is covered by Medicare Part B and my United HealthCare Plan J Medicare Supplement,
   
   
3. Subtracting Item 2 from Item 1, my co-pay, and
   
   
4. Any other miscellaneous charges, including but not limited to, anesthesiology, facility charges, and anything else.

I would think that a Urology Group that has done this procedure numerous times would be able to tell me these costs, up front. But no, they are obfuscating. Whether it's laziness on the part of their billing department, or an attempt to hide the costs until after the procedure, requiring me to sign an acceptance of responsibility for undisclosed costs, I don't know their reasons, but it's pissing me off.

When I got out of the Navy I had some surgery done by a VA doc up in Raleigh NC. I had a friend drive me back home as I was supposed to take it easy for a few days. (This was throat surgery).

The second day I was home I sneezed and felt a little "pop" in my throat. Next thing I know blood is pouring out of the surgery area in my throat. There was enough that I was concerned so I quickly asked a friend next door to drive me to the emergency room.

She gets me to New Hanover Hospital in Wilmington and the emergency room staff sees me holding a bloody towel against my mouth and ask what's wrong. Turns out the surgeon had nicked a blood vessel and when I sneezed it let go.

A few minutes later they tell me that they have no one there who can help me and get this... I have to drive myself to a ENT who will help me. My friend was still there and she got me over to the ENT specialist. The doc was great and removed the huge clot that tried to form and produced this coagulant spray that he applied to the bleeding area. About fifteen minutes later I was fine and was able to leave.

So I think everything is fine until about two weeks later I get a bill from NH Hospital. It's a bill for emergency room services for $500.00.

I call the hospital and tell them there must be a mistake as the emergency room didn't do anything.

"OH, NO!". They say. "The nurse took your temperature which constitutes emergency services"... I thought they were kidding but they pursued me for several months even to a collection agency before the ENT shamed them into dropping the charge.

quote:

I would think that a Urology Group that has done this procedure numerous times would be able to tell me these costs, up front. But no, they are obfuscating. Whether it's laziness on the part of their billing department, or an attempt to hide the costs until after the procedure, requiring me to sign an acceptance of responsibility for undisclosed costs, I don't know their reasons, but it's pissing me off.

Every time you call an insurance company they read a disclaimer stating that a final determination will be made once the claim is submitted and there is NO guarantee of payment. I would press the matter further and ask the Urology billing department how many procedures they have done for Medicare patients. As you know if Medicare pays, then United Health pays up to the Medicare allowable. Good luck.

quote:

Originally posted by a1abdj:
It should be illegal for a business to sell products or services that they can not price up front. Period.

Towing companies used to catch a lot of flak over just presenting a bill (usually outrageous) after towing a car. Laws were then passed that mandated a fee schedule be available so that somebody could view and/or negotiate the charges prior to accepting service.

What makes the medical community any different?

The medical community is "special". They tell us they know guns are evil and must be banned.

However they sidestep the issue over medical blunders that kill nearly a half million people each year. They call it "Complications".

I keep everything for the year in a binder and scrutinize the EOB statements closely. I have had more than a few bills that were much larger than I expected and I found that they were rejected on the EOB because they filed incorrectly or such. I also get the names of anyone I talk too and jot that down and the time I talked to them.

it is also important to understand your policy, requirements, and use tier 1 network providers whenever possible. Just because someone accepts your insurance does not mean they are a tier 1 provider. For us we need pre approval for any outpatient diagnostic imaging and it pays to shop around for that.

quote:

Originally posted by zoom6zoom:
and it's not just a single bill for the hospital. No, you're getting a separate bill for every doctor who even stuck his head in the door of your room, even if you don't remember seeing them.

That happened to me,came by an open door of my room as I was recovering from kidney stones.
He said [how are you doing] I said [sore]
Billed me a month or so later after insurance and co pay was done.

quote:

Originally posted by V-Tail:

quote:

Originally posted by 45 Cal:

quote:

Originally posted by zoom6zoom:
and it's not just a single bill for the hospital. No, you're getting a separate bill for every doctor who even stuck his head in the door of your room, even if you don't remember seeing them.

That happened to me,came by an open door of my room as I was recovering from kidney stones.
He said [how are you doing] I said [sore]
Billed me a month or so later after insurance and co pay was done.

1. Find his office address.
   
   
2. Stop in and say "Good Morning, how are you today?"
   
   
3. Send him a bill.

He would pay me just as I paid him,$400 + I suppose he needed to send money to India