That happened to my Uncle. We never got a bill until after they turned it over to a collection agency, well over a year later. I sent them back the address of the cemetery where he was buried...

quote:

Originally posted by a1abdj:
Maybe patients need to start requesting signatures from the professionals the same as they request them from us.

Perhaps a form that the doctor signs that says he, the facility he's operating out of, any other parties he requests be present, and any of the supplies he uses are all covered by your plan. Any bills that are not are their responsibility.

Why the h are there "networks" to begin with?

In a related issue my regular dentist is not in the Medicare advantage network. So I am keeping my previous separate dental insurance. It would be nice if big dental bills would then have double coverage./

quote:

Why the h are there "networks" to begin with?

^^^^^^^^^^^^^
This is called one aspect of MANAGED CARE. Blame your insurance company. To be part of the network the doctor must fill out tons of paperwork to be credentialed wait six months and then agree to a discounted fee. The insurance company then pays 80 percent of the discounted charges. Believe me, the doctors did not come up with this mess. The patient has less of a cost seeing a network doctor.

quote:

The total bill: $96,377 for the surgery was billed by the hospital, Sky Ridge Medical Center in Lone Tree, Colo., part of HealthONE, a division of the for-profit hospital chain HCA. It accepted a $3,216.60

This is the other problem.

This practice sucks. There should be a single point of contact at the hospital ensuring everything is under the insurance plan just like a general contractor.

quote:

Originally posted by ZSMICHAEL:

quote:

Why the h are there "networks" to begin with?

^^^^^^^^^^^^^
This is called one aspect of MANAGED CARE. Blame your insurance company. To be part of the network the doctor must fill out tons of paperwork to be credentialed wait six months and then agree to a discounted fee. The insurance company then pays 80 percent of the discounted charges. Believe me, the doctors did not come up with this mess. The patient has less of a cost seeing a network doctor.

Exactly.

I'm onboard with the fact health insurance & politicians are a majority of the problem.

What I'm having trouble processing is how health-care providers knowingly bring 3rd party non-covered assistants into the treatment of a patient, fully aware the patient is going to be billed for care that isn't covered nor that they were advised would be billed.

As a mechanic providing repair services to a customer at an agreed-upon price, my adding a sub-contractor to the job who plan to demand payment & will sanction the customer long-term is not ethical.

Some of the feedback here indicate there are health-care providers that put some effort into hiding this from the patient until the bill comes.

quote:

Originally posted by a1abdj:

quote:

The total bill: $96,377 for the surgery was billed by the hospital, Sky Ridge Medical Center in Lone Tree, Colo., part of HealthONE, a division of the for-profit hospital chain HCA. It accepted a $3,216.60

This is the other problem.

Indeed. 100k for a 20 minute surgery.

quote:

Originally posted by soflaac:
I'm onboard with the fact health insurance & politicians are a majority of the problem.

It has been that way since Obozocare, and they are meant to be part of the problem. So they can be part of the solution. Single payer.

As fate would have it, just received a bill today for care my wife received relating to her emergency surgery a couple months ago.

The vultures in the health care field (surprise billing) look remarkably like the vultures in the insurance field from my house.

I had a similar experience after my last surgery - everything was covered except an assistant. They sent a bill and I told them I wasn’t going to pay it because I had no contract with them. If they wanted money for services they should have cleared that with me first.

Never heard back from them.

I ran into the same issue several years ago. I had a surgery and several months later I received a bill from an unknown "surgical assistant" that billed more than the actual surgeon. I tossed it in the trash and never heard anything again.

Honestly, I think it's a buddy system of sort. "Hey, I'm doing a surgery tomorrow wanna come along and send a bill too?" They then send a bill. If it gets paid awesome if not I'm not gonna push it.

My favorite story of medical billing:

My ex had to get a MRI. She found a place in network who warned her it was still going to cost $750. She said okay. A week later they called to confirm the appointment and to let her know it was going to cost $750. I guess a lot of people are shocked at their copay. My ex said she knew and was okay with it. The day of the MRI my ex goes in and they tell her it’s going to be $750. She told them she knew and paid the $750 and got the MRI. Two months later we get a bill for a few hundred bucks. We call the place and get told that they realized they could charge more because they did some procedure there that qualified them as a hospital.

No matter how often you ask apparently nothing is enough. I have no idea how it’s legal to quote a price, take payment, preform the procedure and then come back later and demand more.

quote:

Originally posted by DaveL:
I had a similar experience after my last surgery - everything was covered except an assistant. They sent a bill and I told them I wasn’t going to pay it because I had no contract with them. If they wanted money for services they should have cleared that with me first.

Never heard back from them.

I did the same thing when I had a procedure that the doctor had assured me was fully covered. He used an anesthesiologist that tried slamming me, claiming she didn’t accept my insurance. I told them they made that arrangement without involving me so they should work out her bill the same way. Never heard from either again.

quote:

No matter how often you ask apparently nothing is enough. I have no idea how it’s legal to quote a price, take payment, preform the procedure and then come back later and demand more.

^^^^^^^
They should have accepted the agreed upon price. To me it seems like a verbal contract. It is very poor business practice.

quote:

It is very poor business practice.

Seems to be normal.

Here's something that just happened to me that's in the same vein, but the opposite.

Needed an MRI, and was going to have it done at the Hospital's facility with insurance. They told me my portion would be $968ish, and I agreed. Just like Pale Horse's story goes, they called me about a week out to confirm the appointment and remind me of the $900+ I would owe and that they expected up front. The day of I go in, paid their fee, and got the MRI.

Eventually I get an explanation of benefits from my insurer which I usually don't even look at. I opened it this time and saw that the insurer was presented with the $900+ bill, of which they paid their negotiated amount, leaving me with $400 as my responsibility.

The hospital billed me the total in full, collected from me, then turned around and billed the insurer, collecting from them as well. Do you think the hospital caught that mistake? Apparently they use the same computer system the government does. If you owe them a fraction of a cent lights flash and bells ring, but when it's the other way around they don't even have a button on their computer that takes them to that screen.

After going around and around and around I simply reached out to my insurer. They got it straightened out.

^^^^^^^^^^^^^^
I agree that errors like this are much too common. Glad you got it worked out. I have had to do the same all too frequently. Overpayments should be promptly mailed to the patient. In the future call the Hospital Administrator. They have the power to correct the error on the spot.