Scared to pay hospital bills

The BBQ Pit
21

I had a breast reduction in 2001.

Now, as I understand it, coding the form for a breast reduction is confusing. In reality, each breast is considered its own seperate surgery, so the insurance claim form should state that I had two bilateral reduction mammoplasties.

I guess, tho, there is another little box you can check for a breast reduction, although I don’t really know what it is.

Anyhoo, I went for over a year occassionally getting a bill for over $13,000 from my surgeon’s office. So I’d call my insurance company to find out what was wrong. And they’d tell me it was coded incorrectly. So, I’d get a name and number of the person I spoke to and call the business office at my doctor’s. Tell her the problem, and tell her who to call at BCBS (or vice versa. I dunno. I tried to hook them up so many times, I can’t remember).

Finally, I got exasperated and got my HR department involved. That finally got the situation taken care of, but I got this explanation from my HR rep:

Apparently, the business office at the docs repeatedly submitted the paperwork incorrectly such that it looked like I had *three boobs reduced at one time * (now, they did take off 6 lbs, so one could see it that way… ). BCBS, understandably, denied the claim, saying that paying for the reduction of a three-breasted woman was not in their policy. And the two offices would go back and forth, back and forth, never seeming to take the time to make a damn phone call and clear the situation up.

In the end, I needed to redo my surgery (another 3 lbs off!! Whoo hoo!!!). But when I contacted my doctor, she said, “Considering you haven’t paid your bill for the last one, I’m hesitant to perform the surgery again.”

WTF??? The reason my bill isn’t paid is because your business office won’t pull their heads out of their asses!! (Not to mention the fact that I had to do the whole thing over because she fucked it up in the first place. But that’s a rant I’ve spewed elsewhere and will spare you.)

So, I told her - effectively - to shove it and went to another doctor who knew - and who’s business office knew - what the fuck they were doing.

Oh, and I did get sent to collections twice by the same fuck ups. Even after I made sure that the payments I made (wholly in order to keep from going to collections whilst this cluster fuck worked itself out) were acceptable.

Fucktards.

22

First off, Maureen: You can make numbered lists with vbcode by using the “LIST=1” tag…

Second… :slight_smile:

OK–in your first sentence, you say everyone is charged the same amount, and in your second sentence, you appear to say that, while insurance companies are charged the same amount, they’ve reached an agreement with the hospital that allows them to only pay a fraction of what they’re billed.

If that’s what you’re saying, I don’t think there’s a practical difference between the two (be sure to remove any Goggles of Beuracracy +1 you’re wearing when you read the two sentences ;)).

In any case, there have been a lot of succesful lawsuits on the topic, and it’s been well reported on, so I think it’s fair to say that, in practice, hospitals do charge the uninsured substantially more then they charge the insurance companies for providing the same survices to the insured.

23

No. They charge the insurance company list price. The insurance company pays the agreed upon, contracted rate. The hospital takes a write off for all but however much of the allowed charges they are going to bill the patient. The claim goes out the door with the same exact price they bill uninsured patients. And, yes, there have been plenty of successful lawsuits on the subject. I’m sure that has nothing to do with why the hospital increases its fee for services at all :rolleyes:

24

That’s my beef, too. Listen, I know that there’s plenty of people who abuse the system, and I know that what with Medicaid, Medicare, multiple insurers, HMO’s, and whatever, that this is pretty damned complicated sometimes (another argument for nationalized medical care?). And I know that you have a tough job. But I demand that you treat me with the courtesy and respect I deserve as a human being unless I demonstrate otherwise before you automatically pull out the big stick of the collections agency.

One example: We received a bill from my wife’s physician for treatment she never received. A simple clerical error, no big deal. My wife calls to let them know, expecting “Oh, I’m sorry Mrs. Yorick. We’ll look right into it.” Not on your life. She’s treated like we’ve never paid a bill on time and threatened with legal action.

Next month, another bill for another procedure she never received, and now it says payment is 120 days late even though our previous bill 30 days prior said nothing about it. Listen, I write software for a living, I know software screws up, I know you didn’t intentionally try to make our lives miserable. But could you, maybe, look at her chart first, before assuming that your medical software is as infallible as the burning bush?

That’s what chaps my ass. I’ve dealt with billing snafus plenty of time, but medical billers are in my experience the most arrogant, least helpful personnel I’ve encountered so far.

Granted, though, I’ve never been in hock to a loan shark.

25

Also, is it CLEAR to people that they can arrange a payment plan to attempt to give the hospital at least something? It’s not that it’s defensible that if you’re living on the breadline and get 57 scary and complicated bills you might just hide, but it’s sort of understandable that some people can’t cope.

26

Actually, a friend of mine is in this position right now. She’s unemployed, and her unemployment benefits ran out in January. She has an arthritic condition that precludes her from working retail or any kind of job where she’d have to be on her feet for hours at end, and she cannot find work in her field. She has no income and she lives with her parents who are themselves struggling. She does $15 mystery shopping jobs just to have enough money to pay (out of pocket) for her prescription medication for the arthritis.

She went with a girlfriend to visit the girlfriend’s family down in Tennessee. The girlfriend was going anyway, so my friend did not have any expense related to this trip. After arriving at the family’s home, my friend got sick and ended up in the hospital where she had to have her gallbladder removed and due to complications, she was there for 9 days. Because she was honest about not living in Tennessee or a neighboring state, Tennessee’s medical assistance program wouldn’t cover her. And because she lives in New York, which has no reciprocal agreements with Tennessee, New York’s medical assistance program wouldn’t help either. She came home and the first bill beat her to her doorstep – $32,000.

Now she’s faced with a choice: send the hospital some paltry sum or buy her prescription. Her parents cannot help her, they’re robbing Peter to pay Paul – or more accurately, robbing ConEd to pay the mortgage – as it is. What should she do? She’s still trying to find a job, something complicated by the fact that she’s now recovering from surgery and the associated complications, which put something of a damper on her enthusiasm to pound the pavement submitting resumes.

Is she just a deadbeat because she is making the Hobson’s choice to buy the medication that keeps her functioning from day to day rather than send some distant hospital $5 a month? (Realizing that even if she were sending $100 a month, it would be 26 years before she paid that bill off.)

That’s a difference without a distinction. What it boils down to is that if I go into the hospital with my wonderful insurance and have my gallbladder removed and have complications and end up staying for 9 days, my insurer will pay the hospital far less than the $32,000 they expect from my friend, and will pursue her over until she pays or dies. That there may be programs from which she can beg the money to pay the bill, it still comes down to this: the amount the hospital expects to receive to render care is greater when the patient uninsured.

Whether or not there is an “insurance price list” or an “agreed upon contracted rate” it still boils down to a functional reality of two different price lists. It makes no sense, and hopefully the newest spate of lawsuits will end the discriminatory practice once and for all.

27

I had no idea it was illegal. If you think I was cranky before, look out! :mad:

28

Of course not. What happened to your fried sucks, no doubt about it, and I empathize with her situation. Trust me, I would be happier than most to see the system revamped (please see Dr. J’s thread). But…do the people who helped your friend not deserve to get paid for the work they do? You expect to be paid for doing your job and doing it well, yes? So should nurses, phlebotomists, orderlies, etc, work for free? Cuts come from the most obvious source: staff.

Actually, no. Hospitals see patients who have insurances they are not contracted with, as well as insurances they are contracted with. Those non contracted insurances are expected to pay at 100% of billed charges, or whatever the patient’s out of network rate happens to be. It is not just uninsured patients that providers bill at 100%. See what I call the “Medical Mafia” in california: Emergency Physicians (I wont use the name of their group), and several anesthesiologist groups who flat out refuse to contract in order to get 100% of their charges paid. If that’s not a lawsuit waiting to happen, I don’t know what is.

Explain to me how it’s discriminatory? Providers bill their charges at 100% to all insurances and patients. Due to a contract, they agree to adjust off close to 2/3 of their fees. No, not out of the kindness of their hearts, in order to get referred more patients. As a result, claims are denied due to all kinds of interesting reasons, most of which boil down to: hospitals operate on a shoe string.

I realize all this is frustrating, and it’s easy to point a finger. I’m not saying administrators are blameless; not. at. all. But saying “it’s all greedy hospitals and doctors” is just bullshit.

29

Yes, ma’am, jsgoddess, it certainly is. Tell them you’re reporting them to the HealthCare Finance Administration and requesting that your insurance company does an audit. See how fast it changes.

30

I agree. I had a minor operation some years back. My insurance covered it, save for the deductable.

But you would not believe the number of bills that were sent to my house. I ws till getting odd bills a full 6 months after my insurance paid up and after I paid what I thought was left. Bills for stuff I didn’t know about, for doctors that I never saw (“well, we showed him your EKG, so he had to bill you!”) I swear, you’d have to have an accounting degree to make sense of all the paper that they sent me.

I think maybe that was the point.

31

Can you make a behind-the-scenes contract with a hospital to provide you with a discount on their services?

No, you can’t?

Neither can I.

But an insurance company can.

That sums it up.

32

I agree that this situation sucks, but it’s not really discriminatory. It would be like working with a store that sells widgets (for an incredibly bad example). You tell them that you will send them 20 customers every month, but only if you can get a mark off of the widgets (paying $20/widget, rather than $35). They agree to that deal because they’re guaranteed 20 extra customers every month. The other customers still have to pay that $35/widget.

That is a terrible example, but the best one I could come up with. The hospitals make the deal with the insurance companies because they are guaranteed payment; it might not be the full amount, but they are guaranteed something. Also, hospitals get to write off the remainder that is not paid by the insurance company for grants and the like.

33

That is the most ridiculous thing I’ve ever heard. Well, no it isn’t but it certainly is on the list. “The hospital is descriminating against me because they entered into a contract with an insurance company and not with me!” :rolleyes: Are you going to refer 500 patients or so every quarter to them? Are you willing to pay them a certain amount for services rendered in 45 days or less? You sign paperwork saying that you understand that YOU ARE RESPONSIBLE FOR ENSURING PAYMENT OF YOUR BILL. It’s right there on the admission form. You want to explain to me how it’s descriminatory that you be held to something that you agreed to?

Look, I will say it again. I absolutely agree that the system is busted. It needs fixing. Any suggestions? Have you any ideas? If so, I’d love to hear them. Suing hospitals senseless isn’t going to do anything but drive the prices up, and make them even more twitchy about seeing people who are uninsured. (“Send 'em to county, we can’t help them” infuriates me.)

Socialized medicine has been overturned time and time again. Everyone says they want it, but no one is willing to fight for it. Certainly, no one is willing to pay for it. Because it would come from…where? That’s right. TAXES. And no one wants higher taxes. The money is not going to appear out of the ether. It comes out of taxpayers’ pockets. Medicaid programs exist hand to mouth as it is. They can only pay pennies on the dollar, and there are more and more applicants every year, as well as longer lists of disallowed “elective” procedures (explain to ME how a knee replacement for a woman with zero cartilage is elective). I am as big a patient advocate as you will find. But you cannot tell me it’s all the hospitals’ and providers’ faults. It is not true. Look, they have to operate, too. And, like it or not, it takes capital to do that.

Maybe you can explain to me why someone is willing to go out and pay $40 for a great meal, but they’re not willing to pay their doctor the same amount to get out of bed at 2am and take care of them?

Again, if you have any suggestions besides “sue em all!” which fixes absolutely NOTHING, I’d love to hear 'em.

34

It’s almost a relief reading this thread-- like lancing a butt boil:

125A-3684 ----- Office Procedure (not covered) ------ $935

Since we have the kind of insurance that only kicks in if one of us is hit by a falling meteor, I always ask up front what everything is going to cost. Medical billing is so opaque and seemingly capricious though, that it hardly helps.

We recently got a bill for an office visit for $129 and then another for the follow up visit for $182. WTF? The second visit lasted about 5 minutes, the first more like 20. Numerous calls for an explanation have yielded exactly zip, so rather than let the bill get turned over for collection, we paid the damned thing. The sarcastic woman in billing assured me, in that snotty tone reserved for the most egregious deadbeats, that she really had “no idea” why, but “the statement is correct.” She either can’t or won’t do anything except put my “concern” into the black hole she calls “dispute.”

After they finish up with jsgoddess, they can bite me too.

35

Harleen, that was directed at TeaElle, not you.

36

That’s bullshit. Being on the low/no income program, you really shouldn’t have to pay for anything. Have you tried calling the insurance co? That may not be any better than the hospital runaround, but if you get the necessary information, it may make your fight a little easier for you. If you can, and are so inclined, try to find out if they denied charges with “member held harmless.” If that’s the case, it’s a big no-no for the provider to bill you.

37

Since you are so well aware of this, you may want to enlighten the “dumbasses” since not everyone is as well-versed in insurance-speak as you. If you are not going to submit claims properly, then just give the paperwork to the patients & tell them to do it. They’d probably actually get the billing correct.

38

They probably have a set dollar amount per procedure. Did they only bill for the office visit, or did they add the “extras,” too?

On second thought, this may be stepping into the realm of too personal. Feel free to tell me to fuck off, if need be.

39

You are slime.

Pure slime.

You are a phlegmbag who is venomously pointing a finger at others and when your corrupt industry is called out for not doing insurance billing correctly, your answer is to call people dumbasses and not to do the coding and biling accurately.

I hope you get fired and are put into the position you so blindly and moronically pit.

40

Nope, the other stuff was itemized (the entire bill was a gruntload more than just the office visits). The two charges for “office visit” and “follow up office visit” are what is so incomprehensible.

I swear, unless I’m dying, I’m going to rely on grandma’s remedies and prairie medicine from now on.