How do I fight an unfair medical bill?

Just looking by people with experience in the hospital or insurance field on how to negotiate.

Story is Cad Jnr. breaks a tooth (on his birthday no less). We call the nurse practitioner hotline for the insurance who for the sake of anonymity I will call Indigo Cross Indigo Shield. The NP basically was “OMFG!!! You need to get him to an emergency room right now!” When I asked if she was sure considering it wasn’t bleeding the reply was a diplomatic form of, “What do you not understand about RIGHT FUCKING NOW!!!”

So after an hour and a half in the waiting room, what I expected to happen happened. Blood pressure and temperature taken then the doctor comes in and said, “What are you here? You need to see a DDS although he did give a few samples of a pain killer for him.”

Total cost: $350
Total cost to me: $230

I really do not want to pay this bill for two reasons.
The NP clearly gave bad advice making us go to an ER late Sunday night considering we could (and did) got an emergency appointment with a DDS less than 12 hours later.
$350 for a blood pressure and temperature and no treatment and a few free samples. Not acceptable. Yet again, the proof that the real problem with health care is the excessive price the practitioners charge assuming insurance will pay for it.

So how should I deal with BCBS . . . oops ICIS and the hospital to reduce or eliminate the unnecessary and excessive bill?

Your issue is that ICIS told you to go to the ER, so you want ICIS to pay more for that “bad” advice. You may have a difficult time trying to prove the NP’s advice was “bad” though, especially based on a phone call description of the injury.

So I don’t know if this will actually help reduce or eliminate your portion of the bill, but request (in writing, of course) the call report from the ICIS NP and an itemized bill from the hospital. Review both. You can always try to negotiate the hospital bill down. Sometimes you get double-billed or charged for things that never happened or charged $98 for an aspirin, but the odds are against you. You can also try to negotiate with ICIS. How did they justify paying only $130 on a $350 bill? Their “usual and customary” charges vs. the hospital’s?

The hospital and insurance companies do this because they can. You may just have to eat this one and call your congresscritters to pass healthcare reform with the public option for the next one.

This is not legal advice. I am a lawyer, but I am not your lawyer, or anyone’s else lawyer. I am probably not even licensed to practice in your state and because this is a free and anonymous message board, I may even be lying. Conduct yourself accordingly.

I have Blue Cross Blue Shield but didn’t realize I needed to call an insurance company nurse practitioner representative to get advice on something like a broken tooth before receiving treatment. I just go to the docs that take the insurance and get treated. Is this SOP? I didn’t even realize they had this front end gate-keeping requirement.

It depends on the insurance company. Many have started “mandatory pre-authorization” and will cut (or eliminate) payment if their steps aren’t followed.

To give a particularly horrific example, a kid (that used to work for me some years previous) keeled over for no apparent reason outside a movie theater. The ambulance took him to Chamber of Horrors Medical Center, our local hospital (no longer in business). When checking him over, they decided he needed an immediate quadruple bypass and prepped him for surgery.

When his insurance found out (I think it was Indigo as well), they told him that they would not be covering his “procedure” because he didn’t wait 24 hours and have the mandatory second opinion. CoHMC found out and moved him from a double room to a ward, where the bed next to him had a screaming guy handcuffed to the bed. [CoHMC provided medical services for the local prison.]

After he eventually recovered, CoHMC and their billing processors hounded him for hundreds of thousands of dollars (unsuccessfully) until he died.

As for my own experience at CoHMC, I was taken there with acute left-side chest pain and tingling in my left arm. After sitting in the emergency room for more than half an hour, I got up and used the pay phone to call another local hospital - Somewhat Friendlier (now also out of business) - and asked them how long it would take to be seen there. The receptionist said “we aren’t the motor vehicle agency - we don’t publish a waiting time”, but when I told her about my chest pain, she said to come right over. So I hung up the phone and used it to call a cab to take me to SF. CoHMC tried billing me something like $300 for the privilege of sitting in their waiting room (and this was long enough ago that there weren’t any cell phones other than the big 5-pound “bag phones”).

I also have BCBS and they have an “advice nurse” available that you can call for advice on how to treat minor injuries and illnesses. While not required, it can be handy for avoiding a trip to the doctor for minor issues or evaluating whether a trip to the doctor is necessary, as it seems Saint Cad was trying to do. I don’t think this issue had anything to do with pre-authorization.

Agreed. I have called that hotline several times for advice. It is not required.

Did the tooth break? Or did it fall out from the root?

If it broke you got bad advice. If the tooth fell out from the root it was correct. A tooth that has, well basically been pulled, needs to be set back as soon as possible. The longer you wait the less likely it will be able to reimplant itself.

If the tooth is just broken and the root is still in there, there’s not really anything an ER can do about it, except give you some pills for the pain, if any.

It sounds like the NP was thinking the tooth fell out from the root.

For a typical ED visit you will get two bills: One from the physician and one from the Hospital.
Call both, explain what happened, and ask that the charges be dropped. Only then will you know whether you need to take any additional steps at all.

A completely avulsed non-decidual (permanent) tooth is occasionally salvageable, and minutes can count; a non-painful broken tooth is not an emergency of any kind. However the average phone-line advice is unreliable.

The tooth was between a bad chip and broken but no pulp or root showing or bleeding which I made clear to the NP. The main purpose of the call was to find a 24 hour DDS or an emergency DDS for Monday.

I think I will ask for an itemized bill from the ER considering the entire listing was “Emergency”. I did call the hospital and they said most of that cost was triage (BP and temperature)

Would involving BBB (I’m thinking about the excessive charges charged by yhe hospital) have any impact if they do not negotiate?

Remember, the BBB has no enforcement authority, worst thing they can do is basically say you have unresolved complaints. A bill for triage at an ER would probably fall on deaf ears unless they tried to bill you $10K for triage.

Absolutely not, and while I sympathize with your experience, that’s not really an excessive charge for an emergency room visit. It’s not the hospital’s fault that you came in for a non-emergency.

I think your beef is with the insurance company’s NP. From what you say, it seems that she gave a wildly incorrect diagnosis and inappropriate ER referral over the phone. It seems very reasonable for you to ask the insurer to cover the $230 co-pay.