I know whereof you speak. Three years ago, I went to an ER when I was gushing blood like a geyser from my rear. Scared the hell out of me. I had blood tests, and a doctor gave me a rectal exam.
Turned out to be hemorrhoids. I never would’ve gone if I had known for sure what was happening to me. I could’ve been hemorrhaging from previously undetected rectal cancer, I didn’t know.
So what happens? Three thousand dollars over the course of two and a half years. All for some tests, and a doctor’s finger up my ass.
I was temping at the time. I had no idea how or if I could pay. Luckily, I found permanent employment later, but I was still on the hook until recently. I would still be paying if I hadn’t put six hundred of it on my credit card, just to free up some cash flow for other bills. And on the card it sits, generating interest charges, so I’m really still paying.
Healthcare in this country is a goddamn disgrace to humanity.
Because it fattens the wallets of people who own and/or invest in insurance companies and other pharma/health companies. Never forget what motivates Republicans. ( $$$ ) It’s as obvious as an exploding head, which is the reason for all of the diversionary measures.
I’m sure you thought this was funny, but dick move under the circumstances.
OP - some other options.
Another question - did the insurance company pay a percentage of the charges or none at all? I’m wondering if they covered the part that they would normally be covered as “out of network”, usually 80%, or if they covered none. If they’ve covered a big chunk of this already, your options are likely limited. If they are covering none of it, then it’s worth exploring a few more things.
In addition to those mentioned, see if the hospital has an ombudsman or patient advocate. They may have ways to manage the appeals process that would help you.
Also, who handled the appeal - was it you or the hospital billing department? Try it both ways.
Try looking for a consumer advocacy group in your area. Something like the local news station often has a “fix it” person, who will go to bat for you, and put it on the news. Bad PR is not wha the insurance company wants.
Look for the state insurance oversight group. Your state may or may not have one, but if you do, you may be able to appeal through them to help them.
When all else fails, you can write to your congress person or senator and ask for their help in sorting this out.
All your Canadian friends weep for the trials you are facing at such a difficult time. It seems heartbreakingly cruel to us. The fortitude of Americans facing such awful challenges impresses me every time. Wishing you Good Luck and speedy recovery! We truly wish we could do more than empathize and watch in horror!
HMOs, State insurance, no insurance, nothing is good anymore. My daughter has no health insurance, so she went to one of those quicky med places. The nurse there told her to go to the ER because she could have a kidney infection. The ER triaged her and gave her a urine test. Never saw a doctor, just another nurse. She got a scrip for antibiotics and an eyeroll for thinking she had a kidney infection. Seven thousand dollars, including almost a thousand for a doctor she never saw because, as she was told, the clinic where the on-call doctor works can bill because the nurse works for him. I don’t get it. And she tried to negotiate down, but only the hospital itself (there were five separate bills including TWO for lab work for ONE urine sample!) would bring down the cost and only if she agreed to pay in full within 12 months. My daughter makes ten dollars an hour. She will be paying on these bills for several years.
My other daughter has state insurance. She has autism and that means several types of therapy. Twice she’s lost therapists, one of them we didn’t even know until we were there for a visit, they called me to the front desk and said she couldn’t be seen anymore because our brand of state insurance was no longer accepted. The next year I changed our group so she could go back. I called to get her back in, but they changed from THAT insurance to our OLD group so she still couldn’t see her therapists. These kids have to develop a good relationship for therapies to be most successful. Changes like that really affect them. And now a new problem. My sweet child has PTSD from being raped when she was six and now she’s starting to have intrusive thoughts and pretty bad anxiety as her 13th birthday approaches. I have called 8 mental health care clinics in our area in the past 2 weeks that on our group’s website lists as accepting new patients AND accept their insurance. They aren’t or they do not. None of them so far, I believe six of eight have called me back. One had gone out of business. The last one is our only hope, otherwise this kid will not get any sort of mental health care even though she qualifies and has coverage. She’s just SOL and I don’t know what to do. I can’t afford for her to see a therapist out of pocket. I barely have pockets.
Our young son got hit by a car (a Crown Vic with “Protect & Serve” on the side*…) and when they asked his broken body where he wanted to go, he muttered the name of the hospital that his mom worked at.
The one hospital not covered by our HMO.
We appealed to the hospital’s mercy, and eventually got most of the bill rescinded. But every once in a while, months later, another little bill would trickle in: “Hey, Hon, did you know that it costs $52.50 for a janitor throwing out the kid’s bloody bandages?” “Don’t pay it. I’ll call the hospital.”
*And we got a settlement from the city, so the kid has college money when that day comes…
Even if you go to a hospital that is in your network, the ER doctors may not be (and you don’t exactly have a choice who you see). If they are not in the network, they can also charge whatever they want scary story.
Depending on how an ambulance is summoned, you may end up with one that is out of network and have to pay, even though in an emergency you don’t really have time to call an in-network ambulance another scary story
Even when your insurance covers emergency care, they only pay at most what they have contracted for with their participating hospitals, and you are responsible for any balance billing, which depending on what the hospital you are at charges, can be a significant amount of money yet another scary study. While often the hospital will settle for what your insurance pays, they don’t have to.
In other words, this health care system is totally screwed. But then, again, in Canada, you wait months for a routine operation unless you come to the US where if you have enough money you can get it the next day [/Republican apologist] It’s totally worth it for the truly ill to go bankrupt so that the rich can get care whenever and wherever they want :rolleyes:(except for the fact that even with universal health care the rich could still potentially go out of network and isn’t it better to have to wait for a routine surgery than to not be able to afford it?)
Or maybe I’m just pissed that my personal health insurance went up 68% this year, for a plan that went from a PPO to an HMO and a deductible that more than doubled. So, I’m paying 2/3 more for significantly worse coverage. In positive news, though, even though Trump cut outreach by about 90%, I still get an email reminder to sign up for health insurance via the exchange every single day and a robocall about once a week.
Next time someone asks why the US system is so much more expensive than other nations, think about how much bureaucracy and employment all that billing, negotiating, chasing down payments and insuring generates.
That’s mostly a myth. The number of people that travel from Canada to the US for medical treatment is actually tiny, and certainly dwarfed by the number of Americans sneaking free healthcare in Canada.
And why would Canadians pay US prices rather than go to places like the UK, Costa Rica etc anyway.
I don’t think it’s funny I think it’s a fucking desperate situation. Yet when I point this out in, say a IMHO thread NOW some tell me it’s not that bad, just because it’s the same as the third world it doesn’t mean healthcare is so bad, etc, etc: people - with healthcare - still making the case for US healthcare. Currently. On this message board.
This kind of thing is unforgivable: [Why do so many US women die giving birth?
This is what a lot of people don’t understand. It always changes. The doctors always change, the covered hospitals always change. In some cases, depending on what type of insurance you have, there is no fucking way to do one’s due diligence.
The problem with the healthcare debate is insurance, and unfortunately, the average person doesn’t think about insurance - until they have an emergency. That’s why the insurance scam artists - er, companies - can convince ordinary folk that health insurance reform is somehow solving a problem that doesn’t exist. People don’t want or don’t demand reform because they think it’s someone else’s problem.
Most of it is shit unless you’re with a really good employer and a really good plan. The number of good plans is shrinking, and you can bet your bottom dollar that if the plan is cheap, it probably doesn’t cover shit. Increasingly the problem isn’t just no coverage, but not being covered enough.
This. My insurance (not HMO) requires that they be contacted within 48 hours of an ER visit in order for some fees to be waived. If you miss the window, you’ll be billed for everything. I learned this the hard way years ago.
It’s not just health and insurance industries which benefit. Employee anxiety is good for business. Since changing jobs puts your health insurance in jeopardy, workers are less likely to ask for raises or look for new opportunities. Anxiety also stimulates some types of consumer spending. Win-win.
I have a U.S. passport but have not visited the states for many years, partly to avoid the possible inconveniences and bankruptcy due to injury or disease. (Now I’m eligible for Medicare but just understanding that seems troublesome.)
A few years ago I had an EKG in Thailand. It was almost free — had I been a Thai national the EKG would have been included in the $1 cover charge — but at the last moment they noted I was an alien and tacked on $7 for the EKG.
I’m giving him the benefit of the doubt and assuming he didn’t really mean to poke at the actual poster; rather, that was probably for the benefit of everyone else reading it. A sober reminder of how the right wing in this country lives in a post-truth world, a world of alternative facts, one in which Project “Veritas” ironically tries to troll us with fabrication. And yet…inexplicably…we somehow keep voting for this shit. As I put it in another thread, we somehow keep stabbing ourselves in the eyes with pencils and expect it to feel good - if we just do it one more time, maybe it won’t hurt.
Sometimes tough love is needed. I do not take delight in the OP’s misery at all, particularly as someone with a pre-existing condition. But I support up_the_junction’s efforts to dish out a little tough love.
I’m always proactive, to the point of being a dick, anytime I deal with healthcare. This has saved me a pile of money.
In a situation where I determined I was covered for treatment but not hospitalization, I forced the issue with my doctor. For three days in a row I went through all the paperwork, etc for discharge each day, went through the cashier, rolled out the door in a wheelchair. Then rolled back in and was readmitted. Total theater, but it made my insurance happy. Each “treatment” lasted 22 hours, so as far as my insurance was concerned, I was never “hospitalized”.
After stent placement I was being discharged. A nurse brought in my medication, which I declined. I was stopping at a pharmacy on the way home and would take my meds then. She argued, saying my doctor wanted me to take them before leaving. I asked that she page him to see if he would pay the inflated charges out of his pocket. I signed an Against Medical Advice release and the pills were taken off my bill.
When I was being transported by ambulance from one hospital to another for surgery, a half hour on the phone with my insurance company saved me money. Had I taken the ambulance that was waiting at the curb I would have had to pay for the ten minute trip out of pocket. Instead, I called for transport from my local ambulance company (over an hour away) and it cost me zero.
The last time I had blood work done, it involved a long list of tests. I called my insurance company and found out that one of the tests wasn’t covered and would cost me $175.00. I crossed it off the script from my doctor. When I discussed the results with him I told him what I’d done. He admitted the test was redundant, he had written it out of habit.
Back to the OP’s immediate issue, ^this, but simultaneously loop in your State Insurance Commissioner. They generally don’t like these kind of “gotchas”.
On a couple of occasions when a family member has had surgery the anesthesiologist was out of network, even though the hospital and surgeons were in network. Our insurance tried to pay that portion of the bill at the (much lower) out of network rates and stick me with the rest, even over my protests that one doesn’t get to choose the anesthesiologist. In both cases one call to the Insurance Commissioner’s office resulted in the insurance company suddenly seeing things my way.
You shouldn’t have to go through all these hoops, for sure, but it can pay off.
Not that I know shit about the American system, beyond it being shit, of course, but I did read a very interesting medical hack that y’all might enjoy hearing. I cannot attest to it’s effectiveness, clearly.
It goes like this:
Whenever you’re refused coverage for something call insurance company to speak with the HIPAA compliance officer (by federal law, they MUST have one!) Ask for the names and credentials of everyone accessing your info, involved in that decision. (Again by law you’re entitled to know!)
They will likely reverse their decision immediately rather than admit it’s most always low paid high school grads, (even if it’s medical personnel it won’t be a board certified Dr from the applicable specialty!) They so, SO desperately don’t want you to know this or to have to reveal it.
Any refusal, to provide what you’ve asked, should be reported to US Office of Civil Rights as an actionable HIPAA violation.
(Before you rag at me, I’m a Canadian, but when I read about it I thought it was pretty slick and wondered how many Americans knew this.) Either way, it’s a great story, right?
