USA medical billing practices.

Listen up ASSHOLES. You, you in the billing department, and you in the insurance industry. YOU should know what the FUCK is going on.

I do not have surgery every day. YOU however deal with this dozens of times a day. Best practice IS NOT to bill everyone and hope for the best.

Send me a bill and my insurance company a bill? Threaten me with 18% late fees when the insurance company is paying. Then I get dribs and drabs of checks from my insurance. SOME CHECKS come to ME, some go to the hospital. Some go to the anesthesiologist. Nothing matches up. What’s the check for $14 for?

WHY the hell do you send me a bill 2 MONTHS before you send the bill to my insurance company? And TELL ME that the bill is my responsibility or you’re are charging ME late fees. You’re DOUBLE DIPPING you ASSHOLES. And now you owe ME about $1000. And I WILL get it.

All MY ducks are in a row. You have ALL my insurance information. I should not have to put together a database and spread sheet to manage payments for a simple surgery that took all of 1 fucking hour 80 days ago.

YOU guys need to get your shit together.



The nation would be better off if their industry died on them.

We’ve been dealing with a third party billing company ourselves, after our (former) doctor’s front office lightly told us we owed nearly $700 that had been accruing since July of last year. And this after we conscientiously inquired as to our balance on each and every visit. When we asked why we had never seen a bill, their excuse was that they don’t bother billing out for $11 or $13, but prefer to let it ride. And then blammo!

Once or twice, maybe, in five years, we’ve gotten a bill from them. When you do get a bill, it shows many months of detail items on page after page, with no page footing and no clear application of credits against specific charges. There is no running balance, and no practical way to reconcile their charges with the downloaded claims from the insurer’s website and what we have paid in. It looks like they fired up the old Okidata or Sideways to print the damn thing out.

And when we demanded an accounting for all this, the first one they sent couldn’t be delivered, because they had not put quite enough stamps on the envelope–$.17 FTR.

These people do it for a living. And rent business premises in Newport Beach, CA, a block from the ocean. Why they are allowed to exist at all is a mystery to me.

I am sorry about this and feel bad for you. I’ve been doing consulting work in this field for years and I am sad to say, this isn’t uncommon.

Billing departments attempt to keep things straight but the problem is, your specific insurance may have five or more different plans they sell. You may have a $2500 dollar deductible while your neighbor has the same insurance company and has none.

It is standard practice to bill the patient. Generally though, it should say the charges are pending insurance. If your surgeon’s office didn’t bill it out to the company yet, I guess that explains why it did not say that.

There are a few things to keep in mind…

  1. Your insurance is your responsibility and you should know your benefits and which providers have contracts with your plan. If the checks are going to you, that most likely means certain providers involved in the surgery did not. The checks should say what services and providers they are for. Immediately send them a personal check along with the explanation of benefits.

  2. It isn’t the physicians responsibility to fight for your benefits. It they send a check to the doctor and it says you owe $700, you should be billed the $700. If that isn’t correct, you should take it up with your insurance company. I have seen too many patients that think the price of the surgery comes with bookkeeping services as well.

  3. If you feel you are being over billed, your insurance company will take up your cause if it is a contracted provider. Call member relations and tell them the situation.

I hope the surgery was a success and your paperwork woes are resolved soon.

This is totally unacceptable. I advise practices not to send bills for less than a $10 balance when the patient is still in treatment but that is total.

You certainly should call and talk to the office manager or administrator (depending on how large the practice is) and ask for a discount due to the inconvenience.

Why is insurance my responsibility? What do you get paid for? For some reason we thing by dealing with millions of claims ,you guys might be pretty wise about the business. But ,make it confusing, do it in parts and loot the customer. It is shameful.

I’m insured through work. We are self insured and have a third party ‘manage’ the system. Everyone has the same plan.

All the providers have contracts that work with our insurance plan.

What’s irritating is the anesthesiologist sent a bill to me, and then sometime later (months?) sent one to the insurance company.

I don’t see any point in billing me until they know how much I’m going to owe. And that leaves me hanging. Are they going to notify me when/if they settled up with the insurance company? Or are they going to just start tacking on late fees.

The other providers settled up with the insurance company, and then billed me for the remainder.

I still don’t know why the insurance company sends some checks to the HCP’s and some checks to me. And it would be nice if they explained what the checks are for. The values don’t match anything I’ve been billed for.

I just like to see some consistency.
The good news is the anesthesiologist recognized that they owe me $1018 and are sending me a check.

Because it is YOUR insurance. You pay for a service from them. It isn’t your physician’s job to make sure the insurance you pay for honors your claims, it is yours.

If a physician has a contract, they are agreeing to accept a negotiated fee but if the claim is rejected for a reason not associated with the billing procedure, why should the office follow up? At that point, you are responsible for your bill.

I don’t know if it’s systemic looting or simply systemic dysfunction. My guess it systemic dysfunction.

The US has a private insurance system, meaning the benefits and costs are written as contracts between private parties. In most cases it’s a group of employees under one employer where the employer negotiates the terms of the contract and pays most of the cost(IIRC the industry average is about 60% of the premiums paid by the employer). Because these benefits can vary from contract to contract, it simply isn’t possible for a Doctor’s office to keep track of which benefits any particular individual has. Most Doctor’s offices provide courtesy services where they try to figure it out and bill your insurance appropriately. They are not required to do this, they simply understand that if they make the patients file the claims they’re more likely to be screwed up and they’ll never get their money, as well as losing potential patients who don’t want to deal with the paperwork. This has created the illusion, in the patient’s mind, that the Dr’s are supposed to handle the paperwork. If you’ve ever read the new patient information for your Dr. odds are you’ve seen something that says “you agree to be responsible for any and all charges as a result of your treatment.” This isn’t there for no reason. If they can’t figure out how to interact with your insurer, they just send it to you. From there you’re responsible for filing claims, based on the bills they present, and being reimbursed for your covered expenses from the insurer.

If it’s a racket, it was one created to help the patient deal with as little paperwork as possible. The Doctors typically float thousands of dollars worth of charges while people, who they pay, wade through your benefits and insurer’s paperwork and do the claims filing for you. It’s kind of like how credit cards work. Most people don’t know the credit card companies charge the merchants fees whenever a card holder uses a card to buy from a merchant. Why would a merchant ever pay a fee(~3% for Visa/Mastercard and up to 7% or so for American Express) to sell things? Doesn’t that cut directly into their profits? Yes, and that’s exactly why there used to be two prices for gas at the pump. A cash price, and a credit price. The gas stations were about the only businesses being honest about the cost of doing business through credit cards. Eventually they gave in and just started charging everyone a surcharge to cover the merchant fees.

All in the name of being customer friendly and easy to do business with. The reality is that people like the yourself, enipla, have been the beneficiary of hundreds of thousands of hours of work between insurers and health care providers to keep you from having to do paperwork. It’s created a complex web of providers who have tight relationships with insurers(the “in-network” providers) and have smooth-flowing billing and payment methods(contracted rates) and those without such relationships and who bill whatever they choose, while insurers use actuarial tables(Reasonable and Customary charges based on the service) to pay based on the service. Ultimately, though, the patient is the responsible party and is expected to either make up the difference between what a provider charges and an insurer pays, or to go with providers who are contractually bound not to charge more(usually “in-network”).

It’s made worse by Doctors who will gouge insurers and insurers who would deny claims for stupid reasons, of which there have been enough to make both sides of the transaction very cautious, thus increasing the paperwork, and increasing the need for specialists(not the average patient) to handle it. If you want some first-hand accounts of how this works, from a Dr’s point of view, take a look at some of the posts from Qadgop the Mercotan a few years ago when he made the decision to get out of private practice and go to prison.

Just one of the many reasons a single-payor system(universal health care) might actually LOWER the costs of health care in the US.


That is pretty unlikely. Do you mean all providers that were involved in your surgery?

As I said, generally if a physicians are non par, the check is sent to the member. Anesthesiologist practice are notorious for this. A contract is between a physician and the insurance company; rarely a group. If the hospital uses one big practice, one physician may not have their paperwork through or there is some other problem. What happens is the claim gets paid without a discount and the checks go to the members.

I will say that you are mostly correct. I feel I must clarify in this age of managed care that many doctors do have a contract stating they will do the paperwork for the patient. It isn’t a courtesy. It is written in the agreement the provider signs to be included in the referrals from the plan. However, once a claim is rejected or there is a patient responsibility, the job of handling the paperwork again rests with the patient.

Once again we learn the wonders of American capitalism and billing…
on the other hand…
I recently spent 4 tension-filled weeks at the bedside of a relative in the ‘non-functioning-kidneys-ward’.
She survived…
But I kept adding up the bills in my head:
After the first week, I was getting worried…and by the time the ordeal was over, my math was proved right:fees for 25 days,and I was furious-----

The entire bill had to be paid, and there was no appeal process:
It cost me 20 dollars a day for the parking garage, and the damn hospital wouldn’t give me the discount unless the patient had previously recieved authorization for long-term treatment.
And the hospital has an inefficient bureacracy, too. The paperwork before and after the hospitalization consisted of writing the patient’s name and address on 3 or 4 different forms …It seems to me like once would have been enough.
But when I suggest to my American friends that maybe imitating us furriners with socialized medicine is worth trying, they scream “but you can’t choose your own doctor like us.”
And they’re right. And they get free parking, too.

Of course.

Just to clarify, I think Qadgop the Mercotan didn’t GO to prison, he currently WORKS in a prison. That is all.

My health insurance provider (BC-BS) has suddenly decided that I am enrolled in Medicare Plan B and therefore Medicare is the primary insurance with BC-BS secondary. The problem with this is the fact that I do not have Medicare Plan B. Why BC-BS thinks I have it I don’t know. I’ve been fighting this issue with them for the last three months. I’ve sent copies of a letter from Social Security that plainly states that I do not have Plan B; I’ve mailed and faxed copies of that letter to at least five people, all of whom tell me the problem is resolved. But it isn’t. They are still denying payment due to my (imaginary) Medicare Plan B. In some cases, where claims have actually been paid, they are demanding the health care provider return the money as BC-BS states they were paid by accident. I now have two doctors who will not see me in an office visit unless they have pre-authorization from BC-BS.

I don’t know if Universal Health Insurance would be better, but I know I’m caught in a seemingly unending loop. It would be easier if I just went to various ERs and blow off paying a dime.

The absolute best health insurance I ever had was Kaiser-Permamente. Too bad I can’t get it here.

I pay $108/month for provincial plan coverage for my family. I also pay an additional $120/month for extended medical (covers most prescriptions) and dental (pays 80%).

I don’t deal with the billing issues at all for non-prescription issues (for prescriptions, I must send receipts to my extended insurer for reimbursement). For Doctor visits, he bills the single medical service plan (MSP). For a serious medical stay for my wife, the hospital billed the single MSP. We did not see a bill. If I care to see, the amount that the MSP reimburses medical professionals is published on a public website. Doctors deal with a single insurer, and do not have to hire nearly as many accounting and billing professionals.

One thing that I’d like to see is members of the public getting a receipt when they use medical services marked “PAID BY MSP”. This would give us an idea of what our medical care is costing us all, and that it is not “free”

While I generally agree that a hospital or doctor’s office isn’t REQUIRED to bill insurance, and there are a lot of insurance company and plans, that is the extent of my sympathy for the service providers. Why do they need to see my insurance card before they will do anything if I am the one they intend to bill?

Where else in the world does a single profession have such an extensive system to collect and distribute funds - all because that profession is so hugely (overly?) expensive that normal people can’t afford the service without instalment payments. And the service providers cry because they have to document the services before they can get their money - boo hoo.

Health insurance isn’t designed to allow us all to get the medical care we need - it is designed to collect the doctors fees over time so that the doctors can charge higher prices. With insurance, hospitals and doctors have a huge pool of funds that they can tap as they please. The only limitation is the requirement that they document what they have done and send to the correct money pool for a given patient. The insurance company then doles out the cash as long as the doctor stays with a set price range.

With my insuance (BC-BS) I pay a $15 co-pay every time I visit an office. Then, everyone that touches me or even looks in my direction bills BC-BS for $15-$30 more than BC-BS allows. Then they try to collect the difference from me. So a recent visit for a coloscope got me - $15 co-pay, bills from 3 different Docs, only one of whom I ever met, for $20-$30 each and then the huge paperwork where BC-BS has to sort out how may cotton swabs are allowed (at $5 each) and how many tubes of grease are nomal (butt grease - priceless).

I never pay a doctor’s bill until it says “90 days past due”.

What free parking? I’d say about half of doctor’s offices don’t validate. Medical office garage parking is usually exorbitant, so I try to use public transit when I can.

Whoa. That’s the most expensive office space in Sector 001, right?

I have a finance and IT background (and a personal computer), and I ended up getting sent to collections on a couple of bills from my hospital stay last year. I tried mightily, but I just could. not. reconcile that shit. It simply HAS to be intentional; no one could fuck up a statement like that unless they meant to.

Because collecting from individuals is vastly different than collecting from a large company? At least with the company, they will always be able to find them and contact someone to work something out. It’s bad enough to for hospitals and offices to work with a dozen different insurance companies - let’s not multiply the problem by a thousand by working individually with each person.

Doctors aren’t business people. If anything, most of them are painfully unaware of what treatments/medications/parking cost people. There’s no grand plot to squeeze money out of people, really.