Fun with health care billing (RANT)

[Lady's Human]

RANT!

I'm going to leave all corporate names out of this to protect the guilty.

I had bloodwork done as a routine physical earlier this year.

The first mistake was done by the person in the Dr.'s office, who wrote up the bloodwork as part of a visit for bronchitis. I'm still waiting for an explanation from the Doctor how a cholesterol screening is part of a bronchitis diagnosis.

Off the bill goes to my ins. co, who promptly denies the claim and refers it back to me as a medical necessity, which applies to my annual out of pocket, as opposed to routine diagnostic, which they pay for.

I called the ins. co, get told why they denied the claim, and then call the Dr. Office, and ask why they billed bloodwork for a physical as part of a visit for bronchitis. Go through the runaround with them, get them to resubmit with the correct codes.

They resubmit, and the ins. co. denies the claim as a duplicate.

Call the ins. co., get told it's a routine denial for a dup claim, get someone to actually look at it, light dawns in yon distant cavern, and it gets approved. As they pay 100% for preventative diagnostics, and I've already paid the co-pay, I'm thinking all is finally settled with this bill.

I get the mail today, and in a nice letter from the hospital in question, is a bill for $26 and change for the above work. The total due, however, is $226 and change for the same service date.

Being that the amount due is in bold, and the pay this amount is in fine print, I'm wondering how many people they've scammed into paying a bill like this?

Call the "Patient care" office, and get told they have no bill like that in their system, however, I do owe them $26, and if I don't pay it will go to collections. I ask them about the $223 again, and get told they have no idea what I'm referring to.

I'm going to take all the paperwork, copy it, and mail it to their president's office, with a note enclosed telling them I'll pay the bill when they remove their collective heads from their posteriors.

And some wonder why a single payer system seems like such a panacea? The only problem is that instead of me opening the bill and smelling a rat, a govt. computer will instantly cut a check for the total due.


/Rant

[RICHARD]

To paraphrase an elected official, who's name rhymes with Pantsie Nelosi?

"just pay the bill and worry about it later......"

-----------------------------

I love the days when you could TALK to the person who billed you, not some simp who runs the billing office and has no idea HOW the billing is done.

Can anyone say "On Line Degree"?

(Don't blame the Data Entry People......We....ah.....they just do what they are told.)

[Karen]

Paul's sister works for a law office that deals with this sort of stuff all the time! Pretty sad it happens often enough for that to be the case.

[Cataholic]

I spent more than an hour on the phone today with my insurance company trying to make heads or tails out of some bill. THEN, I called the providers, and asked what I thought was a logical question, "why haven't I received an itemized bill (or any bill)"? Seems if your insurance pays it, or mostly pays it, you get this statment that takes more thought than I had today, apparently, to figure out.

I remember walking out of my doctor's office, last year, I think, asking for a bill. They couldn't produce one..they don't do the billing there. She had no idea what the bill would be.

I hate billing, from the patient side AND the attorney side.

[Marigold2]

You have a right to pay them $2.00 a month if you so wish. Once you send in that amount you can NOT send in $1.00 the next month. It has to be at least $2.00. They legally cannot touch you. On the bill write the following.
I am paying you $2.00 a month which is my legal right.

[tokolosh]

I'm all confused - could be their intention maybe? Insurance finally paid but didn't tell the doctor's so they're still billing you based on the original denial? And I don't understand the hospital aspect at all. Are these different charges from the ones from the doctor's in part 1 of the story? Same charges in a different format? What happened with the extra 200 bucks between 26 and 226? Do they cover you for mental health issues caused by the medical system out there?

No wonder some people feel like it's just simpler to stay sick.

[wombat2u2004]

No wonder some people feel like it's just simpler to stay sick.

Yes, it makes one wonder at times if the system is set up to either dupe patients or as you say, not be bothered with getting help.
There has to be a better way.

[Cataholic]

You have a right to pay them $2.00 a month if you so wish. Once you send in that amount you can NOT send in $1.00 the next month. It has to be at least $2.00. They legally cannot touch you. On the bill write the following.
I am paying you $2.00 a month which is my legal right.

Legally, this is an inaccurate statement. Everyone is entitled to have their bill paid in full, unless other arrangements have been made. Now, it is true that many places do accept monthly payments...but it is not a legal right violation if they do not.

[lizbud]

LH, ever get your bill taken care of? I guess it's my turn to rant now.
I've never had a reason to quesion any ins bill till just recently. Got a bill
from the Allergist I was sent to by my Primary Care Dr. I do owe then for
my co-pay which is right, but the bill they sent me was for much more
than that, it was huge.

After talking to my Ins co. they said the Allergist I saw was out of
Network & wouldn't be covered. My primary care DR chose the Allergist,
not me. Why would they pick an out of network provider? Seems
to me they made the error, & they should therefore cover the bill.

Last I heard my ins co is fileing a grievance (to themselves) for me over
this error. It's just crazy.

[pomtzu]

LH, ever get your bill taken care of? I guess it's my turn to rant now.
I've never had a reason to quesion any ins bill till just recently. Got a bill
from the Allergist I was sent to by my Primary Care Dr. I do owe then for
my co-pay which is right, but the bill they sent me was for much more
than that, it was huge.

After talking to my Ins co. they said the Allergist I saw was out of
Network & wouldn't be covered. My primary care DR chose the Allergist,
not me. Why would they pick an out of network provider? Seems
to me they made the error, & they should therefore cover the bill.

Last I heard my ins co is fileing a grievance (to themselves) for me over
this error. It's just crazy.

Liz - don't you have Medicare?

[Puckstop31]

My primary care DR chose the Allergist,
not me. Why would they pick an out of network provider? Seems
to me they made the error, & they should therefore cover the bill.

How is it their responsibility to pick a provider that is covered by YOUR insurance?

Ill give you that maybe they SHOULD care.... But only from a good customer service point of view.


I think we can see one of the causes of high health care costs here.... Nobody questions anything with their doctor it seems, especially when it comes to payment. "Somebody else" pays it, so who cares? Until, of course, "I" have to pay it and not "somebody else".

[Lady's Human]

Puck, perhaps it's like the health care provider I use......99.9% of their docs are covered under my ins. plan as the big umbrella "charitable" org that runs they system is normally completely covered by my ins., however, particularly if there's a new specialist involved, they might not be in the PPO list. I only get a PPO list once a year, and I'm fairly certain the list changes more often than that.

[lizbud]

Liz - don't you have Medicare?

Yes, a portion of the bill is covered with Medicare & a portion by my
Insurance co. & I pay a co-pay amount.

[lizbud]

Puck, perhaps it's like the health care provider I use......99.9% of their docs are covered under my ins. plan as the big umbrella "charitable" org that runs they system is normally completely covered by my ins., however, particularly if there's a new specialist involved, they might not be in the PPO list. I only get a PPO list once a year, and I'm fairly certain the list changes more often than that.

You're right LH, that's how it works. My primary care Dr works for the (my)Insurance group.

[pomtzu]

Yes, a portion of the bill is covered with Medicare & a portion by my
Insurance co. & I pay a co-pay amount.

So Medicare should have paid a big chunk of it - right? - and it's your private insurance that doesn't want to pay?

Might it benefit you to change to a different private carrier? I have Medicare and United Healthcare, and I never have to pay a penny for anything, or stay within any network. I can see whatever doctor I want and don't even need any referral. What Medicare doesn't pay, United does.