Playing bill collector

[Jstpssng]

This is another rant, which I will delete tomorrow night. Right now am just trying to form a plan of action...

October 2022 I received a bill from my hospital for routine tests. Original amount was $225.00. My insurer paid their share; there was an insurance adjustment; I paid my deductible,
everything totaled up to $225.
The bill was for an additional $175.

After months of unanswered phone calls I finally paid it to keep from screwing up my credit. A few months later I finally talked to a live person who said he would look into it. A few days later he called me back and said that I was right, and my account would be credited the next time I had a bill with them.

It wasn't. This summer I had the same routine test done. When I didn't see the credit I called and got the same person; who didn't know what I was talking about and couldn't even find records of a previous bill.

OK!

I dug out the old bill and called back, leaving yet another message giving the invoice numbers and asking somebody to get back to me. Still no reply. After a few months my new bill was about to go to collections so I paid the difference, making a note that I was only paying the undisputed amount. Still no reaction. In October I wrote a letter including both old and new invoices, asking if they would at least explain why I had to pay so much more than the original bill. (Sent registered mail so that I can prove that they got it.)
Still no reply.
Last month I contacted my insurer, asking if they could explain the discrepancy. They quickly wrote back stating that the hospital could not charge more than the contracted amount. After looking into it further they said that I should receive an adjustment in a couple of weeks.
It's been 3. If I know they are going to refund the money I will pay the current bill. Not only will that keep it from collections but I can get reimbursed from my Flex account. If I pay it,then find out they just plan to credit my account I will have to go through this fiasco again... and I'm not one to write interest free loans.

Sorry for the long rant, but I plan to call tomorrow to find out what's going on. This will keep me from using my default mode... full scale nuclear.

Tomorrow night this rant will be gone.

 

[Carl_NH]

Rant justified - have a similar situation - preventative CT scan ordered by Primary Care Doc - no issue - all paid for under "preventative care", but followup CT scan ordered by same doc 6 months later they want $500 copay.

 

[ultrarunner]

This is why more are opting for payment at the time of service…

Providers are licensed and getting a regulatory agency involved can cut through the noise.

But… if the contract with insurance isn’t being honored the insurance company needs to step it up and insurance companies also highly regulated.

Minutes before my brother was to go into the operating room the anesthesiologist was switched from in network to out of network and not explained but that is a secondary issue as a person sedated can argue unable to provide informed consent.

Scheduled anesthesiologists was in a case running late so the switch.

My brother started getting out of network balance billing from the substitute doc and every time he did he would call the doctors home and complain… the wife said not to call so my brother showed up on the Doctors doorstep and said expect to be seeing me every time you contact me so take care of it and doc did.

 

[Jstpssng]

This is why more are opting for payment at the time of service…

Providers are licensed and getting a regulatory agency involved can cut through the noise.

But… if the contract with insurance isn’t being honored the insurance company needs to step it up and insurance companies also highly regulated.

Minutes before my brother was to go into the operating room the anesthesiologist was switched from in network to out of network and not explained but that is a secondary issue as a person sedated can argue unable to provide informed consent.

Scheduled anesthesiologists was in a case running late so the switch.

My brother started getting out of network balance billing from the substitute doc and every time he did he would call the doctors home and complain… the wife said not to call so my brother showed up on the Doctors doorstep and said expect to be seeing me every time you contact me so take care of it and doc did.

This is a bit different. The bill was 225$. Insurance paid $86.38. "Adjustment" was 61.38. I paid $250.
I may not be a mathematical genius but even I can tell somebody got screwed... and I'm the one who winces everytime he sits down. They can mess up my credit, and would have if I hadn't paid. My only recourse is to change providers. It took me 10 years and 3 changes to find somebody I trust... I hope it doesn't come to that.

 

[ultrarunner]

This is a bit different. The bill was 225$. Insurance paid $86.38. "Adjustment" was 61.38. I paid $250.
I may not be a mathematical genius but even I can tell somebody got screwed... and I'm the one who winces everytime he sits down. They can mess up my credit, and would have if I hadn't paid. My only recourse is to change providers. It took me 10 years and 3 changes to find somebody I trust... I hope it doesn't come to that.

As you paid under protest I bet filing a small claims case gets this resolved pronto…

I’ve seen this on the hospital side where business office accepts amount paid as payment in full after weighing the options.

I’ve filed twice on bills of under protest and the moment served the company involved reached out asking what they can do to resolve.

It’s a great way to put frustration to constructive use if you have the time…

 

[ponytug]

Sorry for the trouble. We've been there more than a few times, too.

I've done small claims occasionally against large corporations, and it is surprising how fast things get resolved when they realize it will cost them many times the amount just to dispute it, even if they were to win, which they would not have (for my disputes).

We had one drag out for four or five years at one point. They wanted something like $5k for a device that was required, prescribed, and covered. Lots of bills, finger pointing, and I kept pointing at the documentation that stated balance not covered by insurer to be covered by the device company. They gave up eventually. Did I make minimum wage disputing it? Who knows? I didn't let it get to me.

I have been told that if you pay by check, and the check states above the endorsement "Payment in full" it ends dispute in some places.

All the best,

Peter

 

[Dftodd]

This is why more are opting for payment at the time of service…

Providers are licensed and getting a regulatory agency involved can cut through the noise.

But… if the contract with insurance isn’t being honored the insurance company needs to step it up and insurance companies also highly regulated.

Minutes before my brother was to go into the operating room the anesthesiologist was switched from in network to out of network and not explained but that is a secondary issue as a person sedated can argue unable to provide informed consent.

Scheduled anesthesiologists was in a case running late so the switch.

My brother started getting out of network balance billing from the substitute doc and every time he did he would call the doctors home and complain… the wife said not to call so my brother showed up on the Doctors doorstep and said expect to be seeing me every time you contact me so take care of it and doc did.

My wife had that happen to her during an ER visit. The hospital was her in network hospital. But the ER doc ended up being out of network.

We called the doctor and told them if they wanted to be paid, they needed to file with her insurance first.

I had a dentist office do that as well. They excepted my dental insurance. Used them for a few years without issue.

Paid what they said I owed and left. A month later I recieved a notice saying said dentist was no longer accepting my insurance.

About 9 months later I recieve a bill for almost $1000 This was 10 months after I was treated.

Called them up. The gal said she would check into it and call me back. Never heard anything from them.

A year later (last week) I recieve the same bill again for $1000

I called them up. The gal actually had the gall to tell me the insurance company told them they waited to long to file the claim.

I told them that I wasn't gonna pay it either. I paid what was expected of me at the time of treatment. If they can't file their claims, that's their problem.

 

[sandman2234]

I kind of hate to see this one get deleted! We all know dealing with doctors, hospitals and such can be frustrating to say the least. We will all learn a little as you describe your learning curve with your posts.
Some of us will need how to deal with these people when we do stupid things with our tractors, chainsaws and ladders!
David from jax

 

[ultrarunner]

In my opinion it adds lots of stress to an otherwise stressful experience.

The only patients totally not bothered are workers comp because it’s left to someone else to figure out and those with my county low income coverage where they never worry about a bill…

Mom had a good Medicare supplemental which was not cheap but provided peace of mind as she was basically covered… my understanding is this type of plan is no longer available to join?

Even with all our billing being centralized 100 miles away we will have one person in house with full access and direct numbers or teams messaging.

I might use that resource too much but if a patient comes in to discuss a charge I don’t send them away with a number and wish them well.

I bring the business office manager to the front and if not available promise to put a post it on that persons screen…

We do also get confused patients where everything is 100% correct but requires detailed over and over explanation.

At one point we were pleased to offer certain procedures at a fixed, one invoice price but no longer are able due to Stark Law conflict of interest… so now a surgery may have at least 3 if not more separate bills… surgeon, facility, anesthesia, lab, etc… this way the patient knows exactly who is getting paid what but I liked the old way with one check paying for all services.

 

[fatjay]

My wife had a small procedure just over a year ago, 15 minutes, in and out. Doctor billed $400, anesthesia billed $75, hospital billed $11,000.

Paid the doctor and anesthesia, but called the hospital and asked what this was about, there were no line items or specifics. They couldn't tell me. Then every Monday morning at 8am I would get a call, do you want to pay your bill or set up payments? I said i would like to go over the bill details. Please tell me the line items that add up to $11,000.

They said they would have to have my wife formally request it. I said sure, what's that process. So we went through that. They said it'll be 2 weeks before the detailed line items. Eventually, when it came, it had one line item. Room Fee. $11,000.

I am in the medical industry. I know for insurance carriers to pay bills, they must be billed through ICD10 or HCPCS or CPT codes, which are published. The doctor billed under the right code, the anestesia guy billed under the right code, the hosptial didn't bill under any code.

Next time hosptial called for their bill, i said i got hteir bill, i don't understand it, there's no codes, can you explain it. Their answer was no, they would have to request a formal inquiry. I said you're in billing, but you can't tell me what you're billing for. Another department. I asked to be connected to them. They said that was impossible.

In total I spent probably 30-40 hours on the phone with people telling me they couldn't answer my questions for what I'm being billed for. I told them I'm not paying unless you can explain what I'm paying for. They stopped calling.

I'm not against paying my bills, someone gave me service, they deserve to get paid. I expected a line item 2024 ICD-10-CM Diagnosis Code Y92.234 Operating room of hospital as the place of occurrence of the external cause. I have the ability to compare that to comparable items. I looked up the hospital's bills for comparable procedures, since I can do that. Typical total cost, all in, is $1500. It's what I expected.

Hospitals can be dicks. Don't just roll over if something seems wrong.

 

[Rockbadchild]

bureaucracy at its finest

 

[Alan W.]

Local hospital went from doing their own billing to outsourcing it a few years ago.
I was my Great Aunts power of attorney when she passed. She was a poor woman who was on Medicare and Medicaid and due to her income status never had to pay anything for medical services the last three years of her life.
Over a year after her death I get a call from the billing company telling me that she owes thousands of dollars for her last hospital visit.
They had failed to bill Medicare and Medicaid in time and was trying to cut their loss. I informed them the estate was closed and their stupidity was not my problem.

 

[thclimer]

bureaucracy at its finest

I wonder what the percentage of a medical bill is associated with bureaucracy of billing...maybe 20%? Just think of all the people who are employed by insurance companies, by hospitals, by doctors offices..........by companies who write the software to manage the billing system.

We go to a small dental group who has 2 dentists and probably 6 dental hygienists, but there has to be 3-4 people who are doing billing in that office.

Its no wonder the United States has the highest healthcare cost in part due to the high prescription costs but the system as a hole sure seems to be overly burdened with a complicated process for insurance and billing.

 

[ultrarunner]

As some say it's enough to make you sick...

Every week maybe 2 or 3 out of 125 elective surgery patients will make the effort to understand costs... the rest simply sign with the vast majority not understanding how their carrier pays claims.

If hospitals were like car repair a ok would be needed for complications resulting in additional work but the patient in the middle of the procedure isn't available to say yes or no should a case go over...

That said we have patients that travel to the United States from Canada choosing to pay out of pocket instead of using their covered Canada plan

 

[dodge man]

I’ll chime in and my wife has gone through our wonderful healthcare system with a problem and similar results. She finally found a doctor that went through the trouble to diagnose her. She was waiting to get her insurance to approve a test and they said the hospital never requested it. Somebody had sat on it for 3 weeks. I feel the doctors and nurses attempt to do a good job it’s the administrative staff that is lacking.

 

[EddieWalker]

When my mom had her knee replaced, the cost was about $75,000. Her insurance covered most of it and my parents paid when they where required to pay. They never got a list of what they where paying for. When it turned out that the Surgeon had messed up and they had to bring in a specialist to do it all over again, her insurance paid for everything. We never found out what that amount was.

When I had the knee replaced on one of my dogs, the total cost was $2,500. When I asked the surgeon if there was any difference between replacing a dogs knee and replacing a human knee, he said that it was all the same thing. The extra money spent for a human knee is to deal with the regulations and liability issues, along with what we assume is a bigger profit for everyone involved.

A friend back in California is a CFO for a medical clinic with multiple locations from SF to Napa. Her biggest challenge is from being forced by the government to provide service to people in the country legally that plan their trips to the country to get sick and receive treatment. Most of them come from Asia, and once they enter the clinic for an "emergency" they are required to get treatment. The clinic has a fund set aside to handle these people, but it's limited, so they swap people with other clinics and hospitals to maintain their budget. This fund comes from everyone who actually pays for services there. They have to add on to everyones bill a certain amount to have the money available to treat the medical tourists.

 

[oosik]

My situation is a bit larger but it came out just fine. During her final days my wife was confined to a hospital bed.

About a month after she had passed and everything had settled - I get this large package from the hospital.

It was the hospital bill. 112 pages - single spaced. Just a tad under $400K. I still have the damn bill - its in the bottom drawer of my dresser.

I had a meeting with the hospital administrative staff. I was allowed to file several forms and the hospital wrote this entire bill off. $400,000 and I did not have to pay a nickle. The hospital told me this was more common than you would realize. This $400K was a wright off against their federal taxes.

Otherwise - I have no idea what would have happened. The bank would not give me a loan for that much. Besides - if they did - it would have been high interest and I could not have even paid the interest generated by the loan.

And - yes - the wife was covered with insurance. But why they refused to pay the bill is an entirely different story - for another day.

 

[EddieWalker]

Sorry to hear about your wife.

When my brother passed away last year, the hospital, and several doctors all sent bills. His insurance covered most of it, but they wanted me to pay $75,000. Since I'm still dealing with his estate, and will be for a few more years, I ignored the bills, which eventually led to more bills from collection companies. Every month, the amount that they where demanding decreased. I think the total is now in the hundreds of dollars amount. I'm still not paying any of those bills until I'm forced to by the Judge, when we get to that point. My dad passing in October has affected my brothers estate, and now that has become the priority.

 

[ultrarunner]

When dad passed I answered every letter asking for more information and later for a sit down with all the doctors involved… of course that was never going to happen.

Eventually they collectively tired of my requests… they were very well paid but on the last 3 days a battery of tests were ordered against dads wishes…

 

[buckeyefarmer]

Been there also. Had Johns Hopkins threaten me with a collection agency, over a bill I had paid.
Just before my last colonoscopy, the Dr practice got bought by a different company. The insurance now said, Out of network, I owe thousands, yet the Dr who did it was in network. Took a bunch of calls and emails and such to get them to cover it. And when they did, they didn't tell me or send me any papers (I have them mail be my EOB), I found out by going online and finding it. They all make mistakes.