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.