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Frequent Contributor
Posts: 268
Registered: ‎04-19-2016
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Gripe About Hospital Bills - Major Setback

I had plans to get all of my debt paid off in a year, and now my savings since buying the house has to go to hospital bills. Looks like it will take a bit longer, as I need to rebuild my buffer. This is just a gripe.

 

My daughter went to the doctor for stomach pain. It was appendicitis. Went to an in-network urgent care, did our due diligence asking for in-network care, got a referral to the ER. Went to the in-network ER, same deal... asked for in-network everything, talked to every doctor we saw about their network participation. Got checked into the hospital for surgery. Again, everyone we saw was asked about their network participation, and we asked the hospital if anything they contracted anything out of network. We were advised no, it should all be in-network, with the caveat that they can't guarantee anything. Oh, that was SOOOOOOOO not the case after all.

 

Now bills are rolling in that are out-of-network, which has a 20% coinsurance with a max out of pocket of 12k. So far we are maxed out. That's right, 66k in out-of-network charges. All but 12k is covered by my insurance. In-network is covered 100% with a copay for admission to the hospital. I bought the best plan available through my employer. I did everything I could to stay in-network. Now I get to spend time negotiating these bills down to UCR, and getting that info is like pulling teeth.

 

Just another day in the life. 

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Posts: 1,307
Registered: ‎01-31-2008
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Re: Gripe About Hospital Bills - Major Setback

Which charges were out of network? One of the fast ones pulled on patients is to have an in-network surgeon. But, they have their out-of-network surgeon buddy assist them with the surgery. The assisting surgeon ends up making more than the primary surgeon.That is downright criminal in my opinion.

 

I imagine you talked with the hospital liason. Me, I would be contacting everyone about this issues. Contact your Senators, Representatives, complain to the hospital. Contact the department of health. I understand your frustration and feel the anger. In this case you need to be the squeaky wheel to protect yourself and others in the community.

 

If the hospital has a Facebook page, post your story on the page. (I am on a roll) Call up the news station and see if they have a consumer action department.

 

Breathe slowly (talking to myself), truly sorry to hear you have to deal with this BS.

Frequent Contributor
Posts: 268
Registered: ‎04-19-2016

Re: Gripe About Hospital Bills - Major Setback

Thank you!

 

Charges were for a surgeon (not the one I met or understood was doing the surgery), a different surgeon consult (not the one we saw, never saw this guy), 3 doctors that we don't even remember seeing (we got business cards from those we saw), out-of-network lab services (they sent out a bunch of stuff to the tune of over 10k), radiology review x3, pathologists x2, 'hospital services' whatever general bucket that is... I am at a loss with all of this.

 

Our insurance covered a set amount of it, which is the in-network rates they usually pay, but because these were out of network, we can also be balance billed. Since the amount is substantial, state law allows me to appeal the charges, which is what I am starting with, after negotiating with the hospital and finding out if there's justification to all of these charges. I am working with a 'liason' in billing.

 

I am grateful that my daughter is healthy again, but **bleep**. 

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Valued Contributor
Posts: 1,307
Registered: ‎01-31-2008

Re: Gripe About Hospital Bills - Major Setback

I would bet that this is something that happens all of the time at the hospital you were at. You are completely correct, thank goodness your daughter is alright.

 

I would be upset enough that I would seek a lawyer's advice to look over the bill. As a consumer you did everything you could to protect your interests. 

 

I had an emergent appy last year and the total bill was $60,000+ with insurance paying around $10,000. Like you I checked that everyone was in-network for my plan. This was a religous backed hospital so maybe they were just more above board.

 

I don't mind the people involved getting paid but it should be at the in-network rate if the consumer checks with the hospital. Balanced billing is such an unfair deal.

Moderator
Posts: 8,361
Registered: ‎06-20-2015

Re: Gripe About Hospital Bills - Major Setback

[ Edited ]

I feel your pain, and I know what you're talking about.

 

I had a hernia repair a few years back, and I had a similar experience; I made sure my surgeon and the hospital were in-network (they were), but as you know there are many people you might not ever even see who will send bills.  In my case, there were several that were out-of-network.

 

I reached out to my insurance administrator (at the time, Aetna) and told the front-line CSR what had happened.  I was actually impressed with how it was handled; with a few keystrokes she was able to see the bills on her side, and she said that in situations such as mine that all the other providers would be covered as if they were in-network since I had no say in choosing them.  She led me to believe this was 'business as usual' for them, and we ended the conversation with me a happy camper.

 

Of course things change (and can vary greatly from insurance company to company) but it might be worth a try to call your insurance company to see what they say (again, stress you "did your part").  If you don't get anywhere right away escalate to a supervisor... there's little to lose but a few minutes of time.

 

All this aside, I hope your daughter is doing well.  Smiley Happy

Valued Member
Posts: 43
Registered: ‎07-05-2016

Re: Gripe About Hospital Bills - Major Setback

I'm kind of going through this myself due the fact that I was recently diagnosed with melanoma. In an odd way, it's somewhat of a relief knowing that I am not the only one dealing with this kind of frustration. My bills have yet to come in, so I do not know how much I will have to pay. While I have great insurance, I was given the run-around from almost everyone at the oncologist's office, the pathologist, and the hospital about how no guarantees could be made about anything truly being in-network. It's certainly not helpful at all. What choice do you have? Tests and surgery can't be delayed with these kinds of issues. You have to act before an in-network/out-of-network determination can be made!

 

In my case, surgery was the main thing I needed, but the jury is still out on whether or not I need a round of radiation or immunotherapy. That all depends on the result of a certain genomic test, and I only gave authorization for that test after a week of back and forth calling the oncologist, pathologist, and insurance company, and only giving the okay after wading through the contradictory information I received from all parties. The only reason I felt I could wait a week was because of the good prognosis I received post-surgery.

 

Anyway, I apologize for the rant. Please remember that you are not alone! You got this!

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Frequent Contributor
Posts: 268
Registered: ‎04-19-2016

Re: Gripe About Hospital Bills - Major Setback

Thank you again everyone! It's nice to just gripe together sometimes.

 

Step 1 - Let the rest of the bills come in. I can see from my insurance (Cigna) what was paid, what I owe, and what CAN be balance billed.

Step 2 - IF I am balance billed, talk to each individual biller about waiving the balance. If not, appeal through the state.

Step 3 - Apply for charity care, as obviously this is more than 25% of my income for the year. This only applies to hospital bills directly, which is a small portion.

 

I have talked to my insurance provider, and they were most unhelpful. I was advised that they pay UCR rates, and that bills more than that which are out of network are my responsibility. I was also advised to talk to each biller and see what can be done, and for balance bills of over a certain amount I can use the state appeals process to allow the providers and insurance to mediate.

 

I have preemptively called each provider that has billed my insurance so far, and although no one has their checks from Cigna back, they have all stated that for balances this large they will take payments at 0 interest for varying periods. One provider said as long as I pay $50 a month, I can stretch it as long as I'd like. I asked about the appeals process, and the only 2 provider billing offices that had experience with it said it usually results in a balance bill percentage reduction by the doctor, they haven't seen the insurance pay more. I have planted the seed already that I NEED these balance bills waived if possible.

 

It's a little early to get the news and congress involved, I want to give all parties a chance to come to a reasonable agreement. In the meatime I am getting small bills from labs used by urgent care, etc. that I am just paying because they are not appealable and not worth the time. ($2.19, 5.87, 20.06, 50.96, 59.06, 48.64).

 

But, seriously, my insurance was charged 23k for a CT scan. That one was covered, but wow. No way. 

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Valued Contributor
Posts: 1,307
Registered: ‎01-31-2008
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Re: Gripe About Hospital Bills - Major Setback

Remember the politicans work for you. Mind you a collective you but they represent you. A story like this that involves a child may just get your Senator on the phone talking to the hospital. 

 

The out of network people know exactly what they are doing when they bill your insurance. 

 

Just out of curiosity, what part of the country do you live in? I am in the MidWest and I do not hear too much about balanced billing cases.

Established Contributor
Posts: 779
Registered: ‎01-15-2017
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Re: Gripe About Hospital Bills - Major Setback

I am so sorry. I went through this Got them to write it down to what the insurance would pay by sending letters and calls. I told them like you in network only. It took months. I hate balanced billing. 

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Posts: 17,442
Registered: ‎12-30-2011
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Re: Gripe About Hospital Bills - Major Setback


ProfGoGetter wrote:

Thank you!

 

Charges were for a surgeon (not the one I met or understood was doing the surgery), a different surgeon consult (not the one we saw, never saw this guy), 3 doctors that we don't even remember seeing (we got business cards from those we saw), out-of-network lab services (they sent out a bunch of stuff to the tune of over 10k), radiology review x3, pathologists x2, 'hospital services' whatever general bucket that is... I am at a loss with all of this.

 

Our insurance covered a set amount of it, which is the in-network rates they usually pay, but because these were out of network, we can also be balance billed. Since the amount is substantial, state law allows me to appeal the charges, which is what I am starting with, after negotiating with the hospital and finding out if there's justification to all of these charges. I am working with a 'liason' in billing.

 

I am grateful that my daughter is healthy again, but **bleep**. 


I have been fortunate in not having had to go to a doctor / ER / similar since I was aged 7, but seriously, **bleep**?

 

It's not like getting one's appendix out is an uncommon procedure.  I can't support Elizabeth Holmes looking at the record, but I seriously wish she and her company had succeeded, what a stupid racket.

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