More insurance questions

So...I'm sure almost everyone on this forum has had to deal with hospitals at some point, no?

Is there any chance of settling a bill for out-of-network physicians at an in-network hospital? Apparently I owe about $900 for physicians that I NEVER SAW who stopped by and read my chart, or something. The insurance website claims that they paid nothing, but that my member cost should only be about $300...but whatever billing center these guys used wants all of the money.

It's not like I was even given a choice of checking their network status. I didn't even know these guys existed until the bill came today (they aren't affiliated with the surgeon, anesthesiologist, or any of the imaging services). So frustrating.

Do I appeal to the insurance? The center the physicians bill through? The hospital?

It's not uncommon for "hospitalists" to provide care when you are inpatient. Like other hospital-based physicians, they may or may not have a contract with your insurance company. If not, the insurance may only allow a "reasonable and customary" amount, which in turn could be applied to your deductible (I suspect that's what the $300 represents). The physician will then balance bill you for the difference between the R&C amount and the total billed charges, in addition to the deductible you're already responsible for.

I would advise you to contact your insurance company - start by calling the customer service phone number. Some companies even have a "Live Chat" feature on their member website (I love this because you can print a transcript of the chat). Many companies have a policy that they will reprocess the claim to allow full billed charges if the patient is being balance-billed by a hospital-based provider. Of course you may still be on the hook for the amount if you haven't met your deductible yet.

"Apparently I owe about $900 for physicians that I NEVER SAW who stopped by and read my chart, or something. The insurance website claims that they paid nothing, but that my member cost should only be about $300...but whatever billing center these guys used wants all of the money."

You may be able to argue some of those charges as well, just like any other bill you receive. Perhaps I'm a skeptic, but I've heard of a lot of people being billed for bogus charges at hospitals. Sounds like you have no idea who these physicians are or what they did. At the very least, I'd find out what the heck you're paying for, and what service they provided to you. How many doctors are listed? What did they all do? If it was just consults on your chart, why were so many people needed (worries me about what the attending physician does or doesn't know!). Although never this extensive, I've contested items such as lab fees, and "extra" charges for procedures that I did indeed get reversed. There are those out there who try to take advantage of the fact that not everyone reads their bill, and those of us that do probably don't understand a lot of it.

The NYT has a timely article today: http://www.nytimes.com/2010/09/14/he...tml?ref=health

Whew. Well, the insurance and the physician's network are reviewing the costs. The insurance says the physicians were out-of-network, but will be re-reviewed for an in-network rate because it was emergency care. The physician's network says that they are in-network. Either way...my fingers are crossed.

I think the physicians were people who were consulted prior to surgery (to decide to call in my surgeon) and after surgery (since my surgeon only works on emergency trauma cases and isn't regularly at the hospital). Just a guess though.

And wow - thanks for the article - my "itemized" bill from the hospital has a "pharmacy/supplies" (yes, that's as itemized as it got) cost of over $72,000 (!!!!). I guess the insurance wasn't too particular and just paid all of that, but it is really and truly insane. I should've gotten to keep the hospital bed for that price :)

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Originally Posted by jessmarimba

And wow - thanks for the article - my "itemized" bill from the hospital has a "pharmacy/supplies" (yes, that's as itemized as it got) cost of over $72,000 (!!!!). I guess the insurance wasn't too particular and just paid all of that, but it is really and truly insane. I should've gotten to keep the hospital bed for that price :)

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Wow, I'll say ! I missed what you were in for, but my entire bill from Duke for ER care, x-rays, CT scan, meds (lots), major orthopedic surgery, 5-day hospital stay, PT, and medical equipment rental (hospital bed in my home) when I had my cycling accident in 2005 was "only" about $45K as I recall. Insurance covered 90%, I paid 10% out of pocket (but later got it reimbursed by the insurance of the folks whose dogs caused me to have the accident). This was all in-network care. Amazing what a racket it all is!

It's a terrible racket, which is why healthcare providers are foaming at the mouth over the disasters created by insurance and the billing dance (and BS) that must be done to appease the Insurance Gods.

Some doctors have gotten so disgusted with the for-profit control exerted by insurance companies over doctors, that they have decided they must break free. Check out examples like Qliance: http://www.qliance.com/ And that's only one, there are others.

I haven't heard yet of a hospital that does that. In the old days the "Saints" (St. Josephs, St. Lukes, etc.) would hold themselves free of insurance companies, but that really isn't the way it is now.

What hospitals charge for pharmaceuticals, supplies, and implants is all part of the disaster.

It's the entire system, not just the insurance companies or just the hospitals or just the doctors, that makes up the mess we're in - all these parties (and the government) played a role in getting us to this point.

Emily - I was in for a similar experience. Bike wreck, broken back, surgery to fuse a couple vertebrae, 9 day stay to rehab and recover. I think the grand total is somewhere in the neighborhood of $145k. I don't know if the higher total is inflation, private hospital, or just cost-of-living difference here, but I'm astounded at the charges reading through the claims. I don't know what I would do if I didn't have insurance.

My son had a bone marrow transplant and a four month hospital stay.

Our hospital costs.

$0.

Birth of my kids

$0

Foot and ankle surgery

$0

Recent Xray and ER visit

$0

I am so thankful for universal health care.

Snowroo, it's not completely "free". Most likely your employer or hubby's employer pays for the monthly medical standard fee to provincial govn't health authorities --regardless of whether or not you use any medical service that same time period.

In British Columbia, it's:

$57.00 for single person per month
then there's sliding scale upward for families per month.

Alot of employers pay it as a benefit for employees or it's docked off the pay cheque. That's why we take it for granted. I'm not sure what the rate is in Ontario. It does vary by province.

I don't think hospital bed stays for a long time are automatic. It depends on medical condition, and if person has supplemental private health care insurance for their own rm., etc.

One notices the monthly benefit/fee, when one no longer has it..when one is unemployed or retired. (And an unemployed person still has to pay annual income tax.)

Then person must pay directly that monthly fee to govn't.

Still, yes it is alot better than south of the 49th parallel border.

And dental care is not free. Unlesss it's a benefit offered by employer, which might only cover a % of dental care costs per visit.

By the way, an emergency ambulance ride in B.C., is not free. It costed dearie about $50.00 or so..and the hospital was only 2 kms. down the road from where another cyclist collided into dearie and knocked him unconscious for a few min. or so.

But still yes, snowroo things could be whole lot worse.

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Originally Posted by snowroo

My son had a bone marrow transplant and a four month hospital stay.

Our hospital costs.

$0.

Birth of my kids

$0

Foot and ankle surgery

$0

Recent Xray and ER visit

$0

I am so thankful for universal health care.

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It's still getting paid for, via taxation or something. I don't understand why people think that their portion should be free, or that they shouldn't pay at least some sort of premium or portion of the fees. I'm more than willing to pay my share, but the scary thing down here (states) is that depending on where you live and what insurer you do or don't have, the cost of a specific thing will vary from $10 to $10000, which is just wrong.

I'm not going to pretend to understand the Canadian system, though.

Don't mean to throw a match into the fire. I always refer back to the great Frontline documentary, very impartial, that compares five different health care systems, when I need to try and understand how different countries do it.
http://www.pbs.org/wgbh/pages/frontl...roundtheworld/

bottom line, here in the USA we are being taken with a very badly broken and expensive system. We have huge gaps in health insurance coverage, we have people who are sick who can't get insurance, other people that are sick who do not take care of themselves because they can't afford the RIDICULOUS prices we are charged for medication, and big fat corporations in the pockets of politicians and vice versa who have absolutely no reason to care about our poor, and I'm specifically talking about the people who USED to have good jobs but can't work any more because they were sick and now have run out of alternatives. This isn't the America I grew up in.

sorry for the hijack.

Biciclista: doesn't get better when one gets older. I will be honest, there was a time in life I might have considered a career in the U.S....but it wouldn't have never meant living permanently in the U.S. The health care system and its direct cost to citizens/residents is a big turn-off.

For the sake of many in the U.S. who cannot afford proper health care but need it alot, I hope the U.S. American health care system improves in terms of affordability and access when people need it at different times in life.

But change is glacial and the private health care insurer companies have their lockhold to survive.

Canada does have private health care companies but it's to purchase supplemental care and services if it's not covered by the government medical health care insurance or by an employer's benefit plan or private pension/retirement pkg.

I guess after being employed by public and private sectors where different employers provided different benefit pkgs., also different times in life where I've been unemployed (such as now) plus having siblings who are health care professionals themselves, I've learned certain things along the way.

And even well into my mid '30's, I took for granted our health care system.

So when I get good health care from a professional..I truly appreciate it on several different level now. (Of course, it helps to get free 2nd professional opinion from some siblings.)

Quote:

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Originally Posted by jessmarimba

Whew. Well, the insurance and the physician's network are reviewing the costs. The insurance says the physicians were out-of-network, but will be re-reviewed for an in-network rate because it was emergency care. The physician's network says that they are in-network. Either way...my fingers are crossed.

I think the physicians were people who were consulted prior to surgery (to decide to call in my surgeon) and after surgery (since my surgeon only works on emergency trauma cases and isn't regularly at the hospital). Just a guess though.

And wow - thanks for the article - my "itemized" bill from the hospital has a "pharmacy/supplies" (yes, that's as itemized as it got) cost of over $72,000 (!!!!). I guess the insurance wasn't too particular and just paid all of that, but it is really and truly insane. I should've gotten to keep the hospital bed for that price :)

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I've had several experiences with insurance companies where they initially didn't want to pay for service but after I contacted them they revised things and increased what they paid. In 1993 after I had ankle surgery, I had to send them a copy of the surgeon's operative report, and then they covered everything at 100%.

More recently with the dentist, I had a filling that needed to be replaced and due to the size of the filling and the fact that the tooth was a molar that did lots of heavy-duty chewing, the dentist replaced it with an implant instead of a regular filling. At first the insurance company refused to pay for the implant, so I called them and said I wanted to appeal. I explained the reason for the implant over the phone and based only on what I said, they reconsidered and paid for the implant. I later learned that the dentist's office had included documentation with all the same information when they initially filed the claim on my behalf. I think the insurance companies figure they should deny things at first and see if anyone will make the effort to appeal.

So, hopefully you will have the same experience and they will cover those doctors' costs now that you've contacted them.

BTW, I was still getting bills for that ankle surgery more than a year afterwards. The major bills came pretty quickly, but bills for little things like the crutches I got from the hospital trickled in very slowly. Also I was frustrated by multiple bills for things like radiology and testing -- first I'd get the bill for the x-ray or MRI or lab, then a couple of weeks later I'd get a separate bill for the person who read the results. I hope things are more streamlined for you. Most importantly, I hope you heal well!

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RIDICULOUS prices we are charged for medication,

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Here's an interesting example, my recent experience.

I take a daily medication that is, and has never been covered by any insurance that we've had. I've mail-ordered from a legitimate Canadian pharmacy for years, as the cost has been 1/3 of what I would pay out of pocket down here.

My dosage was changed recently, and just for grins I called around locally to see what the price was for a month supply. Savon, $325. Rite Aid, $328. Fred Meyer, $325. WalMart, $308. Canada, $129/a month. Then I had a flash and called Costco. $28/month. I went up to the pharmacy manager to make sure I had heard right. Yep, that's correct. I was expecting the price to be somewhat lower, but 92% lower? No one seems to have an explanation for the huge price disparity, and they were willing to match it with documentation.... but I just don't get it, and the whole thing smacks of price fixing or some sort of scam on the consumer to me.

wow, maybe i ought to look into that costco thing for my husband's prescription!
that's nothing short of miraculous.

Totally, health care in canada is not "free". It's covered by taxes we pay. A bmt cost about 400,000 in the US. I think we got a good deal. It's not perfect here. We have big waits.

What I am sad to hear is that insurance companies dictate the care the person gets, not the doctor. That's just backwards.