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Posted: 12/16/2016 10:17:37 AM EDT
[#1]
Don't pay it.
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Posted: 12/16/2016 10:23:31 AM EDT
[#2]
That has been the medical scam for years now, give false quotes, fail to disclose true pricing and contract out stuff that isn't covered under insurance so they can full bill.
They are worse then used car salesmen crossed with lawyers. I'd dump my Dr over it personally and fight the bill amount. They are all in on it. |
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Posted: 12/16/2016 10:33:21 AM EDT
[#3]
Had that happen on a large hospital bill. One out of network person.
Called hospital, told them to FOAD. Called out of network person, told them to FOAD. Called insurance and told them I told everyone else to FOAD. Hospital re-coded it, insurance paid it. |
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Posted: 12/16/2016 10:38:05 AM EDT
[#4]
So you didn't check to see if the Doc was in network, and you did a colonoscopy referral after the first Doc said you didn't need it?? It's shitty that it happened, but damn talk about not looking at all of the issues beforehand. The Docs aren't going to figure out if they're in your network or not. That's your job.
That's on you bud. |
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Posted: 12/16/2016 10:40:42 AM EDT
[#5]
I can only speak for myself and it may not be a popular opinion.
I do not believe what I am told regarding the insurance payments, I check with the provider and the insurance company myself. I know who is who before anything is done, I pay my premiums and I consider it my job to know what is going on in regards to my bills and money. I will not rely on someone who does not have my best interest at heat regarding my wallet. Short version: Do your own homework and don't trust others to make decisions with your money/insurance. |
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Posted: 12/16/2016 10:42:41 AM EDT
[#6]
Wait till you have to go to the ER. Then you find out a month later the ER doc was out of network working in an in network hospital. Looking at you Baylor Scott & White.
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Posted: 12/16/2016 10:56:08 AM EDT
[#7]
If the Gastroenterologist was in network and the facility was in network this is as issue for the facility, they should write off the bill. What happens is that they bring in a new or contract anesthesiologist who they haven't credentialed yet with your insurance. Your responsibility to use a gastro in network but you cannot be responsible for ancillary services provided at the facility like x-ray, labs, and anesthesia. This happens all the time and they should write it off.
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Posted: 12/16/2016 10:57:29 AM EDT
[#8]
Quote HistoryQuoted:
Had that happen on a large hospital bill. One out of network person. Called hospital, told them to FOAD. Called out of network person, told them to FOAD. Called insurance and told them I told everyone else to FOAD. Hospital re-coded it, insurance paid it. Pretty much this |
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Posted: 12/16/2016 10:57:32 AM EDT
[#9]
The best thing to do is appeal the denial. If they don't work call the provider and speak with a billing supervisor. Ask for a reduced rate at what the insurance would pay. They will almost certainly lower the bill, but the question is how much.
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Posted: 12/16/2016 11:02:08 AM EDT
[#10]
Quote HistoryQuoted:
So you didn't check to see if the Doc was in network, and you did a colonoscopy referral after the first Doc said you didn't need it?? It's shitty that it happened, but damn talk about not looking at all of the issues beforehand. The Docs aren't going to figure out if they're in your network or not. That's your job. That's on you bud. Bullshit. It's the facility's job. A patient does not select their support services. These are picked by the faculty. The only time you meet your anesthesiologist is when your half naked lying a fucking gurney. Doctors have been comoditized and they're all trying to scam the system these days. Any new health law should dictate that the point of service shall ensure all services provide are either in or out of network. |
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Posted: 12/16/2016 11:02:18 AM EDT
[#11]
Doc told you, to your face, I assume, that you didn't need a colonoscopy, yet you scheduled one upon a mailer from your doc's office.
Am I getting that part correct? |
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Posted: 12/16/2016 11:03:18 AM EDT
[#12]
And doctors are going to wonder why the public thought single payer was smart.
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Posted: 12/16/2016 11:04:12 AM EDT
[#13]
Quote HistoryQuoted:
Had that happen on a large hospital bill. One out of network person. Called hospital, told them to FOAD. Called out of network person, told them to FOAD. Called insurance and told them I told everyone else to FOAD. Hospital re-coded it, insurance paid it. Nice... |
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Posted: 12/16/2016 11:06:08 AM EDT
[#14]
I've had similar circumstances. Mine was for $250 in lab work done at the lab inside the same complex as the doctors office. Asked them specifically if they take BC/BS and they said yes. Turns out they "take" any insurance but that doesn't mean that they're in network. Since you are responsible for payment, you're the one that needs to do the verification.
In this case, they took off about 30%, but I still had to pay the rest. As someone else suggested, see if coding it differently will work. |
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Posted: 12/16/2016 11:06:55 AM EDT
[#15]
Quote HistoryQuoted:
If the Gastroenterologist was in network and the facility was in network this is as issue for the facility, they should write off the bill. What happens is that they bring in a new or contract anesthesiologist who they haven't credentialed yet with your insurance. Your responsibility to use a gastro in network but you cannot be responsible for ancillary services provided at the facility like x-ray, labs, and anesthesia. This happens all the time and they should write it off. That's eaxactly what they did for me. |
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Posted: 12/16/2016 11:07:23 AM EDT
[#16]
Had this happen to my wife on her colonoscopy at the beginning of the year. Center and doctor were in-network. Both my wife and I had ours done at the same place. Since we were over 50 and never had one, it was covered 100%. My anesthesiologist was in network, but my wife's was out of network. We got a $1900 bill for that (the center and DR charges were less than this!) When challenged, I was advised to request a "re-submit" of the bill to our United Healthcare coverage requesting an "involuntary out-of-network fee waiver". This was accepted by UHC and the fee was paid in full.
That said, this whole problem of out-of-network providers operating in in-network facilities is a huge, stinking pile of shit!!!!! Anesthesiologists are notorious for not taking ANY insurance and charging more than the surgeons for their services. Hopefully the TRUMP work on the health insurance industry will end this sleazy practice. |
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Posted: 12/16/2016 11:08:27 AM EDT
[#17]
Quote HistoryQuoted:
If the Gastroenterologist was in network and the facility was in network this is as issue for the facility, they should write off the bill. What happens is that they bring in a new or contract anesthesiologist who they haven't credentialed yet with your insurance. Your responsibility to use a gastro in network but you cannot be responsible for ancillary services provided at the facility like x-ray, labs, and anesthesia. This happens all the time and they should write it off. This. When my wife had her bilateral mastectomy we got a bill afterwards from the out of network anesthesiologist. I called our insurance and they basically said they would cover it and the anesthesiologist would have to accept their payment or something like that. Bottom line it was for the same reason. The hospital, surgeon, etc was all in network but we had no choice in anesthesiologists. Our insurance did cover it and I never saw the bill again. |
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Posted: 12/16/2016 11:09:09 AM EDT
[#18]
Quote HistoryQuoted:
Wait till you have to go to the ER. Then you find out a month later the ER doc was out of network working in an in network hospital. Looking at you Baylor Scott & White. I got a notice that my local hospital's ER was still in-network, but the ER physician staff was now out-of-network. 
If the insurer gives you crap about being below 50, remember that Aunt of yours who had colon cancer you told the primary care doctor about? 
Kharn |
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Posted: 12/16/2016 11:10:39 AM EDT
[#19]
It was super cool when my wife almost died and had to have emergency surgery and the anesthesiologist was out of network. Young families enjoy unexpected $2,500 medical bills.
Next hospital stay will involve me busting up into the OR and checking creds of anyone involved. |
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Posted: 12/16/2016 11:12:23 AM EDT
[#20]
Quote HistoryQuoted:
Had that happen on a large hospital bill. One out of network person. Called hospital, told them to FOAD. Called out of network person, told them to FOAD. Called insurance and told them I told everyone else to FOAD. Hospital re-coded it, insurance paid it. I am going through this right now. When you call them on their bullshit, they fix it. Our medical and it's billing system is hopelessly screwed up. |
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Posted: 12/16/2016 11:16:43 AM EDT
[#21]
The lady friend got a substantial lab bill related to a retinal surgery. Being an OR nurse and having worked that particular surgery many times over the last decade, she knows there are never lab specimens to take.
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Posted: 12/16/2016 11:18:18 AM EDT
[#22]
Quote HistoryQuoted:
The lady friend got a substantial lab bill related to a retinal surgery. Being an OR nurse and having worked that particular surgery many times over the last decade, she knows there are never lab specimens to take. How is a normal person supposed to know what services and goods were actually provided? That sounds like fraud. |
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Posted: 12/16/2016 11:20:02 AM EDT
[#23]
Quote HistoryQuoted:
Bullshit. It's the facility's job. A patient does not select their support services. These are picked by the faculty. The only time you meet your anesthesiologist is when your half naked lying a fucking gurney. Doctors have been comoditized and they're all trying to scam the system these days. Any new health law should dictate that the point of service shall ensure all services provide are either in or out of network. You may be correct, but I have always asked about the support services ahead of time and have had answers given to me. This includes whether or not the anesthesiologist is in network. Same with any services afterwards, such as physical therapy on my shoulder a few years ago, they referred me to one place and I ended up at another due to their referral being out of network. The answers are there, ya just gotta ask and get stuff in writing, it's not that hard. |
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Posted: 12/16/2016 11:26:18 AM EDT
[#24]
Your Doc is dick.
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Posted: 12/16/2016 11:32:49 AM EDT
[#25]
Had a similar occurrence when our second child was born. We received a bill from a nurse practitioner that was out of network and assisted our in network doctor.
Called her and said, "I'm not paying this. I had no control over the doctor calling you in." BCBS ended up paying her whatever they would for an in network practitioner and that was that. When our first was born both of us were working full time and had health insurance. Lady called from one of the ins. companies asking for info on the other health ins. company. She said, "We will coordinate benefits and let you know how much you will be responsible for." I laughed and said, "I'm not paying a dime. Between the two of you everything will be covered." Last I ever heard..... ETA: Another BS event w/ a dentist. Called the dentist, asked if they take BCBS, was told yes, had some work done, received a bill because the dentist is NOT an in network provider. When I called she said, "Yes we take payments from them but we are not an in network provider" I said well you're not getting a dime above whatever BCBS agrees to pay you. And if you even think about pursuing this I will contact the authority that regulates your practice. Never heard back. |
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Posted: 12/16/2016 11:35:53 AM EDT
[#26]
Quote HistoryQuoted:
And doctors are going to wonder why the public thought single payer was smart. We don't need (or want) single payer. We need "any willing provider". It's the insurance companies that try to increase prices for procedures and pull all this "network" bullshit to try to maximize their profits by marketing one thing to their insureds, while at the same time getting providers to toe the line on who, where, and what they can provide to patients at what cost. With "any willing provider" you could shop your doc and get the quality and price YOU wanted. Just like cars, furniture, a plumber, etc. When you need a body shop for a car, the insurance has a "preferred" shop, but you can get quotes from whomever you want and use another place. Not so in healthcare. And then the insurance companies try to hide the real cost behind layers of paperwork and delays. |
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Posted: 12/16/2016 11:37:46 AM EDT
[#27]
When the new doctor's office quoted you the price, she should have known that they were out of network for your insurance. You also should have checked.
Your doctor should also explain why he referred a colonoscopy after saying you didn't need one. You also should have asked why especially when you found out it was going to cost you 900 bucks, even with insurance chipping in. Doctors and Insurance companies are a pain to deal with because of the system they are in. I went in for my annual physical that is 100% covered under my plan. The doctor's office gave me a questionnaire to fill out. I answered those questions which included a question about whether I had been experiencing any pain. I indicated recurring back pain, and discussed it with the doctor when she went over the form. I was billed by the office later for my copay because I discussed a condition which no longer made it an annual physical. I told her to check the form she had me fill out, and that I only answered questions I was asked. After a couple calls they agreed to recode it. The doctors and admin staff should know this stuff and should be more helpful. The insurance companies should care more about their clients. But in the end you're the only person you can count on, so you need to double check everything. |
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Posted: 12/16/2016 11:40:33 AM EDT
[#28]
Quote HistoryQuoted:
So you didn't check to see if the Doc was in network, and you did a colonoscopy referral after the first Doc said you didn't need it?? It's shitty that it happened, but damn talk about not looking at all of the issues beforehand. The Docs aren't going to figure out if they're in your network or not. That's your job. That's on you bud. Do your homework. You're an adult. |
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Posted: 12/16/2016 11:41:42 AM EDT
[#29]
I heard the other day an anecdote about a hospital that just hired an anesthesiologist for $1.3m per year. Outrageous, you say? Apparently they have to pay their own Med malpractice insurance to the tune of approx $1m per year. Not sure why anyone would do that job. They must spend half their damn time in court.
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Posted: 12/16/2016 11:47:53 AM EDT
[#30]
During post op I was having issues with pain. My doc was back in surgery with another patient. An attending Post Op physician looked at my chart, said give him xyz and walked away...60 seconds tops...came into my room the next morning, sogned my chart to indicate he visited me, total 45 seconds, 1:45 seconds total visit both days...billed a total of $2800 to my insurer...my max out of pocket had been made so no skin off my wallet but yes...its a racket.
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Posted: 12/16/2016 11:51:44 AM EDT
[#31]
Quote HistoryQuoted:
I am going through this right now. When you call them on their bullshit, they fix it. Our medical and it's billing system is hopelessly screwed up. Worst mistake I ever made; paying hospital bills in full. Once they know you have money, the flood gates open. |
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Posted: 12/16/2016 11:52:30 AM EDT
[#32]
Why did you schedule a colonoscopy when your primary specifically told you that you didn't need it?
That part makes zero sense to me. And yes what happened was shitty but ALWAYS, ALWAYS, ALWAYS confirm that who is doing the work is in network. |
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Posted: 12/16/2016 11:54:08 AM EDT
[#33]
Quoted:
I heard the other day an anecdote about a hospital that just hired an anesthesiologist for $1.3m per year. Outrageous, you say? Apparently they have to pay their own Med malpractice insurance to the tune of approx $1m per year. Not sure why anyone would do that job. They must spend half their damn time in court. it pays well and it's relatively easy work. the higher legal risk comes with territory (and pay) friend does the job, he loves it, just has to hang out after he knocks the patient out to make sure there are no issues, his hospital pays his malpractice insurance though. Makes good money. |
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Posted: 12/16/2016 11:54:50 AM EDT
[#34]
Whatever you do, don't not pay it.
Negotiate with the hospital to re-code it, but if you don't pay it will go straight to collections. |
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Posted: 12/16/2016 11:55:54 AM EDT
[#35]
While I sure as hell don't condone the system that has developed, one can't ignore the fact that the system was developed to soak us privately insured folks so we can fill in financially for all the patients with one or another government insurance which sets reimbursement rates too fucking low.
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Posted: 12/16/2016 11:57:51 AM EDT
[#36]
Quote HistoryQuoted:
Had that happen on a large hospital bill. One out of network person. Called hospital, told them to FOAD. Called out of network person, told them to FOAD. Called insurance and told them I told everyone else to FOAD. Hospital re-coded it, insurance paid it. This covers it. You were misled...maybe on purpose. Original doc seems confused at best. |
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Posted: 12/16/2016 11:57:56 AM EDT
[#37]
Quote HistoryQuoted:
......... ETA: Another BS event w/ a dentist. Called the dentist, asked if they take BCBS, was told yes, had some work done, received a bill because the dentist is NOT an in network provider. When I called she said, "Yes we take payments from them but we are not an in network provider" I said well you're not getting a dime above whatever BCBS agrees to pay you. And if you even think about pursuing this I will contact the authority that regulates your practice. Never heard back. They would have no idea if they are in your network. It's your responsibility and you have access to all of that information at your fingertips. If you ask for pre-approval and estimate, that's a completely different matter. Most dental work is not an emergency and you have plenty of time to do the payment research yourself. |
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Posted: 12/16/2016 12:00:30 PM EDT
[#38]
I work in insurance and had it happen a couple times to me as well with ER visits where the hospital is in network but the physician doing the work isn't or the radiologist isn't.
Do not pay it. File an appeal with your insurance company, they denied it based literally on an electronic check which said, Is this anesthesiologist in network. Yes, pay it based on network rates. No, deny it. What will happen is that even though that doc is not in network, they will apply their in-network reimbursement to his/her bill and pay it. You might be on the hook for anything left unpaid, but then you just call the anesthesiologist's office and tell them (okay ask them) to write it off. It's common, don't sweat it. |
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Posted: 12/16/2016 12:00:57 PM EDT
[#39]
My wife went to an urgent care clinc and we requested and was told that they would make sure she would be given a doctor in our network.
Paid our copay and went on with the examination. Got a bill a few weeks later. They switched doctors on us to someone not in our network. I called them and they wouldn't tell me anything because of privacy bullshit. So I had to have my wife tell them that it's OK to release any information to me. Then I called them back and raised hell over the $300 bill, which we wouldn't have gotten a bill if it was in network. They said they'd look into it and call me back. They didn't call me back. So I called a few hours later and they told me the bill was taken care of. Fight it. |
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Posted: 12/16/2016 12:01:07 PM EDT
[#40]
If ANY other industry... any industry one day up and decided to suddenly model themselves after the medical billing and insurance business, you wouldn't be able to build prisons fast enough, and the likes of John Gotti would look like petty thieves in comparison to some of the new convicts.
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Posted: 12/16/2016 12:01:11 PM EDT
[#41]
Quote HistoryQuoted:
They would have no idea if they are in your network. It's your responsibility and you have access to all of that information at your fingertips. If you ask for pre-approval and estimate, that's a completely different matter. Most dental work is not an emergency and you have plenty of time to do the payment research yourself. You think the admins in an office like that don't know every single plan and who they cover? The office/doctor/dentist has to work out network relationships with the providers, they know exactly which carriers they work with, and which plans within those carriers they take. |
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Posted: 12/16/2016 12:01:43 PM EDT
[#42]
Quote HistoryQuoted:
Had that happen on a large hospital bill. One out of network person. Called hospital, told them to FOAD. Called out of network person, told them to FOAD. Called insurance and told them I told everyone else to FOAD. Hospital re-coded it, insurance paid it. Less the FOADs, same thing happened to my wife. Everything and everyone execpt the gas passer was in network. BCBS said they'd pay him the lesser in-network fee. Never heard another word. |
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Posted: 12/16/2016 12:07:10 PM EDT
[#43]
Quote HistoryQuoted:
If the Gastroenterologist was in network and the facility was in network this is as issue for the facility, they should write off the bill. What happens is that they bring in a new or contract anesthesiologist who they haven't credentialed yet with your insurance. Your responsibility to use a gastro in network but you cannot be responsible for ancillary services provided at the facility like x-ray, labs, and anesthesia. This happens all the time and they should write it off. This is what happened. My wife needs a hip replacement and i went to my HR to discuss how to plan for this and what to expect with insurance. She said before you schedule ANY procedure make sure you state that they used hospital services. She even brought up the fact that hospitals use contract anesthesia personnel. And to state that they NOT use contractors. Because of the reason stated by OP. Never accept contractors for procedures because they are not covered by insurance. |
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Posted: 12/16/2016 12:08:43 PM EDT
[#44]
Tell the doc that it's between him & the insurance company - it has nothing to do with you at this point.
They should have disclosed any additional bills prior to the appointment. It's their own fault for not knowing what each insurance company pays & who they are contracted with. (I'm sure they did know but they made the conscious decision to try to fuck you over instead of telling you up front that they weren't in your network because they didn't want you going somewhere else.) |
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Posted: 12/16/2016 12:11:08 PM EDT
[#45]
I had a similar problem, except the Dr. claimed they were in network. 3 months after the visit i get a bill for 100, insurance claim that they were out of network.
I changed my benefits during open enrollment (after seriously considering dropping it all together). I will get my money back by the end of jan. |
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Posted: 12/16/2016 12:18:59 PM EDT
[#46]
WTF is it with facilities doing this? Same thing happened for an in-network colonoscopy but there was an out of network pathologist that charged a crazy amount. I ended up negotiating it down to almost the same amount as insurance, but in hindsight I probably should have put my foot down.
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Posted: 12/16/2016 12:41:24 PM EDT
[#47]
Quote HistoryQuoted:
Doc told you, to your face, I assume, that you didn't need a colonoscopy, yet you scheduled one upon a mailer from your doc's office. Am I getting that part correct? After the exam, (as I was zipping up from the "finger probe"  ) He said "No colonoscopy until 50". Before the exam they drew a couple gallons of blood and a urine test. I had not heard anything back from the doctors office in regards to any of the lab results, then I received the letter referring me to the doc for the colonoscopy. I'm not a doctor, nor did I stay in a Holiday Inn Express, so I naturally assumed that perhaps they found something in the blood work or whatever, so I went to the other doctors office.
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Posted: 12/16/2016 12:45:21 PM EDT
[#48]
Quote HistoryQuoted:
You think the admins in an office like that don't know every single plan and who they cover? The office/doctor/dentist has to work out network relationships with the providers, they know exactly which carriers they work with, and which plans within those carriers they take. The insurance carriers have many plans. If you had any experience in buying your own insurance or negotiating for a group, you would know that. Unless and until YOU give them YOUR plan information, they cannot possibly know what product YOU purchased or what is covered. Yes, they contract with many insurance companies but it's impossible for them to know what the details of every option. Even if they did, how would they know about your plan until you give them the information. Ask that they contact your insurance company before telling you what to expect in terms of payment or contact them yourselves. Deceit is one thing, but being purposefully ignorant is another. Unless you were deceived, or there was a purposeful omission, you are responsible for the bill. You are the one that purchased a product, the medical providers are providing a service. Each and every time, I get a referral for services or a specialty medication, I have learned to call the insurance company, not the provider, to see if their services are covered. Don't get me wrong, I'm not defending any method or system, just pointing out that you are responsible for finding out about your plan and what it covers. If it's too hard, go sign up for Obamacare and have the government take care of you. |
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Posted: 12/16/2016 12:47:22 PM EDT
[#49]
Quote HistoryQuoted:
WTF is it with facilities doing this? Same thing happened for an in-network colonoscopy but there was an out of network pathologist that charged a crazy amount. I ended up negotiating it down to almost the same amount as insurance, but in hindsight I probably should have put my foot down. It's because they don't like the reimbursement rates (that they agreed to) so they scam you directly. Most people probably just pay it because they don't want to fight - so it's profitable for them... |
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Posted: 12/16/2016 12:51:05 PM EDT
[#50]
Quote HistoryQuoted:
So you didn't check to see if the Doc was in network, and you did a colonoscopy referral after the first Doc said you didn't need it?? It's shitty that it happened, but damn talk about not looking at all of the issues beforehand. The Docs aren't going to figure out if they're in your network or not. That's your job. That's on you bud. The Dr doing the colonoscopy was in-network. That Dr does NOT do anesthesia. The anesthetist that put him out and monitored him during the 'scope was not in-network. Very often the surgery center where the colonoscopy happens contracts with another company to provide anesthesia services. Not so much a "scam" as it is just plain confusing. How the heck does a patient know these things? They don't, unless they already know and no one volunteers that information. Being on the receiving end of that billing sucks. If you carefully read the paperwork you sign going into the procedure, the info is there.... if you understand how it is worded. Joe Public generally will not know what is meant. Sucks. |
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