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Medical Bill Rant!!!
What's wrong with our system? Last month I had a cortisone injection done in the big joint of my big toe (think bunion!) in a local private lab/facility. It was done there where they could use flouroscopy to guide the needle. The procedure took almost 3 minutes from start to finish - lay on the table, numb the joint with lidocaine and then inject it with the cortisone. I was in their facility - waiting room and all - for less than one hour.
I just about fell out when I opened the explanation of benefits that I got from BCBS today. I knew this place was associated with a private hospital in their building and out of network. They had said I would not have to pay my copay if I just sign over the insurance check to them. This sounded like a pretty good deal and I owe nothing.
But I am shocked beyond words that they billed my insurance $14,600 for this simple procedure. Or course my insurance is ONLY going to pay them $3,900, but still I am shocked. My husband's stent put into his heart and a three day stay in the hospital was less than $14K.
Among the billed items was pharmacy charges for contrast, which I know I definitely did not have. I had licocaine and cortisone. Period. There were also other charges which make no sense but that was the most expensive one.
I am scheduled to have my other foot done in December, but have serious reservations, now that I have seen this bill. Can anyone out there give me an explanation as to why something so simple would cost so much? There was nurse, a radiologist and my doctor in their "operating room" which was not a sterile environment. They took my vitals before and after. But that was the extent.
puzzled and shocked,
Lulu
I just about fell out when I opened the explanation of benefits that I got from BCBS today. I knew this place was associated with a private hospital in their building and out of network. They had said I would not have to pay my copay if I just sign over the insurance check to them. This sounded like a pretty good deal and I owe nothing.
But I am shocked beyond words that they billed my insurance $14,600 for this simple procedure. Or course my insurance is ONLY going to pay them $3,900, but still I am shocked. My husband's stent put into his heart and a three day stay in the hospital was less than $14K.
Among the billed items was pharmacy charges for contrast, which I know I definitely did not have. I had licocaine and cortisone. Period. There were also other charges which make no sense but that was the most expensive one.
I am scheduled to have my other foot done in December, but have serious reservations, now that I have seen this bill. Can anyone out there give me an explanation as to why something so simple would cost so much? There was nurse, a radiologist and my doctor in their "operating room" which was not a sterile environment. They took my vitals before and after. But that was the extent.
puzzled and shocked,
Lulu
Lulu,
Did you end up having to pay anything for this bill? I'm in a similar situation and am going to fight it this week. I'm afraid to go up against the "big dogs", but have been doing my research. I'm wondering if you have any advice.
Thanks,
Sara
Did you end up having to pay anything for this bill? I'm in a similar situation and am going to fight it this week. I'm afraid to go up against the "big dogs", but have been doing my research. I'm wondering if you have any advice.
Thanks,
Sara
Argh! I know I answered this last night and now I don't see my reply. I called the clinc - they said yes, it was billed correctly.
I called the doctor (who only got paid $85) and they said it was the typical bill for this and it is considered surgery. WTF?
I called my benefits manager, and she agreed with me it was totally out of line but nothing she could do about it.
I called BCBS and was told they accept bills submitted at face value and they can't question every claim that is sent to them for payment. I was advised by BCBS that I should call the clinic place again and ask more questions.
The way I see it, I don't need the extra stress. If BCBS isn't concerned, should I be?
This was a very frustrating experience.
I called the doctor (who only got paid $85) and they said it was the typical bill for this and it is considered surgery. WTF?
I called my benefits manager, and she agreed with me it was totally out of line but nothing she could do about it.
I called BCBS and was told they accept bills submitted at face value and they can't question every claim that is sent to them for payment. I was advised by BCBS that I should call the clinic place again and ask more questions.
The way I see it, I don't need the extra stress. If BCBS isn't concerned, should I be?
This was a very frustrating experience.
Holy Schmoley - you'd think they injected you with the formula from the fountain of youth!
That's crazy! Both of my surgeries last year were less than that! They must have made a mistake.
Tammy
Tammy
Do what was the outcome here? What did BCBS think about this type of billing? Did they think there might be a more applicable code? Oh how I hate loose ends :)
Just for another comparison, hubby's arthroscopic knee surgery was billed at $4375 from the surgery center plus $1650 from the surgeon. The surgery center will accept $2493 from insurance and the surgeon will accept $734. Neither gets anything from us. Anesthesia hasn't billed yet. Maybe they're sleeping?
Mary
Just for another comparison, hubby's arthroscopic knee surgery was billed at $4375 from the surgery center plus $1650 from the surgeon. The surgery center will accept $2493 from insurance and the surgeon will accept $734. Neither gets anything from us. Anesthesia hasn't billed yet. Maybe they're sleeping?
Mary
Seriously Julie?
Maybe you missed the news when the hospital had you so unfairly incarcerated.
Andy Rooney died November 4, 2011 of complications following minor surgery. Apparently, retirement didn't agree with him after all.
I bet he gave more than one opinion about health insurance issues if we can find an archive of his work.
Mary
Maybe you missed the news when the hospital had you so unfairly incarcerated.
Andy Rooney died November 4, 2011 of complications following minor surgery. Apparently, retirement didn't agree with him after all.
I bet he gave more than one opinion about health insurance issues if we can find an archive of his work.
Mary
It comes down to "buyer beware and buyer be warned". I was just in the hospital and now that has me worried that I shoudl have "known" to ask each and every doctor who saw me if they were in my PPO. There should be a disclosure requirement for these hospitals/clinics and we shouldn't handle these issues. Isn't that what we pay our monthly premiums and ever increasing copays for?
And shame on BC/BS if they are not scruitinizing these charges either. Maybe they will tell you Lu that they just can't catch all these issues unless we the patients bring it to their attention. So, bring it to their attention.
Where is Andy Roooney when we need him - Seriously!
And shame on BC/BS if they are not scruitinizing these charges either. Maybe they will tell you Lu that they just can't catch all these issues unless we the patients bring it to their attention. So, bring it to their attention.
Where is Andy Roooney when we need him - Seriously!
So all this is part of and the result of the classic years-long dance between insurance companies (fueled by Medicare 'reform') and health care providers.
Insurers find way to deny or lessen payment for services already rendered and sometimes pre-approved by themselves.
Providers look for ways to insure they get reimbursement sufficient to cover expenses and run in the black.
And round-and-round she goes.
Let us know what BCBS's take is on this Lu. I'm guessing it will be a little different and then the facility will cry about how they didn't know and it was an honest mistake. I think the next time I call someplace to check on an about error I'm going to tell THEM up front that the call may be recorded for quality purposes!
Mary
Mary
Insurers find way to deny or lessen payment for services already rendered and sometimes pre-approved by themselves.
Providers look for ways to insure they get reimbursement sufficient to cover expenses and run in the black.
And round-and-round she goes.
Let us know what BCBS's take is on this Lu. I'm guessing it will be a little different and then the facility will cry about how they didn't know and it was an honest mistake. I think the next time I call someplace to check on an about error I'm going to tell THEM up front that the call may be recorded for quality purposes!
Mary
Mary
When I complained to my insurer about a bill from an out-of-network provider for services she performed while my husband was a patient at our A#1 100% coverage preferred hospital, I was told we should have checked her out before the service was provided.
Oh, yeah, right! I forgot that I should be suspicious of providers within the host hospital. I did call our HR department. They said they would take a look at it. It was never rebilled and it's been >6 months ago so I'm hoping for the best.
The insurer did say they will reconsider coverage for charges in an emergency room where people may not (?) have the opportunity to check out what tier a doctor falls into. How considerate. It's always worth a try to debate charges.
Mary
Oh, yeah, right! I forgot that I should be suspicious of providers within the host hospital. I did call our HR department. They said they would take a look at it. It was never rebilled and it's been >6 months ago so I'm hoping for the best.
The insurer did say they will reconsider coverage for charges in an emergency room where people may not (?) have the opportunity to check out what tier a doctor falls into. How considerate. It's always worth a try to debate charges.
Mary
Well, if you are going to cause a scene if you do go to your next foot appt with them, then I think you really should go. Then have someone video tape it for our viewing pleasure. :-)
It really should be the law that they tell people when they are getting services that are out of network. I cannot believe their plastic surgeons are all out of network. I really hope they were told that before they went through the minor plastic surgery. That is a real crime if they didn't.
-Kelly
It really should be the law that they tell people when they are getting services that are out of network. I cannot believe their plastic surgeons are all out of network. I really hope they were told that before they went through the minor plastic surgery. That is a real crime if they didn't.
-Kelly
Well - long story made short - after several phones calls to the facility and the doctor's office, they claim the charges are correct. They say they used the billing codes that BCBS provides for this procedure. I talked to our benefit manager in HR at work, and she was speechless as well.
The person at the doctor's office said if I had the other one done at the other hospital he does this through and they are in network for me, I will then have to pay my hospital copay. She suggested that I might want to call this other hospital, give them the codes and ask what they charge. That would be absolutely no help in this case, because I honestly believe the codes are wrong.
How can you call and injection of cortesone a bone surgery procedure? That is just wrong.
I am going to call BCBS tomorrow and ask them about this type of bill ....
As for the question as to whether this is legal, my benefits manager says that it is not unheard of for a facility that is out of network to waive the patient's share of the bill. It is not illegal.
She gave me another example of true craziness in the medical system - someone at work took their child to the ER and needed minor plastic surgery for a facial injury. It turns out that the entire plastic surgery community that works through that hospital has taken their practices off the insurance list of providers making their services all out of network.
When this parent got the bill from the ER visit, the plastic surgery bill was worse than my foot bill and she had to pay the deductible amount plus the balance, which was about 75% of the plastic surgery doctor's amount. And there was no discounting offered.
For now I have cancelled the appointment to do my other foot next week. I am too disgusted to walk into their facility and I would surely cause a scene.
The person at the doctor's office said if I had the other one done at the other hospital he does this through and they are in network for me, I will then have to pay my hospital copay. She suggested that I might want to call this other hospital, give them the codes and ask what they charge. That would be absolutely no help in this case, because I honestly believe the codes are wrong.
How can you call and injection of cortesone a bone surgery procedure? That is just wrong.
I am going to call BCBS tomorrow and ask them about this type of bill ....
As for the question as to whether this is legal, my benefits manager says that it is not unheard of for a facility that is out of network to waive the patient's share of the bill. It is not illegal.
She gave me another example of true craziness in the medical system - someone at work took their child to the ER and needed minor plastic surgery for a facial injury. It turns out that the entire plastic surgery community that works through that hospital has taken their practices off the insurance list of providers making their services all out of network.
When this parent got the bill from the ER visit, the plastic surgery bill was worse than my foot bill and she had to pay the deductible amount plus the balance, which was about 75% of the plastic surgery doctor's amount. And there was no discounting offered.
For now I have cancelled the appointment to do my other foot next week. I am too disgusted to walk into their facility and I would surely cause a scene.
Wow that's some bill.
I had 2 cortisone injections done one in my shoulder and one in my wrist they were ultrasound guided done privately in the UK £560 (thats about $800). With liconocaine.
Twist
I had 2 cortisone injections done one in my shoulder and one in my wrist they were ultrasound guided done privately in the UK £560 (thats about $800). With liconocaine.
Twist
I sure hope this charge is wrong. The epidural steroid I had in January was charged out at $1008 and insurance paid $872. The set up was much the same as you described.
There actually aren't any "sterile rooms". Not even the operating room is considered sterile. There may be special filtering of the air and gown/glove resirictions there but it is still only the specially prepared body part having surgery that actually is considered the sterile field.
I'd be careful about providers who waive your co-pay or claim they are willing to accept the insurance payment as total reimbursement. There are situations where this is illegal and others where it is merely unethical. I sure hope the place hasn't jacked the price up just to get a better reimbursement.
I hope your insurance carrier supports your reporting of this. They can't possibly know exactly what service you received in that procedure room and we would be complaining if they asked too many questions. We really don't want them knowing more of our business than necessary. One reason they send out an EOB (explanation of benefits) is because they rely on patients to examine them for accuraracy and then report potential insurance fraud.
You might want to contact the biller before you talk to the insurer tomorrow and give them the chance to do the right thing. Just a suggestion. I'm not excusing any of this but do want to allow for honest mistakes. They do happen sometimes.
Mary
There actually aren't any "sterile rooms". Not even the operating room is considered sterile. There may be special filtering of the air and gown/glove resirictions there but it is still only the specially prepared body part having surgery that actually is considered the sterile field.
I'd be careful about providers who waive your co-pay or claim they are willing to accept the insurance payment as total reimbursement. There are situations where this is illegal and others where it is merely unethical. I sure hope the place hasn't jacked the price up just to get a better reimbursement.
I hope your insurance carrier supports your reporting of this. They can't possibly know exactly what service you received in that procedure room and we would be complaining if they asked too many questions. We really don't want them knowing more of our business than necessary. One reason they send out an EOB (explanation of benefits) is because they rely on patients to examine them for accuraracy and then report potential insurance fraud.
You might want to contact the biller before you talk to the insurer tomorrow and give them the chance to do the right thing. Just a suggestion. I'm not excusing any of this but do want to allow for honest mistakes. They do happen sometimes.
Mary
I"m going to ask about this injection into my returning bunion! the one side is great, but I'm not really a good surgery candidate anymore unless it is necessary!
There was a front page story in our local paper today about hospital costs and what the local insurance companies pay for standard procedures. It was amazing what a wide range these same procedures cost depending on the facility and what the insurance companies will pay.
stay tuned and I'll give an update tomorrow after I call about this bill.
stay tuned and I'll give an update tomorrow after I call about this bill.
The MRI'S that I've done these past few weeks are outrageous , Brain & C- W/WO contrast, then a follow up MRI, T-spine and Lumbar. W/WO contrast.
Its charged as four different MRI'S, almost $4,200 for each, total $16,800 and the insurance pays total just over $8,000 for all four.
I will request that the MSlogist from now on that I only have an MRI once a year, currently they are scheduled every six months, where I start DMD'S or not.
I hate that darn tube..., did I say I hate that darn tube?
take care
Jb
Is it not Ohio State Law that Hospitals have to post charges? May be you could look at what a Hospital near you charged for such procedures and compare since this was outpatient? Of course I found out Hospitals get around the State Mandated Charges in Ohio.
I researched the state mandate awhile back.
My husband is vested with the state and our health insurance is a benefit as well he works at a University.
I hope you get the bill reduced.
Alex
I researched the state mandate awhile back.
My husband is vested with the state and our health insurance is a benefit as well he works at a University.
I hope you get the bill reduced.
Alex
My current primary care doctor & her office has decided not to except any form of insurance anymore. As of 1 Jan 2012 it will be cash, credit card, or check only. She says that she's tired of dealing with insurance companies & what they want to pay for services. Plus, she wants to narrow down their patient base.
Needless to say, I'm on the hunt for a good new primary care doctor that does take insurance.
Needless to say, I'm on the hunt for a good new primary care doctor that does take insurance.
Hi Lu,
I have very good insurance and they do a good job of returning statements to the DR. for additional info. MInd you, I also stay on top of my medical bills and the med insurance. I check out everything. There are too many mistakes made on both sides.
I do feel for others who do not have insurance, I feel a bit spoiled because I have no idea how I would handle my life without it. And believe I do count my blessings.
good luck with that bill Lu, anxious to see what they say..
meg
I have very good insurance and they do a good job of returning statements to the DR. for additional info. MInd you, I also stay on top of my medical bills and the med insurance. I check out everything. There are too many mistakes made on both sides.
I do feel for others who do not have insurance, I feel a bit spoiled because I have no idea how I would handle my life without it. And believe I do count my blessings.
good luck with that bill Lu, anxious to see what they say..
meg
Seeing that EOB would send me over the top too. I look at every single EOB that has been coming in the mail from my hospital stays to make sure there are no issues. If I see somthing funky, I call the doctor's office first to see what was going on, then I call BC/BS so I have the whole story.
BC/BS needs to do a better job of questioning charges as it is not my responsibility as a patient to have to do this. I do check these charges because believe it or not, I actually don't want my insurance company paying a bogus bill. They keep raising our premiums, copays, and paying less for our procedures and one reason is because of the billing practices of these doctor's offices.
I also think these doctor's need to be held accountable for these billing discrepancies whether it is a coding error or embellishment of the actual costs.
Can you have this procedure somewhere else? I had several cortisone injections in the orthopedic doctor's office for my ankle and I didn't need flouroscopy, just lidocane. I recall the bill for that procedure was less than $500. Look into it.
Julie
BC/BS needs to do a better job of questioning charges as it is not my responsibility as a patient to have to do this. I do check these charges because believe it or not, I actually don't want my insurance company paying a bogus bill. They keep raising our premiums, copays, and paying less for our procedures and one reason is because of the billing practices of these doctor's offices.
I also think these doctor's need to be held accountable for these billing discrepancies whether it is a coding error or embellishment of the actual costs.
Can you have this procedure somewhere else? I had several cortisone injections in the orthopedic doctor's office for my ankle and I didn't need flouroscopy, just lidocane. I recall the bill for that procedure was less than $500. Look into it.
Julie
Alex,
I continue to feel for you and the insurance squeeze you have found yourself in, especially with the mounting medical problems. The stress from all of this and the unpaid bills would put me over the top. I hope that I will never be in your position with these financial problems/choices on top of living with MS, but we all know that our insurance/medical bill problems can change dramatically with little notice.
Yes, I do appreciate that I have good insurance because without it we would have been financially ruined televen years ago with my husband's open heart surgery and 14 day hospital stay. I would not be able to afford the medical care I am receiving for my MS, either.
Fortunately I have been with the same employer for almost 22 years and that steady work includes the benefit of my insurance, which I pay part of the premium for myself and 100% for my husband's coverage.
In spite of having excellent insurance, I am aware that just because I have this coverage it doesn't entitle me to waste that money and I do need to question this bill.
L
I continue to feel for you and the insurance squeeze you have found yourself in, especially with the mounting medical problems. The stress from all of this and the unpaid bills would put me over the top. I hope that I will never be in your position with these financial problems/choices on top of living with MS, but we all know that our insurance/medical bill problems can change dramatically with little notice.
Yes, I do appreciate that I have good insurance because without it we would have been financially ruined televen years ago with my husband's open heart surgery and 14 day hospital stay. I would not be able to afford the medical care I am receiving for my MS, either.
Fortunately I have been with the same employer for almost 22 years and that steady work includes the benefit of my insurance, which I pay part of the premium for myself and 100% for my husband's coverage.
In spite of having excellent insurance, I am aware that just because I have this coverage it doesn't entitle me to waste that money and I do need to question this bill.
L
That is about right for something for me. My LP done in 2009 was that much. This is what I keep telling people medical is getting expensive and sooner or later people's insurance does not meet the cost of procedure. I usually pay 50% or more of my bill with my BCBSNC group plan and we are the largest group plan in the State.
I would fight it but it does not matter what you are verbally told it matters what papers you sign say. For example if you sign a paper which says you are responsible for what your insurance does not pay which every care comes with these day You are responsible.
Most billing especially if it is tied to any hospital corporation is separate from the medical.
You can negotiate payments. I have learned from people working in the medical billing office to be really nice because the person on the phone can either work with you on payments or not according to how you treat them.
I liken our Insurance based health care system to the Titanic. Those with out insurance have drowned. Those with lower income and insurance, like me, are drowning. Those in the middle class are swimming or will be. In the end it will not matter what insurance or income you will be struggling for life boats and hopefully a rescue ship will come in time.
I read in the paper Thanksgiving that lawmakers on both sides think Medicare vouchers are a great idea. Give seniors money for premiums for private insurance. It is not the premiums that are going to be the problem it is what the insurance no longer pays for.
It is not the Insurance Companies fault. The truth is medical care is expensive and has out paced insurance. There are no easy answers to our health care crisis.
I hope you are not like me. See I have no savings or assets left to liquify to pay any medical expenses. I am scared. I have outstanding bills for specialists I can't pay even with payments. I have maxed out credit cards. It may kill me. I have this gastro issue which I have not seen a doctor yet and can't afford. I am still dropping weight. I have had to make choices lately like what is more important MRIs three doctors want me to have on my spine, treating pain which is making life not worth living, or finding out why I can't eat.
I am 48 and I do not see myself making it on my current health care tragectory. I am not giving up by any means. I just have to take a much more conservative approach. I hope you Lulu never have to be where I am.
Alex
I would fight it but it does not matter what you are verbally told it matters what papers you sign say. For example if you sign a paper which says you are responsible for what your insurance does not pay which every care comes with these day You are responsible.
Most billing especially if it is tied to any hospital corporation is separate from the medical.
You can negotiate payments. I have learned from people working in the medical billing office to be really nice because the person on the phone can either work with you on payments or not according to how you treat them.
I liken our Insurance based health care system to the Titanic. Those with out insurance have drowned. Those with lower income and insurance, like me, are drowning. Those in the middle class are swimming or will be. In the end it will not matter what insurance or income you will be struggling for life boats and hopefully a rescue ship will come in time.
I read in the paper Thanksgiving that lawmakers on both sides think Medicare vouchers are a great idea. Give seniors money for premiums for private insurance. It is not the premiums that are going to be the problem it is what the insurance no longer pays for.
It is not the Insurance Companies fault. The truth is medical care is expensive and has out paced insurance. There are no easy answers to our health care crisis.
I hope you are not like me. See I have no savings or assets left to liquify to pay any medical expenses. I am scared. I have outstanding bills for specialists I can't pay even with payments. I have maxed out credit cards. It may kill me. I have this gastro issue which I have not seen a doctor yet and can't afford. I am still dropping weight. I have had to make choices lately like what is more important MRIs three doctors want me to have on my spine, treating pain which is making life not worth living, or finding out why I can't eat.
I am 48 and I do not see myself making it on my current health care tragectory. I am not giving up by any means. I just have to take a much more conservative approach. I hope you Lulu never have to be where I am.
Alex
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