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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
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.
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