One other thing to look out for is out-of-network/non participating doctors (anesthesiologist, radiologist, etc.) that "hide out" in in-network hospitals. Depending on your insurance carrier you may still be able to pay as if it was in network and appeal if you are balance billed to have your claim adjudicated.

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One other thing to look out for is out-of-network/non participating doctors (anesthesiologist, radiologist, etc.) that "hide out" in in-network hospitals. Depending on your insurance carrier you may still be able to pay as if it was in network and appeal if you are balance billed to have your claim adjudicated.

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No. Shiite. It happened to me, but I protested and my insurance company treated the anesthesiologist as in-network. That b.s. should never happen.

"Nine times out of ten, patients' complaints should be directed at their carrier and not their physician or medical provider."

Wrong.

So my wife just had a baby 3 months ago. PPO with $250 deductible (we paid high premiums knowing we were going to have a baby). The delivery doctor and hospital both guessed at amounts to pay up front and the hospital took money again after delivery. I paid upfront and immediately after delivery, both ensuring me that accounting would go through it and I'd receive a check in the amount we overpaid (I now know I shouldn't have done that).

Guess how much I've received back. I'll now have to audit and request the itemized bill again for the second time.

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One other thing to look out for is out-of-network/non participating doctors (anesthesiologist, radiologist, etc.) that "hide out" in in-network hospitals. Depending on your insurance carrier you may still be able to pay as if it was in network and appeal if you are balance billed to have your claim adjudicated.

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This x10000000. Wife had a c-section and the surgical assistant wasn't in-network. We had reached the out ofpocket maximum so shouldn't have needed to pay a thing but we got a bill for 3k in the mail. We raised hell and the insurance company finally took care of it.

I had a week long hospital stay due to bacterial infection. I put my insurance card on my table and told every medical professional that walked in the room that I wouldn't talk to them unless they could verify they took my insurance.

Daughter recently wrapped up a 34 day stay at McLanes children's Hospitla in Temple for an E. Coli infection and HUS.


Between pediatric hospitalists, nephrologists, neurologists, radiologists and gastroenterologists we are just waiting for the hammer to fall.

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Daughter recently wrapped up a 34 day stay at McLanes children's Hospitla in Temple for an E. Coli infection and HUS.


Between pediatric hospitalists, nephrologists, neurologists, radiologists and gastroenterologists we are just waiting for the hammer to fall.

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When my kiddo spent 72 days in the hospital we were still getting bills one year later.

Wow a year?



And 72 days is an incredibly long time.

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Ive successfully negotiated several times. Child labor and ER visit. You'll need to pay on the spot when agreed.

Not sure if you're looking for a tactic. I offer half. If they say no the call is done. 3-4 calls later they'll take it. I wouldnt spend alot of time on it. Most of the people you speak with cant negotiate. Eventually the person who can will call.

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Did you call them and offer half or is this when they call you?

We had a kid about 2 1/2 weeks ago so things will come in the mail eventually I'm sure. IHNFC about health insurance or any of that, it's all voodoo to me.

You're about to get an education

Our out of pocket for the youngest was $50. That included pre-natal, delivery, etc. Those were the days.
Of course the real expense was yet to come.

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It's because they do not know how it is going to be coded. Docs don't code their own charts and front desk people don't know revenue cycle management and carrier agreements or charge master values. Because of a multitude of regulations, your bill will typically travel through 3-5 companies before ever reaching your doorstep. The process is so broken up so as to protect against fraud (one reason at least), that we don't receive first ins payment until about 30-45 days after your visit.

They don't tell you because in all honesty, they don't have a clue.

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my son broke a finger and after the swelling did not go down for a few days I was worried it might need more than just a splint and bandage. So called his doctor....lets see, office visit, then send to imaging place, they send images to orthopedic, office visit to orthopedic to read x-rays and see my son. So we would have to visit 3 places and pay 3 different bills.

Call Urgent Clinic down the street "office visit is $59, finger x-ray is $39, no cost for the split". Took him over and was in/out in about 60m. Received and itemized bill, paid it and I submitted the claim to my insurance to count against his deductible for the year.

Son cut wrist while out of town. It was bleeding a lot and my wife insisted we got to ER in case he got an artery and needed surgery. Saw doctor, got x-ray and one stitch in wrist. 4-bills and $1,000 out of my pocket. I tried to pay the bill when we left and they said they would not know until a week or more. My mistake was giving them my insurance. I should have just given them my name, address, phone, then negotiated the bills when they came in, got an itemized bill and submitted a claim on my own.

Obviously if the Urgent care had found something else with my 1st son's finger they may have had to do more, but the fact that they can tell me the basic costs over the phone tells hospitals are lieing about not knowing costs. I've worked in a hospital and in heath care for 12+ years now. Hospitals know what EVERYTHING costs them (salary, benefits, utilities, etc.). If they were forced to provide costs up front or online, it wouldn't take them 30-days to get 90% of the procedures they do routinely published. Obvioulsy there will be exceptions, but they could do it if necessary.

Coding" is code word for "we're going to milk this for all we can..." Not that I blame them, the gov. pushed us all into this model.

UCs and FSEDs bill differently. One is a wall in clinic and one is an emergency department.

If your plan is what is called a fully funded plan, you can ask for a mediation through the Texas department of insurnace if you used hospital based services such as anesthesiology or pathologist.

That all should be covered after you meet your in network maximum out of pocket. Argue the PPACA section 2719a: https://www.copatient.com/blog/reduce-network-bills/

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If your plan is what is called a fully funded plan, you can ask for a mediation through the Texas department of insurnace if you used hospital based services such as anesthesiology or pathologist.

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This.

http://www.tdi.texas.gov/consumer/cpmmediation.html

My son's neonatologists when he spent a month in Nicu were out of network, but they were the only ones available at an in-network facility. We got bills months later for $60k in claims. After a bunch of back and forth we finally went through mediation and insurance settled with them for $20k, and we're paying under $500.

Nobody at the hospital or anywhere else can explain billings in a way that makes much sense. I'm look9ng at a statemet that I received following an outpatient procedure:

Total charges: $44,385 Insurance Payments $2,078 My balance $519. I paid it.

Same with some routine blood work. Billed around $2,200 Insurance paid around $80 My balance around $20.
The billing appears absurdly high. The amount paid seems absurdly low.

The answer I got when out of curiosity I inquired was something about contracts.

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Nobody at the hospital or anywhere else can explain billings in a way that makes much sense. I'm look9ng at a statemet that I received following an outpatient procedure:

Total charges: $44,385 Insurance Payments $2,078 My balance $519. I paid it.

Same with some routine blood work. Billed around $2,200 Insurance paid around $80 My balance around $20.
The billing appears absurdly high. The amount paid seems absurdly low.

The answer I got when out of curiosity I inquired was something about contracts.

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If they are "in-network", then the contract calls for a fraction of the total charges to be paid. The rest is written off as an insurance adjustment and forgiven. Of course, this is dependent on the situation as no two are the same.

The amount paid is typically based on a % of Medicare allowable charges. The higher that %age, the wider the network.

Give labcorp your insurance info. Also try calling them. If you did the genetic screening test they have a substantially discounted cash rate they offer.

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ive got a new issue that is really bothering me.

the wife and i used IUI to conceive and paid a decent amount for the process. after the pregnancy was confirmed, they continued to take blood regularly. i asked repeatedly if this was covered in the fee we paid for the process, and if not, if it would be covered by insurance. they assured me that it was and there was nothing to worry about.

fast forward a few months, and i get a bill for $3k+ from labcorp for all these blood tests and such that they performed. these were all things i was assured were included in the process, and all perfectly normal for a woman to get after finding out she was expecting. I am beyond mad as we already paid a lot for the service. I do not know what to do or how to go about dealing with this. any advice at all on this? SO mad and cannot afford this considering what has happened to my employment in the past year.

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Write letter to them saying the people that told you it was part of the fee already paid or would be covered by your insurance. If they contrinue collection efforts, you will bring suit under dtpa and debt collection act

Womder, what you said about networks and contracts is pretty much what the hospital billing person told me. I understood what I was being said but it still makes no sense. Maybe it's not this simple, but try this: A car should cost about $25,000 to cover dealer cost and a little profit. Dealer asks $75,000 knowing that he/she will get $5,000. How can a $2,100 billing and $100 collected for blood work by the lab make any sense at either end. Fact: It's one big mess--and O-care is going to make it even messier. Can't wait for government run healthcare. It's already largely here and more is on the way. Regs, regs, regs and more regs.

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ive got a new issue that is really bothering me.

the wife and i used IUI to conceive and paid a decent amount for the process. after the pregnancy was confirmed, they continued to take blood regularly. i asked repeatedly if this was covered in the fee we paid for the process, and if not, if it would be covered by insurance. they assured me that it was and there was nothing to worry about.

fast forward a few months, and i get a bill for $3k+ from labcorp for all these blood tests and such that they performed. these were all things i was assured were included in the process, and all perfectly normal for a woman to get after finding out she was expecting. I am beyond mad as we already paid a lot for the service. I do not know what to do or how to go about dealing with this. any advice at all on this? SO mad and cannot afford this considering what has happened to my employment in the past year.

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Write letter to them saying the people that told you it was part of the fee already paid or would be covered by your insurance. If they contrinue collection efforts, you will bring suit under dtpa and debt collection act

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This. Send it certified/return receipt requested and demand a response within 30 days. KEEP ALL RECORDS.

After they respond, go from there re retaining legal counsel.

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Womder, what you said about networks and contracts is pretty much what the hospital billing person told me. I understood what I was being said but it still makes no sense. Maybe it's not this simple, but try this: A car should cost about $25,000 to cover dealer cost and a little profit. Dealer asks $75,000 knowing that he/she will get $5,000. How can a $2,100 billing and $100 collected for blood work by the lab make any sense at either end. Fact: It's one big mess--and O-care is going to make it even messier. Can't wait for government run healthcare. It's already largely here and more is on the way. Regs, regs, regs and more regs.

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It's not that simple. You have state and federal regs controlling along with agreements between the provider group and insurance, you and your insurance, and contracts between billers/coders/collectors. It is a giant spider web of relationships and fees.


Regarding gov run healthcare. Look at the VA and tell me you still want the gov controlling your healthcare...


ETA: Regarding the complexity of everything, I've been in this sector for four years, three as an attorney, and I still learn something new nearly everyday. It is every changing with new rules, regs, and requirements that create a constant need for changes within the system. Unfortunately, those changes cost money and that additional money is billed to patients and their insurance. People want "free" healthcare or universal healthcare and I can promise you that you will see the quality of healthcare run into the ground as smart individuals realize they can't make money to pay their school debts or a live a life worth dealing with the sick and dying on a daily basis. We saw about 1/10 of our physician and midlevel work force (~300 total at the time) in my company retire the day the ACA went into effect because hospital rates would fall. And they were right.

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ive got a new issue that is really bothering me.

the wife and i used IUI to conceive and paid a decent amount for the process. after the pregnancy was confirmed, they continued to take blood regularly. i asked repeatedly if this was covered in the fee we paid for the process, and if not, if it would be covered by insurance. they assured me that it was and there was nothing to worry about.

fast forward a few months, and i get a bill for $3k+ from labcorp for all these blood tests and such that they performed. these were all things i was assured were included in the process, and all perfectly normal for a woman to get after finding out she was expecting. I am beyond mad as we already paid a lot for the service. I do not know what to do or how to go about dealing with this. any advice at all on this? SO mad and cannot afford this considering what has happened to my employment in the past year.

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who did you use? We used HFI and did IUI twice and ended up doing IVF. My wife went every week on friday for an ultrasound and blood work. She paid after each visit.

My daughter got a blood test ordered by an in network doctor, at an in network lab and it got denied because it was "exploratory".

so i call the insurance company to appeal and they say, you should have called before the test...and I say, so I need to call you before I get any test done?...they said yes.

so if I get a bloody nose that won't stop and have to get a test to see what's causing the bleeding, I have to call you first?...Yes.

what a racket.

and before I blame the insurance company, it's really my company who controls what gets denied...so I blame them too...

I think this may be more of a biproduct of your company than your insurance company. I have had a multitude of blood work done over the years. One time they did about 25 tests at once (14 vials drawn) and never had any tossed as exploratory.

I have gone through 6 insurance companies in the last 15 years and I won't say they were all fully covered because they weren't but only one time were some blood tests were denied coverage due to a coding mishap. All the tests were covered and discounted since they were "in network." So I did have to pay for several out of pocket, but after the discounts.

I can easily have a $3-$4k bill for blood tests if they do a full comprehensive blood panel to check for everything that ails me. I have at least 4 blood tests done a month, the lab charges $1100 to the insurance and the insurance turns around and settles for $140.

It is a huge racket. I am just thankful I have good insurance that doesn't cost a fortune. I keep waiting for our benefits to drop drastically and quadruple in price.

My wife was at Medical Center of Plano for 5 days and got large bill charges $45k and we owe $2k which reaches the $4k out of pocket along with all other bills. I'm looking to get a discount ultimately. What is the best way to go about it, in order?

Request itemized bill first. Likely something to dispute. Once resolved, do I offer cash upfront for discount or get on payment plan first and ask later?

Not sure I want to go down this path but the ER was completely negligent. My wife was in a wheel chair and talking about passing out. They triaged her way too low and we waited in ER for over an hour with other patients not needing immediate attention. I requested a bed multiple times and they said they didn't have one open. Took wife to bathroom later and she passed out hitting her face after I partly caught her fall. They were completely unprepared. We got a trauma room then and had ct scan because of fall. At a minimum I suppose I could refuse to pay for ct scan as result of their negligence. Not sure if it's worth pursuing further.

I went to the ER for severe right side abdominal pain - couldn't keep food and liquids down for a few days.

ER gave me a sonogram, which came back negative for pregnancy and gallstones. A couple of IVs and some pain killers and they sent me home.

Three days later, still can't keep food down and still have severe abdominal pain. Followed up with GP, who ordered a CT. They sent me back to the ER b/c my appendix was ready to burst.

I should receive a refund because of how horribly bad the first ER was.

Watch listed for this fall when our baby is due.

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abnother thing that pissed me off about the place is that i gave them my specimen, and then they said it wasnt good enough and charged me again two days later to go give another specimen. so i was double charged in that regard.

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I only see one silver lining in this whole story...