Dr./Hospitals/Insurance rant

[buzzlady]

DH went to ER in Dec. Today, I received a bill from the attending Dr. for the balance of the bill after insurance paid. This was a participating hospital. So what is a person to do - stop while they are dieing (DH didn't die but it was serious enough that he could have) and ask for a Dr. that participates in your insurance?

I did call the insurance company and they said that yes, the dr. can bill the balance. She then said that she would resubmit the claim, with the information that we were being billed for the balance, and that the insurance would pick up the balance. I hope they do.

 

[Lisa loves Pooh]

well not an emergency--but our family doctor was out of town for my baby's birth. He had a back up--but we found out in hospital that he did not have pediatric privileges. So the hospital assigned a Ped Doc to my daughter that was (we later found out) out of network.

I simply wrote my insurance company and explained that I did all that I was supposed to do to use my in network doctor. That while at an in network hospital and them refusing to allow the back up doctor b/c he didn't have privileges--I would like the doctor assigned to be considered in network for payment purposes.

They agreed and paid the out of network portion for me to the doc.

Good luck--I hope they pick up the tab for you.

 

[Certifiable WDW Nut]

I had the same problem - my DD2 spent a week in the NICU, unexpectedly. I never thought the dr would not be in our network. I guess I shouldn't complain, because I think the hospital billed the insurance about $30K for her stay and I only had to pay $1200, but I certainly wasn't expecting that $1200.

 

[bigmerle1966]

I had a co-worker whose husband was having chest pains. For some stupid reason she called the insurance company instead of just calling 911. They sent her to Kensington which is near DC, she was in Columbia, a 25 min. drive away. He ended up having to have stents put in to unblock arteries. Why these idiots with the insurance company did not tell her to hang up and call 911 I do not understand. But that's insurance companies these days.

 

[minkydog]

I had a co-worker whose husband was having chest pains. For some stupid reason she called the insurance company instead of just calling 911. They sent her to Kensington which is near DC, she was in Columbia, a 25 min. drive away. He ended up having to have stents put in to unblock arteries. Why these idiots with the insurance company did not tell her to hang up and call 911 I do not understand. But that's insurance companies these days.

idiots.the liability alone...

 

[kbkids]

Had a similar situation when my 1st child was born. They had to do an emergency c-section, so I had to be put to sleep. Got a bill from the anesthesiologist because my insurance wouldn't pay because he was out-of-network. Called the insurance company and asked how I was supposed to undergo surgery with no anesthesia - they paid.

 

[bigmerle1966]

idiots.the liability alone...

I just don't get some of this stuff they do. Another co-worker was pregnant with twins and had been put on bedrest. She had been in the hospital a couple of times. When she went into full labor 6 weeks early and called they sent her to a differant one because the contract with the first hospital has expired. She is told that her doctor will be contacted and will meet her there. She gets there and her doctor doesn't have privilages and hasn't for a year. She ended up with another doctor. Now she liked this other hospital better, had nicer nurses, but this hospital was 15 min. further from her house. And she had the first baby within an hour of arriving at the hospital.

 

[PrincessKitty1]

Also be careful that you are being billed correctly--I have had two different PARTICIPATING labs try to bill me for the difference between what BC/BS paid and what the lab charged (when they SHOULD have billed me for the difference between what BC/BS paid and what the BC/BS allowable was).

The first lab billed me correctly after I requested a corrected bill, no hassles. The second lab (a pathology lab in Miami) refused to send me a corrected bill and said, "Just pay us what you say you owe us and we'll see if it's correct." I had to call back a couple of times and explain that their billing method could be mistaken for insurance fraud, and that I would have to report it to BC/BS as such if they did not send me a corrected bill. Geesh!

 

[minkydog]

The first lab billed me correctly after I requested a corrected bill, no hassles. The second lab (a pathology lab in Miami) refused to send me a corrected bill and said, "Just pay us what you say you owe us and we'll see if it's correct." I had to call back a couple of times and explain that their billing method could be mistaken for insurance fraud, and that I would have to report it to BC/BS as such if they did not send me a corrected bill. Geesh!

Oh, yeah

 

[JVL1018]

Augh!! Don't even get me started!!
My son had a heart catheterization in October to fix a hole in his heart..I am getting bills every other week..the anesthesiologists at NY Presbyterian apparantly don't participate in any insurance whatsoever(like we get a choice with anesthesia), so I get a bill saying we take credit cards..pay us and then submit it to your insurance co for reimbursement. Yeah, no thanks..I submitted it to insutrance and thankfully that was taken care of quickly.

I got a call from the hospital saying that *I* owed the $6600 for the surgeon because he was out of network..I said no he isn't, I checked with the cardiologist when he referred us, I checked with my insurance company before the consultation AND I checked with the staff when we met with him..this woman at the hospital is insisting that he most certainly doesn't participate in my health insurance, so while I'm on the phone, I pull up his web page on the hospitals website and tell her that i am looking at his page right that very second with my health plan staring me in the face.
She still didn't believe me. Tiold me I was responsible for paying it, I finally told her to resubmit or appeal, but do not contact me again because I have a letter from the insurance company stating that the patient is not responsible for ANY bill.
That also was taken care of immediatly.

I just got another bill for $2500 for the echo the morning after his procedure..a bill that says we are sending this to collection etc., so I call the insurance company and they tell me that bill has never even been submitted. I call the hospital and the lady says, oh disregard that, we just sent that out to the insurance company yesterday.

Well WTH is up with the threatening to send me to a collection agency for a bill I've never even seen before??
Finally got that taken care of..I have to say the insurance people have been awesome, it's the hospital that are morons.

I have to say though for the $60,000 the whole thing cost, the $20 copay I paid still makes all this hassle worth it. LOL


But the best was when I had my daughter, I fought with Cigna for almost 2 years to pay the $5000 bill for my daughter..finally someone figured it out..my daughter was covered under the name L_____, ,Julia, and the hospital bill was for L____, Newborn.
Cigna had no record of someone named Newborn L_____ being covered so they weren't paying.Seriously.

 

[CherCrazy]

We had a battle that went on with Cigna for two years. After much tenacity and finally me threatening to get an attorney, they paid the bill that was due to the hospital where my DH had treatment. It was for about $2000

Our fight went something like this....
Cigna....we have an agreement with this hospital, they give us a discount.
Hospital....we terminated the agreement with Cigna years ago.
Cigna...hospital is wrong
Hospital....Cigna is wrong

Two years of that....Hospital was right. Cigna was wrong.

 

[Pin Wizard]

Definitely contact your insurance company and explain it's being an emergency basis. You can't quite stop and ask the doc...do you participate in my health plan? Ugh. Glad they're reprocessing it!