Drowning in medical bills - any advice appreciated

[wdwfan16]

I apologize in advance - this could get lengthy.

We are in deep trouble with medical bills piling up. We have BCBS thru hubby's work but it seems that fighting with the insurance company is becaoming a full-time job for me. We have a $1250.00 per person copay and then they will pay 80% up to a maximum out of pocket expense of $5000.00, and then they will pay 100%.

Last month, Dh was taken to the ER with a suspected heart attack. After two days in the cardiac care unit and numerous tests it was determined not to be a heart attack but a pulmonary embolism (blood clot in the lung) instead. He was transferred to a regular room for a couple more days then released with very expensive medications. One co-pay was over $200.00 and that script was refilled twice.

Fast forward 7 weeks later and he is still on medical leave from work (paid thank goodness) because even though his primary doc is willing to let him go back with restrictions his employer says he can't come back til fully released. I guess they'd rather pay his full salary for him to sit and home???

His hospital visit alone was over 20K. Charges for lab tests, intern visits and other misc charges are still coming in. It would take a brain like Stephen Hawking to decipher all these bills. I've been trying to match up the insurance explanation of benefits sheets with the bills but half of them do not match at all. HUGE RANT - why can't the billing be simplified to make any sense at all? Would it be so difficult to get streamlined billing in plain english?

So then, in an attempt to find out the cause of the PE, DH has had to see a cardiologist and a pulmonologist. The cardiologist had him do a nuclear/chemical stress test because he didn't think an ordinary stress test was a good idea with the clot (which I just received a letter today from BCBS that that claim of $1700.00 was going to be denied - wth? How can you deny a test if a specialist deems it necessary?).

Went to the pulmonologist yesterday and he says his lung function is fine, the clot has probably desolved by now and by the way, does hubby snore and could he possibly have sleep apnea? Turns out that this pulmonologist is affiliated with a sleep center and according to him everything that hubby has wrong with him - type 2 diabetes, chest pain, slight weight gain over the years, borderline high blood pressure, etc INCLUDING the blood clot, is a direct result of sleep apnea. So now he wants to schedule a sleep study. Call me paranoid, but something just doesn't seem right here. (As a side note and a shout out to the wonderful DIS'ers here -when filling out info at this dr.'s office they asked for info on me as a spouse, name addy, phone, birthdate and SS #. I just about flipped out! I wasn't even the patient, DH was the primary insured and they wanted MY ss#??? Thanks to you guys we left it blank and when the receptionist questioned it I gave her an earful about HIPPA, identity theft, etc. She probably thought I was nuts but she just smiled and said never mind...go figure!)

I'm so grateful that we have insurance but I must admit I get a teensy bit jealous when I hear of people who don't have it getting their medications for free or ir medical bills wiped out.

Anyway, to sum this up: We currently have over $7000.00 ( and climbing every day) in outstanding medical bills. We can pay some of the smaller ones outright, like the ones for a couple of hundred or less. My question is - what to do about the high-dollar ones? Can we just send in what we can afford every month and will that keep us out of collections? We have one credit card for emergencies that we keep zero balance but is is only a 5k limit and we would like very much to keep it that way. Our budget is pretty much set in stone with only two to three hundred discretional money left over each month and that is usually put into savings.

Between the stress of hubby's illness and all the other crap going on in our lives right now I am at my wit's end and just need a break. Any suggestions you guys have wuold be great.

thanks - Lisa

You have to contact the billing office and setup a payment plan. You need to initiate it or they can demand payment in full.

Do you work? You may need to get a job or another job to pay the payments. I expect it could be more than 200-300/month.

Since you know how your insurance works you need to setup a medical emergency fund to cover these costs in the future.

 

[BoogasMom]

CALL, CALL, CALL!!!! I work in a billing dept for an orthopedic practice and I know firsthand that we will work with our patients if they will just call us and explain to us what is going on. We don't like seeing our patients go to a collections agency and if a person calls us and expresses a hardship but also a desire to pay off their debt with us, we will bend over backwards to make a payment plan that will work for them without bankrupting them in the process.

My reply is so long that I decided to PM you the rest!!

 

[Halle]

OP, I work for a cardiologist and know that a nuclear stress test is more than $1700.00. Look over your explanation of benefits again and check to see if they paid the Dr./facility. Chances are you may have not read the explanation of benefits correctly. Insurance companies often deny a protion of the charge because the physician/facility billed more than is allowed by your insurance company, they can not collect those funds from you. Best of luck to you and our DH.

 

[sparklynails23]

Sounds like BC/BS isn't the gold standard in medical insurance it used to be. OP, does your husband's company have an insurance coordinator or contact? There is one at DH's company who can explain benefits and even help with appeals. And our BC/BS does deny a claim just to see if they can get away with it, but we have been lucky so far.

 

[tinker&belle]

Hi. So sorry you have been going through this. One of our DD's had issues last year and has had lots of treatments this year, and dealing with the insurance is tricky. (Not to mention keeping track of each Dr. bill since every single little thing seems to bill seperately.)

My biggest piece of advice is to ask BCBS for a care coordinator. We have had Cigna and Sagamore and have had one for both of these services so I would think it would be offered through BCBS.

We had a charge (around 700-800) that didn't go through that I thought would. I asked to be given a coordinator. After she contacted me I explained the issue. She said she would have a supervisor call me. I hung up the phone and within two minutes a supervisor called me and straightened out my issue. This saved me HOURS!

The other nice thing about the coordinators we have had is they talk to me in plain language, it doesn't seem like they are evading questions the way it does when you talk to a regular representative.

Best of luck. I know it is hard to pay the max OOP for the year (we are doing it for the second year in a row.) If it is ongoing I strongly recommend getting an HSA or Flex benefits and saving an amount each month. The hospital should be able to get you on a payment amount so at least that way you can plan for your payments and they will be tax free. That is significant savings too.

 

[arminnie]

I see you are also in Texas. Unfortunately I think that Texas has the worst insurance protection in the nation and some of the least "forgiving" hospitals when it comes to billing.

The Texas Risk Pool insurance is pretty good though. Friends of mine have used it for years.

My best friend had a double mastectomy 4 days prior to her Cobra benefits running out. No way she could have gotten ANY coverage except for the state risk pool. She ended up with multiple surgeries, hospitalizations, infections, chemo for over a year. She got to go to great doctors and everything was paid for including reconstruction. Hundreds and hundreds of thousands of medical bill were paid for.

If she had been in my state I guess she would be dead now. She owned a house and had a little money so would not have been eligible for Medicaire. But she could never have paid for her care. Yes she could have always gone to an ER - but regular doctors and chemo care probably would not have been available.

 

[r5moores]

Hi there. Soooo sorry for all this stress you are going through. I actually work for BCBS, just not in your state. I can tell you that most of what apnep stated is true, except the part about if you've already paid $ ded out of pocket then bcbs should be paying. We process claims as they come in. So, lets say for example you paid the Hospital $1250 up front because they called to verify your benefits and they were told you have a $1250.00 deductible. They can ask you to pay up front based on your benefits, BUT, and here comes the tricky part, their claim may not come in first. Lets say a surgeons claim comes in first, that will take the deductible. We have NO WAY of knowing you paid the hospital up front. Claims are paid based on first come first served kind of order. So we'd state you owe the surgeon the $1250.00, and you'd have to get your money back from the hospital that you paid up front, because we'd be paying 80% of the hospital claim with no deductible because the surgeons claim processed with your deductible. I can tell you that most likely the nuclear test denied for no authorization. BCBS, depending on your actual plan/company set up requires an authorization for a nuclear test. If its not obtained it will deny.

I know thats alot to digest. Please, please, please feel free to PM me. I will help in ANY way I can to better help you understand. Also, request a statement of payment. It will be EVERY claim that came in so far. It will tell you what went to deductible, what applied to your 20% coins etc so you will know exactly what is owed to whom.

Hope that helped.

 

[Nancy]

appeal all denials--esp. the $1700 nuclear stress test. Get the Dr. to write a letter that it was medically necessary--also talk to billing office. Also, do a search on the web--I believe that BCBS in some other states covers this. For, example, if you do a search for Anthem BC in VA, you would probably find that it is covered--let billing office know this, so they can call BC and discuss with them. If you can arm yourself with some states in which BC covers this, you have a better chance. Also, call your state insurance commissioner and complain politely, esp. if you have evidence that in other states it's being covered, then follow up with THAT person with a letter--they might make a call for you and get the test covered.
Lastly--you can die from pulmonary embolism--be thankful he recognized that he was in distress and went to hospital and had a good outcome! Elaine

Call BCBS first and see WHY it was denied. Nuclear stress tests almost always require advanced notification, I've never seen one that didn't. If the ordering doctor didn't call in the notification then he has to take the hit and can't bill you for it...unless you signed papers saying you would pay for anything that insurance didn't cover. If it was denied saying it was unproven for the diagnosis then you appeal. If it was denied saying the billed code doesn't match the diagnosis then you need to get the doctors office to send a corrected claim.

And insurance companies are not always the big bad wolf trying to blow the house down. If the plans are self funded they are paying claims the way the plan is set up by the employer. They get offered plans and get to choose how and what they want covered.

Also, you have a deductible and co-insurance to your out of pocket max, do you know if your deductible is included in the out of pocket max amount? Some plans do and some don't start applying funds to the max until the deductible has been met.

 

[Nancy]

Hi there. Soooo sorry for all this stress you are going through. I actually work for BCBS, just not in your state. I can tell you that most of what apnep stated is true, except the part about if you've already paid $ ded out of pocket then bcbs should be paying. We process claims as they come in. So, lets say for example you paid the Hospital $1250 up front because they called to verify your benefits and they were told you have a $1250.00 deductible. They can ask you to pay up front based on your benefits, BUT, and here comes the tricky part, their claim may not come in first. Lets say a surgeons claim comes in first, that will take the deductible. We have NO WAY of knowing you paid the hospital up front. Claims are paid based on first come first served kind of order. So we'd state you owe the surgeon the $1250.00, and you'd have to get your money back from the hospital that you paid up front, because we'd be paying 80% of the hospital claim with no deductible because the surgeons claim processed with your deductible. I can tell you that most likely the nuclear test denied for no authorization. BCBS, depending on your actual plan/company set up requires an authorization for a nuclear test. If its not obtained it will deny.

I know thats alot to digest. Please, please, please feel free to PM me. I will help in ANY way I can to better help you understand. Also, request a statement of payment. It will be EVERY claim that came in so far. It will tell you what went to deductible, what applied to your 20% coins etc so you will know exactly what is owed to whom.

Hope that helped.

I probably should have read all the way to the end...I just repeated a lot of what you already said.

 

[sookie]

i recommend you call the hospital and ask for any and all assistance possible. whatever they don't waive, put on a do-able payment plan. the docs are less able but some will give discounts if you say you need it and will put you on a payment plan as well. i hear that a lot of hospitals, however, will work with you in making the balance and then the payments very doable if you just work with them.
he is so lucky that he surivived that pe. yes, sleep apnea can be a contributer to strokes and other health problems. is your husband obese? that can contribute to the sleep apnea as well.

 

[Calliaz]

One important key is to make sure that you use in-network facilities, doctors, etc. It is possible that BCBS is denying that $1700 because you were out of network (a single doctor at an in-network hospital can be out of network for you).

Also, in certain situations, the insurer will not pay over reasonable and customary. My husband had surgery at the Mayo Clinic. It was covered as out of network (we paid 20% instead of the usual 10% for in-network). However, the kicker was that we also paid anything over BCBS's standard payment for the procedure. So, on a $10,000 bill where we should have owed $2000, we actually owed $4000 because BCBS's usual and customary charge was $8000. We owed the difference, plus our 20%.

 

[apnep]

So, lets say for example you paid the Hospital $1250 up front because they called to verify your benefits and they were told you have a $1250.00 deductible. They can ask you to pay up front based on your benefits, BUT, and here comes the tricky part, their claim may not come in first. Lets say a surgeons claim comes in first, that will take the deductible. We have NO WAY of knowing you paid the hospital up front. Claims are paid based on first come first served kind of order...

Yes, this is exactly the reason why as patients and users of private insurance, we have to know exactly how much we have already paid out towards deductibles and why we have to be vigilant in knowing how our plans work. If I go to the doctor or hospital and they tell me I owe them the deductible, I'm going to tell them no I don't because I am fully aware of what I have already paid out.

By the time I got to hospital with my DH, I knew we had already met the deductible so they did not bill us for it. Everytime I go a doctor, I am our plan's website checking the claims and before any claim checks have even been mailed out to the doctors by the insurance, I know what they are covering and what my portion is long before the doctor's billing does. I can also verify this information with the bills I have in hand. This is a very good point that I failed to make clear--first come first serve that's why you as a patient need to know how much you've paid out.

This is also the reason you wait a while before paying anything to make sure everything goes through and the dust has settled.

Thanks, r5moores!

 

[DaniBeems]

I am so sorry to hear about you and your husband! That is such a difficult situation, both emotionally and financially. And the last thing that you want to worry about when a loved one is in the hospital are the bills. However, that issue always seems to be in the back of your mind no matter what. Here is something to help you get some good advice about paying back large medical bills http://www.accumulatingmoney.com/tips-for-paying-off-outstanding-medical-bills/ I hope this helps you and your family out. Best of luck to you and your husband!

 

[weezyree]

I haven't read other's views since I'm on lunch, but found out most hospitals have financial grants available through the large donations given to the hospitals in endowments. An employee reviews each request and goes into great depth to work with you to find you some help. They review your debt to income ration, your household circumstances and may help pay off a portion of the debt.

 

[scrapquitler]

Anyway, to sum this up: We currently have over $7000.00 ( and climbing every day) in outstanding medical bills. We can pay some of the smaller ones outright, like the ones for a couple of hundred or less. My question is - what to do about the high-dollar ones? Can we just send in what we can afford every month and will that keep us out of collections?

Call the hospital. When my son had surgery 2 years ago, our bill for things that weren't covered was pretty large. When I got the bill, I called the hospital and explained to them that I couldn't pay it all at once. They said, "How much a month CAN you pay?" So I told them I could afford $150 per month. They said that was fine, and every month they sent me a bill for $150, which I paid (sometimes I paid more, but not usually). They never charged any kind of interest or fees on it either. So I suggest you call them and set up a plan.

Another thought: when we got that initial bill, there was a statement on the back of the bill that the hospital has a fund for people who definitely can NOT pay the bill, but that the fund is based on your family income. It said that if you thought you might need that sort of help, to call them and they would explain the program (this was at Yale's Hospital, so I'm not sure if this is a normal and common thing), but it couldn't hurt to ask about this sort of thing.

We also have BCBS, and I can tell you that sometimes you have to have things submitted multiple times before they will pay them, and sometimes if things are denied, you can call the doctor or hospital and explain to them that the insurance denied your claim and sometimes they will zero it out depending on the situation.

Also know that the insurance company will provide you an advocate to help you maneuver the red tape involved with all these claims. I think they call it an ombudsman. Call BCBS and ask them for the ombudsman or patient advocate office and maybe they can help you to understand all of it.

Good luck and I hope your husband is better soon.

 

[a1tinkfans]

OP: sorry to hear about your husband. Having to deal with an ill person and still run a home is difficult!

Looks like you got plenty of good advice here. I hope it helps you and that your husband is feeling better very very soon!

 

[disneygirl 17]

I hoped it all worked out - has anyone else noticed that the orignal post is dated July of 2010.

 

[princessnoelly]

Hi there. Soooo sorry for all this stress you are going through. I actually work for BCBS, just not in your state. I can tell you that most of what apnep stated is true, except the part about if you've already paid $ ded out of pocket then bcbs should be paying. We process claims as they come in. So, lets say for example you paid the Hospital $1250 up front because they called to verify your benefits and they were told you have a $1250.00 deductible. They can ask you to pay up front based on your benefits, BUT, and here comes the tricky part, their claim may not come in first. Lets say a surgeons claim comes in first, that will take the deductible. We have NO WAY of knowing you paid the hospital up front. Claims are paid based on first come first served kind of order. So we'd state you owe the surgeon the $1250.00, and you'd have to get your money back from the hospital that you paid up front, because we'd be paying 80% of the hospital claim with no deductible because the surgeons claim processed with your deductible. I can tell you that most likely the nuclear test denied for no authorization. BCBS, depending on your actual plan/company set up requires an authorization for a nuclear test. If its not obtained it will deny.

I know thats alot to digest. Please, please, please feel free to PM me. I will help in ANY way I can to better help you understand. Also, request a statement of payment. It will be EVERY claim that came in so far. It will tell you what went to deductible, what applied to your 20% coins etc so you will know exactly what is owed to whom.

Hope that helped.

This is GREAT Advice!

We had some medical bills with a surgery I had and it took months to get all the right bills submitted and recovered, uncovered, etc. I would call weekly to get an "up to date billing summary" of what had been paid and what hadn't. Just when I thought we were totally done and all current- i got a refund check for $47. I also made friends with one of the ladies in the billing dept, hospital billing and Dr. billing- it was much easier to just talk to the same person each time. Our insurance broker also helped me understand things as to why they weren't paid and did lots of the leg work for me. Contact your HR person and ask if they have an insurance advocate who will help you. And again, a payment plan is key (we paid with our SWA cc and got a round trip ticket out of it all...not a great silver lining).

I'm so glad your DH is well....sorry this is so overwhelming but at least you have him to help you through it now.

 

[PrincessSuzanne]

I hoped it all worked out - has anyone else noticed that the orignal post is dated July of 2010.

I don't think they did, looks like a new poster opened it back up today.

Suzanne