topic Re: I Need To Vent in Community Chat

I Need To Vent

Jordan2 — Tue, 30 Aug 2016 18:35:15 GMT

Let me apologize in advanced as this will be long winded! I had cataract surgery (I am kind of young to have had it) on July 26 of this year at a hospital, it was ambulatory.In the admitting office the woman who handled my paper work takes my insurance card and tells me my deductible is $778 (I have a $1000 deductible I have to meet). She was looking for me to give her a check (I felt obligated to give her something as I felt my surgery relied on it), I gave her $400. I then get a bill from my ophthalmologist's office for the whole $778. I call the doctor's office and am told I shouldn't have given the hospital money as the doctor filed first and the money is his. Flash forward to August and this is a nightmare, my insurance company and I trying to work things out with the hospital. I pay the doctor $378 on August 17 thinking it will buy me a month. Anyway they post my check on the 19 and send me another bill on August 26! I called the office asking why did I get a bill so soon after sending a check. She tells me the bookkeeper sends them out weekly! I am so angry with the office (the doctor has no clue), I have been going there for YEARS, I'm not leaving town! As for the hospital reimbursing me it will take maybe 2 weeks (if I'm lucky). I called the admitting office at the hospital to speak to the woman who admitted me, she was not "available" to speak with me, I spoke with a supervisor. She apologized profusely to me and said this should not have happened. Now I'm short $400 which I cannot afford. The kicker is the hospital filed the claim on August 18 for a July 26 service, they should never have asked me for the deductible.

Re: I Need To Vent

Annabellethecat66 — Tue, 30 Aug 2016 18:46:23 GMT

@Jordan2 I feel your pain. I just got off of the phone with a billing company (Dr). I've been on the phone with them over and over because they kept submitting the incorrect SSN to Medicare. I was on the phone for 56 minutes waiting for Medicare when they finally said, "It's their fault" (Medicare was right, it was their fault). Over and over I kept calling this Drs office. Then yesterday I get another (one of at least many (every 2 to 3 weeks since April) saying the bill was DELINQUENT (big letters) and if it wasn't paid within 30 days it would go to collection! It showed where Medicare had paid their part and the $54. was my copay. That's fine, not a big deal. What bothers me is that the bill (what I owe) is not delinquent! I told them my credit had better not be affected, (I'm sure it won't) but it's the fact that they are threatening me like that when it was their fault the entire time. I always think about other people who don't have money to pay bills immediately (when an office is supposed to be working on payment).

I told her that I wanted her computer that printed out all of those other bills to print out another one to me showing a zero balance. I paid with a debit card over the phone. I had to ask her 3 times for the confirmation number. At first she said "We don't give that out". I was like, "What?" She got her supervisor and she gave it to me.

Just told all of this so everyone (including Jordan2) knows you guys aren't alone. It's frustrating for other's too. While I'm lucky I can pay things, I think about people who can't pay immediately.

Re: I Need To Vent

Nightowlz — Tue, 30 Aug 2016 18:49:38 GMT

Sorry you are dealing with this. Been there done that. I won't pay anything when I go to the hospital for any tests. They always ask for it though. It took 3 months & I don't know how many phone calls to get my refund.

The hospital always asks for more. They have no idea how much of that deductible you still have to pay. They also don't take into consideration that the Hospital charges this amount & the Ins allows this amount & the patient pays this amout.

It's easier to keep track of if you pay after you receive your EOB from the Insurance Co.

Re: I Need To Vent

SahmIam — Tue, 30 Aug 2016 19:15:49 GMT

I don't know where you all live but I can tell you that every hospital and imaging center I've been to in the past 4 years in the mid-Atlantic area has demanded payment up front or NO procedure will take place.

I have names of the people I've spoken with, I have the names of the doctors that billing claims have to give PERMISSION to pay a lower fee up front. Why do I have the names? Because I attempted to file a complaint with the state medical board only to find it's perfectly legal. There is a large sign front and center where I go for imaging (X-rays, MRI's, mammograms, etc). They collect the full amount upfront after checking to see if you've reached your deductible or not. You pay whatever the amount may be in order to cover the cost of the procedure. After pushing for more info (from a few different sources), it's an online system that medical facilities pay to join that link them to your insurance; it also shows if you actually HAVE coverage and the card is not stolen (yes, it's a serious issue). Now, business's have the choice of doing this or not; our orthopedics's and physical therapy practice (which also does x-rays) chooses to NOT do this.

It comes down to the owners (doctors) to make the choice.

Just another perspective and to show that there is not one way of how insurance works.

OP, I hear you. It's akin to being taking hostage regarding your care: pay this NOW or we won't help you EVEN THOUGH YOU HAVE COVERAGE. Ticks me off, it does.

Re: I Need To Vent

LTT1 — Tue, 30 Aug 2016 20:43:47 GMT

@Jordan2

It happened to me.

The medical practice owed us over $800 for money collected prior to having procedures done (DH)

I finally was able to get a person in the billing department who would look at all of the visits, payments, etc. This person was an ANGEL. She called me back and said it looked like they were going to owe us money.

My advice: keep calling until you get SOMEONE sympathetic who will straighten this out for you!

Write their name down!

Keep checking back-- this person is YOUR ANGEL.

I wish you well... my method now is no payment up front if it can be helped.

Good luck my friend.

Re: I Need To Vent

kivah — Tue, 30 Aug 2016 19:20:27 GMT

@Jordan2

I don't trust hospitals when it comes to billing. They're VERY greedy and usually overcharge..

Go on-line and check out the hospital and President of the hospital. Also see if there are complaints against this hospital. Send him a letter, certified mail, and tell him u want ur $400 returned and explain why - and give him a deadline, ie, 10 days later. Years ago, I was billed $4,000 by my local hospital (I didn't have insurance) for a minor procedure in the ER that they didn't do right. I sent a letter to the President -- and he immediately waived the whole amount. You need to go the the very top.

Re: I Need To Vent

Stray — Tue, 30 Aug 2016 20:15:33 GMT

I may be an outlier but have never encountered a problem with a hospital nor have ever been asked to pay upfront for a procedure or admission except for plastic surgery which was done in a private ambulatory care center. And, that was explained well before the dates.. I live in the NYC metro area and basically go to the same hospital all of the time.

Re: I Need To Vent

sweetee2 — Tue, 30 Aug 2016 20:20:40 GMT

I had a melanoma remove on my inner arm. I went on line to my insurances website and ALL three doctors in the office billed my insurance when only one did the procedure. Luckily they were in top of it and denied the other two claims. It must happen all the time.

Re: I Need To Vent

Ms X — Tue, 30 Aug 2016 20:30:55 GMT

I think it's reasonable procedure to require you to pay the deductible up-front. They need to be able to pay their own bills, including payroll, rent, and supplies. However, if they screw up the billing and you've paid your deductible, they should straighten it out.

When I get really hosed by someone and feel I have nowhere to turn, I threaten to call the company president's office. This usually gets them out of their chair and moving. Tell them you'll call the hospital president's office if they don't fix it because YOU HAVE PAID THE DEDUCTIBLE REQUIRED and it is their job to fix the accounting situation.

I actually once made good on my threat with a small regional bank and got through. The bank manager would not fix the problem and simply ignored my calls. I'm sure she was stunned when word came down for her to fix it.

Re: I Need To Vent

chrystaltree — Tue, 30 Aug 2016 20:35:12 GMT

Hospital billing is often a mess and always complicated. I do this for a living so I totally get it. When it comes to deductibles, it isn't a matter of the doctor coming first or the hospital coming first. The deductible is applied to the first claim in. Your story confusing and I can't tell what is going on but I can tell you that the providers don't decide who gets what and they don't who the deductible is charged to. It's an age old story. Hospitals and doctors always want the deductible charged to the other one because they want payment from the insurer. But the first one to get the claim, has the deductible applied to them. You are getting lots of apologies but no (based on your story) did anything wrong. I think they are apologizing because you are upset and it's hard explaining hospital billing to patients. They hospital had every right to ask for the deductible. They went online and as far as they could tell, the deductible had not been met. That's all they have to go on. There is always some lag time or processing time, so it isn't unusual for the system to show that the deductible has not been met when it has been met because there are claims "in the pipeline". The hospital did nothing wrong. It seems like your doctor's office created the problem because they don't bill the insurers promptly and they don't send out patient bills promptly. Monthly billing is something we did 20 years ago. No one bills insurers monthly anymore. First because docs want their money sooner rathe than later and second, billing late cause this type of problem for patients. Good luck getting it all sorted out and if you are due a refund, I hope you get it. I can tell you that when these deductible things happen at my hospital, if we billed properly based on the information we had when the patient checked it....we do not refund the money. We are only responsible for our payments and if we did everything correctly based on the information at the time, we will not adjust. The rationale is that if there are subsequent deductible issues, the patient and the doctor's office have to work it out. We just don't get involved.

Re: I Need To Vent

Ms X — Tue, 30 Aug 2016 20:39:35 GMT

@chrystaltree Are you saying that if a patient overpays a deductible they would not refund it?

Re: I Need To Vent

LTT1 — Tue, 30 Aug 2016 20:46:00 GMT

@Stray
It seems to keep changing, the rules requirement to pay upfront. (For doctors office procedures)

Re: I Need To Vent

LTT1 — Tue, 30 Aug 2016 20:48:31 GMT

@Ms X
Wondering if you can pay these by credit card and then dispute the charges if they are wrong?

Re: I Need To Vent

Ms X — Tue, 30 Aug 2016 20:52:16 GMT

@LTT1 wrote:
@Ms X
Wondering if you can pay these by credit card and then dispute the charges if they are wrong?

I misunderstood your post at first. That's an ingenious idea! That would work if they accept plastic!

Re: I Need To Vent

IamMrsG — Tue, 30 Aug 2016 20:54:27 GMT

Several years ago I had an ordeal with a huge medical insurance company. It began with a store clerk's careless error on a handwritten receipt -- somehow, she wrote the wrong year, and I didn't catch it at the time.

It took several months and many phone calls to get nowhere with the insurance company. What they did not know, however, was that I was keeping detailed records of every date, name and conversation throughout the time.

After I lost patience and hope of resolution, I sent a 20 page printout of those records via certified mail to the President of the company. The claim was settled within a few days of receipt, and I was also told later that "positions were lost" as a result of my notes.

It's unfortunate that such steps are necessary when dealing with 'customer service,' but that's the way it is. To this day, I take notes during a business call. I begin with the date, phone number/extension and name. If I miss the person's name, I have no qualms about asking them to either repeat or spell it. Notes are made as the conversation progresses. The habit has frequently been helpful later, but, luckily, not to the degree I described above.

Re: I Need To Vent

chrystaltree — Tue, 30 Aug 2016 21:04:22 GMT

@Ms X wrote:
@chrystaltree Are you saying that if a patient overpays a deductible they would not refund it?

No, of course not. Deductibles are patient responsibilities. If we did everything properly, with the information we had available to us at the time and if we were not overpaid, we don't refund the deductible. We do not get into fights with the doctors over who got their claim in first. We only refund the deductible if the patient paid it and the deductible had already been met at the time the patient paid it. But that never happens today because its's 2016 and every hospital can verify deductible in 30 seconds by accessing the payor's website online. And every hospital should do that. And even in those rare occasions when there is lag, we seldom actually owe the patient any money because if we took the deductible when we shouldn't have; there is still the 20% co-pay that the patient owe us. So we would apply the money to the co-pay. Generally patients owe co-pays on more than one claim so the money would be applied to anything the patient owes. Once there is a zero balance on all claims, if there is money left over, we would refund the patient. That never happens. The lesson to be learned from op's situation is that patients should always verify their deductible situation with their insurer before their surgery or medical visit. The deductible (and co-pays) are out of pocket, meaning it's the money the patient is responsible for based on their insurance coverage. It's it is the patient's responsibility to keep track of it.

Re: I Need To Vent

Stray — Tue, 30 Aug 2016 21:10:18 GMT

@LTT1- maybe so but, I have not encountered it. My husband was just hospitalized with subsequent rehab and home care. We did a lot of outpatient follow up as well. No one asked for money upfront and we were billed entirely. I've had multiple orthopedic surgeries and no payment was requested upfront by the hospital. I did select an out of network doctor for tendon transfers in my feet and did pay partially upfront to him but I knew well ahead of time and it was explained and my choice. My surgeries were in NYC, HSS....

Re: I Need To Vent

Ms X — Tue, 30 Aug 2016 21:19:45 GMT

@chrystaltree Thank you for the explanation. This is certainly a confusing situation. I hope OP gets it straightened out. One person in one of the offices said it was handled wrong at least at one point. so maybe she needs it fixed. I've generally called the insurer when there were problems with basic coverage denied in error (sometimes I wonder how much of an error it is, since once they denied the yearly physical!). Then I call the billing department at the practice once they tell me what code they want them to use. I buy my own insurance, so I like to know that BC/BS is giving me what I paid for.

You have a very complicated job!

Re: I Need To Vent

ValuSkr — Tue, 30 Aug 2016 21:23:16 GMT

I'm sorry to hear about this. But it's the system we have; it's all about the money. People who don't like it should support politicians who want to change the system.

Re: I Need To Vent

Ms X — Tue, 30 Aug 2016 21:29:15 GMT

@ValuSkr wrote:
I'm sorry to hear about this. But it's the system we have; it's all about the money. People who don't like it should support politicians who want to change the system.

People who go to school for 20 years and then train for three or more require a good salary. If they aren't paid well, they'll do something else and care will suffer. Doctors work very hard for the money they get. That's the case for other medical workers, who are paid even less. So many other occupations pay more! Practices are under increasing financial stress these days as well. I've read quite a few news articles about it.