Re: Who's Responsible

CelticCrafter · ‎03-09-2010

@blackhole99 wrote:
I belong to an HMO and they tell you flat out, if you don't use in network labs, docs, ect. you are on your own. Everything is done in house, so to speak at their hospitals and outside satellite facilities and so far so good. I had their plan before I went on Medicare and then signed up for their supplental insurance and drug program.

We have an EPO plan and it's the same way, go out of network and you're on your own for the entire amount except in the case of an emergency - then they will pay what they normally pay an in network provider and the patient is responsible for the rest.

nun ya · ‎03-09-2010

Lord...I seriously messed us my replies and post on this thread....too early!!

nun ya · ‎03-09-2010

@Moonchilde wrote:
@nun ya wrote:
I think these things are so common, it's sad.

Just a few...
Had bloodwork done, called the Dr to see if they came back normal, the hospital nor the lab ever sent them results.

Got a bill that was a year old from a Dr who practiced in the ER. The insurance wouldn't pay because they waited a yr and I no longer even had that insurance.

Called the Dr when they sent the wrong script amount to the pharmacy, They said they'd call immediately and fix it. Nope, wrong at next refill.

I'm learning to write everything down, and pay attention because nobody will do it for you.

Just a couple of comments on the first two -

Trust me on this - when a doctor or his office tells you the hospital, or the lab, "never sent" them a copy, it's usually just not true. Doctors' offices have literal stacks of filing they are months behind on. It's standard for them to ignore the filing and call the lab to get a copy faxed right then. They will usually swear to you they didn't get it, but the honest ones and the ones you have a good friendly relationship with will say "help meee! I can't fiiind it! Sorry!" And many times the office fax is malfunctioning (off-line, paper out, etc). So yes, they did get it, they will just always blame the lab because it lets them off the hook.

I can't speak to the waited a year part, but in most departments in a hospital, the physician's professional fees are separate from the hospital's facility and supplies fees. And unfortunately it's up to the patient to check whether the doctor's group takes your insurance. Also, it's very common for a patient to never, ever receive a bill for 6-9 months and suddenly out of the blue get a collection notice. It sucks.

@Moonchilde maybe they did get the results, I called medical records at the hospital, they said they never sent it to the Dr.

As for emergency room Drs, when one sees multiple Drs ....I don't know how anyone would know if every Dr there is "in network". I never received another bill on that one. My insurance would have paid had they not waited over a yr.

LTT1 · ‎03-09-2010

@Jordan2

I had a charge for $250 for a CT Scan, which I never received a CT scan. I told the X-ray billing co that I would gladly have the doctor back me up. Oh-no no need to do that.

Three times I called and asked them to send a corrected bill AND bill the correct insurance company.

The date of service was January.

The girl at the billing place made the comment that I had suffered enough and they would wipe my record clean.

Be persistent and I say, insist on a clear, concise itemized bill.

Good luck

~Have a Kind Heart, Fierce Mind, Brave Spirit~

Jordan2 · ‎03-16-2010

I'm the OP and here's where I'm at. I called Quest Lab and explained what happened and gave them my insurance info so they can bill my insurance company. The cs rep said the insurance company will pay. What I don't get if Quest is out of network my insurance company will still pay and the lab will take whatever they receive as payment? I then called my doctor's office and told them they made a mistake in sending my test to Quest. She told me that should have never happened. She then said to mail a copy of the bill to the office and they will turn it over to the rep who will erase it. Between my insurance company and the rep, I'm crossing my fingers this will be resolved in my favor!