[Rant] Billed for medical service over 1 year later!

Author	All Replies
datguy11 @verizon.net	[Rant] Billed for medical service over 1 year later! Heres my rant! My kids goes to doctor in May of 2010, blue cross doesnt pay, says not a covered service. Medical provider gets notified of this. OVER 1 YEAR LATER I get a bill for $245.00 for the "uncovered service" I believe Blue Cross made a mistake, or the provider made a mistake... So... I appeal for a review and Blue Cross writes back that I have 180 days from the date of the adverse notice to appeal, after that 180 days they will not review. Now my gripe is that this should have been paid, or the provider mis-coded it But because of the provider did not notify me in a timely matter, I lost my appeal right. My last day to appeal would have been Nov 21,2010. So Im telling them to screw off, its your fault for not notifying me! What legal recourse do I have? I dont want to pay $240 for a service that would have been covered. I paid my $15 co-pay at the time of service and assumed all was well
	to forum · permalink · 2012-01-30 17:52:16 ·
jjoshua Premium join:2001-06-01 Scotch Plains, NJ kudos:1	You are responsible for paying your doctor. The next time, pay for all services in full and recover the money from your insurance company yourself. Then, you're the only person accountable for getting reimbursed.
	to forum · permalink · 2012-01-30 17:57:50 ·
datguy11 @verizon.net	I used to do that years ago, but as my insurance company changed policies more doctors became "in- network" and it made more sense to pay the co-pay and have the insurance pick up the rest at pre-negotiated rates.. I have no problem paying my doctor (who doesnt do billing hes part of a bigger group and they handle billing) IF the charges were not covered. I DO have a problem paying him if there was a mistake made and now I have to pay because of someone elses screw up! Its simple to me, you didnt get paid, you bill me in a timely matter, I appeal, and you get paid OR I lose appeal and I pay. Now i feel ripped off
	to forum · permalink · 2012-01-30 18:03:45 ·
dandelion Premium,MVM join:2003-04-29 Germantown, TN kudos:4	reply to datguy11 You should have gotten another information sheet from blue cross at the time that said the services weren't covered also, even though your doctor hadn't billed you yet.
	to forum · permalink · 2012-01-30 18:18:03 ·
fatness subtle Janitor join:2000-11-17 fishing kudos:13 Host: Bright House Netwo.. Earthlink DSL TekSavvy Forum Feature Requ.. Need Site Help	reply to datguy11 said by datguy11 : Heres my rant! My kids goes to doctor in May of 2010, blue cross doesnt pay, says not a covered service. Medical provider gets notified of this. If your medical provider was notified of this but you were not, your 180-day appeal period didn't start until you actually were notified. I wouldn't seek legal recourse though, it seems far too early for that. I'd suggest working your way up the chain of command with blue cross, asking them each step of the way to show you when you were notified. -- their dreams a tattered sail in the wind
	to forum · permalink · 2012-01-30 18:29:29 ·
DC DSL There's a reason I'm Command. Premium join:2000-07-30 Washington, DC kudos:2 Reviews: ·Covad Communicat.. ·Verizon Online DSL	reply to datguy11 Medical billing screwups are par for the course these days. They send out gibberish bills that you have no idea wtf they're talking about, and multiple bills from different providers for the same procedure because your imaging and tests were looked at by 50 different people who bill separately...yadda yadda. You need to contact BC and the provider IN WRITING regarding the disagreement. They'll blow you off on the phone just to get rid of you and hopefully make it go away...but in writing they are forced to take a look at things. Be sure you find out the contact information for your state's medical insurance oversight bureau and send them a copy of your correspondence as well (noting it on your letter to the carrier & provider). -- "Dance like the photo isn't being tagged; love like you've never been unfriended; and tweet like nobody is following."
	to forum · permalink · 2012-01-30 18:49:03 ·
fatness subtle Janitor join:2000-11-17 fishing kudos:13 Host: Bright House Netwo.. Earthlink DSL TekSavvy Forum Feature Requ.. Need Site Help	said by DC DSL: You need to contact BC and the provider IN WRITING regarding the disagreement. They'll blow you off on the phone just to get rid of you and hopefully make it go away...but in writing they are forced to take a look at things. This is good advice. -- their dreams a tattered sail in the wind
	to forum · permalink · 2012-01-30 19:06:52 ·
The Pig Bazina Premium join:2009-09-11	reply to datguy11 Pay the doctor or your credit will be mud! The doctor did his/her job and you should pay him/her, it is not the doctors fault your insurance company screwed you! Pay the doctor then fight it out with Blue cross to get reimbursed!
	to forum · permalink · 2012-01-30 19:30:42 ·
DC DSL There's a reason I'm Command. Premium join:2000-07-30 Washington, DC kudos:2 Reviews: ·Covad Communicat.. ·Verizon Online DSL	said by The Pig: Pay the doctor or your credit will be mud! The doctor did his/her job and you should pay him/her, it is not the doctors fault your insurance company screwed you! Pay the doctor then fight it out with Blue cross to get reimbursed! Unfortunately one cannot just go by that assumption. I know from the inside how many practices operate these days, and more often than not the patient is the one getting borked...not the provider or insurance. I'm in a go-round with my own HMO over a series of double-copays for lab work. The written policy states that multiple visits to the lab the same day related to the reason the patient came in for are considered one visit to the lab and therefore only one copay. Nuh uh. Even reading it to the billing people has them coming up with ever more absurd reasons for why they're right and I'm wrong. What's more annoying is I went though this same thing a year ago and they still didn't get the message. "Well, the person you dealt with is no longer here so I cannot verify any of what you're saying." Arrrrrgh. I already have a letter and follow-up letter #1 into them, wondering why it's happening again. Sooner or later they'll catch up. Which is why one needs to put things in writing promptly so they can't turn around and say I took too long...and they hate stuff in writing because that always means it will go higher up the food chain if they don't make the member happy. -- "Dance like the photo isn't being tagged; love like you've never been unfriended; and tweet like nobody is following."
	to forum · permalink · 2012-01-30 20:14:40 ·

datguy11 @alter.net	reply to The Pig Doctor is an in network provider! He is only allowed to charge a co pay at time of visit for covered services. If the service wasn't covered I should have been charged in full or in a reasonable amount of time. If it is a covered charge and they didn't pay doctor according to the contract how is that my fault? They get notified withn 20 days that payment will not be made, its not my responsibility that doc took about 500 days to realize this!
	to forum · permalink · 2012-01-30 20:41:01 ·
cowboyro join:2000-10-11 Shelton, CT Reviews: ·AT&T U-Verse	reply to The Pig said by The Pig: Pay the doctor or your credit will be mud! The doctor did his/her job and you should pay him/her, it is not the doctors fault your insurance company screwed you! Pay the doctor then fight it out with Blue cross to get reimbursed! That's bad advice. He'd have to pay the doc the full amount. The doc only gets the negotiated rate from the insurance. If he settles the matters with the insurance, he'd be out the difference between the paid amount and the negotiated rate that the insurance will reimburse.
	to forum · permalink · 2012-01-31 09:40:52 ·
The Pig Bazina Premium join:2009-09-11	said by cowboyro: said by The Pig: Pay the doctor or your credit will be mud! The doctor did his/her job and you should pay him/her, it is not the doctors fault your insurance company screwed you! Pay the doctor then fight it out with Blue cross to get reimbursed! That's bad advice. He'd have to pay the doc the full amount. The doc only gets the negotiated rate from the insurance. If he settles the matters with the insurance, he'd be out the difference between the paid amount and the negotiated rate that the insurance will reimburse. If the doctor doesn't get paid then he won't be able to go back to him/her! good doctor are rare nowadays!
	to forum · permalink · 2012-01-31 10:27:04 ·
Shafted @verizon.net	The whole medical billing is flawed. I'm BC/BS and a medical provider has until the end of the next year of your date of service to bill you. I've gotten charges 18 months after service. I have a database that tracks all my visits and services and it's still a pain. What really chaps me is the huge submitted charges. Absolutely nothing made of plastic should cost almost $1,000. Also considering some of these "contracts" some hospitals have with your insurance. I got a CAT scan in one hospital and they charged my insurance over $9,000 for it. Insurance paid over $8,000, my cost was $1,700.00 A few days later I had another one done in another hospital in another county and the submitted charge for the same test was $750. I called the insurance and they said it was legal. OMG, you kidding me?
	to forum · permalink · 2012-01-31 12:53:11 ·
Fronkman An Apple a day keeps the doctor away Premium join:2003-06-23 Saint Louis, MO	reply to datguy11 said by datguy11 : Doctor is an in network provider! He is only allowed to charge a co pay at time of visit for covered services. If the service wasn't covered I should have been charged in full or in a reasonable amount of time. If it is a covered charge and they didn't pay doctor according to the contract how is that my fault? They get notified withn 20 days that payment will not be made, its not my responsibility that doc took about 500 days to realize this! unfortunately most insurance companies are not as fast as you give them credit for. for instance, IL medicaid is currently 3 months behind on processing claims. that means that a doctor visit today (1/31) won't even be looked at by IL medicaid until the end of april. on average they take 2 months to process a claim (particularly if is a complicated hospital stay with multiple providers) and then another month before the check is mailed. therefore, we are already at 6 months before the doctor gets paid for the first time. if the payment is incorrect, a dispute is filed and then goes back into the hopper for another 6 month cycle. ONE YEAR AFTER THE ORIGINAL APPOINTMENT, the doctor finally gets the letter saying that your insurance company isn't going to pay for the service he already provided. it gets turned over to his billing company who then takes another month to get the bill sent to you. how many other "free market" businesses do you think could operate in this sort of ridiculous system? i will grant you the possibility that your doctor may have been notified sooner and lost track of the paperwork for an extended time before realizing his error. this doesn't change the fact that you owe him money. if you hire someone to plant a tree in your yard for $100 and he forgets to send you the bill for 6 months or even a year does that mean you don't owe him the money any more? i don't think so. -- Everyone should own a Mac! Go Bucks!
	to forum · permalink · 2012-01-31 13:01:51 ·
DC DSL There's a reason I'm Command. Premium join:2000-07-30 Washington, DC kudos:2 Reviews: ·Covad Communicat.. ·Verizon Online DSL	reply to Shafted said by Shafted : What really chaps me is the huge submitted charges. Absolutely nothing made of plastic should cost almost $1,000. They gave me some prescription Motrin during my overnight stay. $775 per dose (1 pill), 2x. I had a ziplock bag with some ibuprofen I bought at Costo in my computer bag that cost $8 for 750 pills...8 of those (the dosing equivalent of 2 prescription Motrin) would have cost less than $0.10. What a fing ripoff. -- "Dance like the photo isn't being tagged; love like you've never been unfriended; and tweet like nobody is following."*
	to forum · permalink · 2012-01-31 13:08:42 ·
Fronkman An Apple a day keeps the doctor away Premium join:2003-06-23 Saint Louis, MO	said by DC DSL: They gave me some prescription Motrin during my overnight stay. $775 per dose (1 pill), 2x. I had a ziplock bag with some ibuprofen I bought at Costo in my computer bag that cost $8 for 750 pills...8 of those (the dosing equivalent of 2 prescription Motrin) would have cost less than $0.10. What a f*ing ripoff. bogus. there is absolutely no way that they charged you $750 for ibuprofen, regardless of the brand name or dosage. no insurance carrier in existence even allows line-item billing like this for an inpatient stay, everyone uses DRGs. -- Everyone should own a Mac! Go Bucks!
	to forum · permalink · 2012-01-31 13:21:17 ·
DC DSL There's a reason I'm Command. Premium join:2000-07-30 Washington, DC kudos:2 Reviews: ·Covad Communicat.. ·Verizon Online DSL	said by Fronkman: bogus. there is absolutely no way that they charged you $750 for ibuprofen, regardless of the brand name or dosage. no insurance carrier in existence even allows line-item billing like this for an inpatient stay, everyone uses DRGs. I have the "corrected" statement that shows it but I am not going to the trouble to scan it for your edification. I have a good deal of personal insider knowledge of the industry...$775 for an analgesic is nothing. It's a matter of what individual hospitals can get away with. The hospital where my stay was is a big-name teaching facility; meanwhile, across town, another big-name is only charging $32 to administer a standard dose of 2 Tylenol and $67 for prescription Motrin. YMMV. -- "Dance like the photo isn't being tagged; love like you've never been unfriended; and tweet like nobody is following."
	to forum · permalink · 2012-01-31 14:13:11 ·
Fronkman An Apple a day keeps the doctor away Premium join:2003-06-23 Saint Louis, MO	said by DC DSL: said by Fronkman: bogus. there is absolutely no way that they charged you $750 for ibuprofen, regardless of the brand name or dosage. no insurance carrier in existence even allows line-item billing like this for an inpatient stay, everyone uses DRGs. I have the "corrected" statement that shows it but I am not going to the trouble to scan it for your edification. I have a good deal of personal insider knowledge of the industry...$775 for an analgesic is nothing. It's a matter of what individual hospitals can get away with. The hospital where my stay was is a big-name teaching facility; meanwhile, across town, another big-name is only charging $32 to administer a standard dose of 2 Tylenol and $67 for prescription Motrin. YMMV. You had better have another discussion with your insider as you are still wrong. Two reasons why: 1. All insurance companies use a billing method called DRG (diagnosis-related grouping) to pay hospitals for inpatient stays. It means that they pay one price for a particular diagnosis, period. For instance, they pay $3500 for a standard vaginal delivery. The insurance company has decided that this is a fair cost for the actual delivery and to cover a two day stay after the delivery. It doesn't matter whether the mother leaves early or if she stays an extra day, the hospital gets paid the same. It doesn't matter if she has one dose of tylenol or 50 doses of Tylenol, same reimbursement. 2. Your numbers just don't add up. Accordingly to you a single dose of ibuprofen has a retail cost of $0.10 yet they charged you $775 a 7750x markup. Let's say that you have a serious infection and you require IV meropenem (a powerful broad spectrum antibiotic). Typical adult dosing is 1 gram every 8 hours for 7 days or 21 grams total. According to drugstore.com, your treatment would require 42 500mg vials for a total retail cost of $1007. (»www.drugstore.com/pharmacy/price···5_prices). Using your math the 7750x markup would mean a $7.8 million dollar cost just for the antibiotics. Do you really think the hospital is collecting $7.8 million dollars every time they admit an old person with pneumonia? (hint, they aren't). -- Everyone should own a Mac! Go Bucks!
	to forum · permalink · 2012-01-31 15:39:30 ·
DC DSL There's a reason I'm Command. Premium join:2000-07-30 Washington, DC kudos:2 Reviews: ·Covad Communicat.. ·Verizon Online DSL	I happen to be that insider. I'm not the only one...these practices have been bandied about in the press repeatedly. No, they don't do it to every patient because that would certainly blow the lid off it and the insurance companies would put a stop to it. Whenever some investigative reporter catches them, it's always "that must be a clerical error and we'll take care of it." But for every one that does get caught, at least 10 are not. Medicare has been ripped off like this for years: Just last year Medicare was being billed $45 a day for 8 Tylenol and $95 a day for 2 Tramadol a day by the nursing home she was in...and they paid it. Another relative who was in for heart surgery at a world-renowned facility had their insurance billed $350 per dose for Tylenol for a 10-day stay. Their insurance paid all but $10 of it. WTF? -- "Dance like the photo isn't being tagged; love like you've never been unfriended; and tweet like nobody is following."
	to forum · permalink · 2012-01-31 15:59:52 ·
Fronkman An Apple a day keeps the doctor away Premium join:2003-06-23 Saint Louis, MO	said by DC DSL: I happen to be that insider. I'm not the only one...these practices have been bandied about in the press repeatedly. No, they don't do it to every patient because that would certainly blow the lid off it and the insurance companies would put a stop to it. Whenever some investigative reporter catches them, it's always "that must be a clerical error and we'll take care of it." But for every one that does get caught, at least 10 are not. Medicare has been ripped off like this for years: Just last year Medicare was being billed $45 a day for 8 Tylenol and $95 a day for 2 Tramadol a day by the nursing home she was in...and they paid it. Another relative who was in for heart surgery at a world-renowned facility had their insurance billed $350 per dose for Tylenol for a 10-day stay. Their insurance paid all but $10 of it. WTF? sounds like it is time to buy some reynolds wrap stock.... -- Everyone should own a Mac! Go Bucks!
	to forum · permalink · 2012-01-31 16:09:47 ·

Talk > Rants, Raves, and Praise > [Rant] Billed for medical service over 1 year later!