 DC DSLThere's a reason I'm Command.Premium
join:2000-07-30
Washington, DC
kudos:2
 ·Covad Communicat..
·Verizon Online DSL
| reply to Fronkman
Re: [Rant] Billed for medical service over 1 year later! Deny it all you want but that is the reality. What's funny is how indignant and defensive the providers who are caught become: They make the argument that "we are so saddled with the costs of providing care to the un/under-insured, it's only fair that we offset those costs somehow." Same argument for why someone paying cash gets clobbered with bills that are 2-3x what insurance would pay. Rarely does getting caught ever result in actual prosecution or litigation...just an innocuous press report buried somewhere obscure about a fine with no admission of wrong-doing, or a sealed out-of-court settlement, and it's right back to business as usual. Had health care reform actually been passed as originally written, these practices would have ceased...instead, lobbyists for the insurance industry and the health care providers saw to it those provisions were eliminated.
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 DarkLogixPremium
join:2008-10-23
Baytown, TX
kudos:3 | said by DC DSL:Had health care reform actually been passed as originally written, these practices would have ceased...instead, lobbyists for the insurance industry and the health care providers saw to it those provisions were eliminated.
I've gotta disagree with you there
if it had been passed then we'd see gov book padding vs private fraud
million dollar coffee maker anyone.
/ot |
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 thegeekPremium
join:2008-02-21
united state
kudos:1
 ·Suddenlink
·NPG Cable
| reply to DC DSL
said by DC DSL: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 f*ing ripoff. you need to understand that it costs a lot more to press an 800mg tablet of prescription strength ibuprofen than it does a standard strength over the counter 200mg ibuprofen.
/sarcasm
i hate to rat out my employer but a big part of the over-billing for medications problem comes from the pharmaceutical companies. typical standard cost to list price comparison is about 500% for over the counter items, much much more for prescription. and even more when still on patent and not a me too drug. |
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DarkLogixPremium
join:2008-10-23
Baytown, TX
kudos:3 | and oddly the new regulations related to HSA's don't allow OTC to be bought unless the doc writes a RX for it.
can you imagine asking a doc to perscribe OTC ibuprofen |
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 FronkmanAn Apple a day keeps the doctor awayPremium
join:2003-06-23
Saint Louis, MO | reply to DC DSL
said by DC DSL:Same argument for why someone paying cash gets clobbered with bills that are 2-3x what insurance would pay.
incorrect.
this is your beloved "free market" at work. giant firms with large amounts of leverage (ie insurance companies) tell doctors how much they will pay for X procedure or Y treatment, regardless of how difficult it is or how much it costs the doctor or hospital to perform. 25% of laboratory tests cost more in MATERIALS ALONE than what an insurance company will reimburse.
uninsured individuals, on the other hand have absolutely no leverage and must pay what the hospital asks as list price.
both ways are broken.
you are wrong about fraud and abuse as well, medicare widely publicizes the amount of money they recover from fraudulent activities every year. the major news media covers it too, like CBS (»www.cbsnews.com/stories/2011/01/···31.shtml)
i do agree with you about the ACA though. our current public/private insurance scheme is a mess. there is no ethical reason for insurance companies to exist. their entire method of income generation is by skimming money off the top as is passes between patient and doctor. yes, it makes sense as a business, but that doesn't mean it is the ethical or fair thing to do. there is also a strong business argument for using slave labor as well...we don't do that in the US anymore, but many asian countries depend on this to keep their businesses profitable.
having a single-payer system will not prevent fraud and abuse, but it won't make it worse. fraud should be (and already is) sought out and the violators punished. a single-payer system where the controlling body is not trying to make a profit for shareholders is the most ethical (and cheapest) system. the VA system is the best example. they have outstanding coverage and the lowest overhead of any insurance system in the US, public or private.
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Everyone should own a Mac! Go Bucks! |
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 r81984Fair and BalancedPremium
join:2001-11-14
Katy, TX
 ·AT&T U-Verse
·AT&T DSL Service
 ·row44
| reply to jjoshua
said by jjoshua: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.
Wrong if they code or submit the claim wrong then it is 100% on the doctors office, not the customer.
If they did it right, customer pays nothing.
Since they made the mistake they need to eat the cost.
It is the doctors responsiblity to fill out forms correctly and make sure deadlines are met. That is why they pay for a good office staff and not some moron off the street. They cant screw up the process then expect to take you to collections.
If they take it to collections you should easily get it off your record. You have to write letters to the credit bureau's and to the collection company to fix everything.
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 AVDRespice, Adspice, ProspicePremium
join:2003-02-06
Onion, NJ | said by r81984:said by jjoshua: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.
Wrong if they code or submit the claim wrong then it is 100% on the doctors office, not the customer. If they did it right, customer pays nothing. Since they made the mistake they need to eat the cost. It is the doctors responsiblity to fill out forms correctly and make sure deadlines are met. That is why they pay for a good office staff and not some moron off the street. They cant screw up the process then expect to take you to collections. If they take it to collections you should easily get it off your record. You have to write letters to the credit bureau's and to the collection company to fix everything. depends on the state.
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google this "(sqrt(cos(x))*cos(200*x)+sqrt(abs(x))-0.7)*(4-x*x)^0.01, sqrt(9-x^2), -sqrt(9-x^2)" |
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| reply to Fronkman
I totally believe the claim of outragous markup on drugs while in a hospital. Remember my CAT scan I said one hospital charged over $9,000 to my insurance (insurance "only" paid a bit over $8,000) and my out of pocket costs was over $1,700? I called a lawyer and asked how the same test done at two different hospitals resulted in an out of pocket expense of $1,700 in one and $19 in the other. I was told it was legal based on the contract/agreement with that hospital. The fact that my insurance was willing to pay 89x more money to one hospital for the same test is criminal. |
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sailorPremium
join:2003-10-21
Long Island
kudos:6 | reply to DC DSL
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.
The anatomy of a ripoff
»www.nydailynews.com/opinion/anat···.1002077 |
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Reviews:
·AT&T U-Verse
| said by sailor: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.
The anatomy of a ripoff» www.nydailynews.com/opinion/anat···.1002077 The good thing about my insurance, is that no matter what is done in the emergency room, we only pay $100. So the bill the lady got in that article, would have cost us $100. The bad thing about our insurance, we are responsible for 25% of our cost IF we are admitted, up to $3000 per family member(we have 3). And my father got a invoice one time from a hospital who charged him $800 for 2 tylenol pills. The insurance didn't pay anything near that, but that's what the hospital tried to charge.
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No Victim=No Crime |
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| reply to datguy11
When you received the notice, you should have contacted your doctor. maybe it was denied due to wrong code being used. Your insurance company is not going to tell you that. this happens all the time. |
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 KrKHeavy Artillery For The Little GuyPremium
join:2000-01-17
Tulsa, OK
·AT&T DSL Service
| reply to DC DSL
Medical Billing in this country is at best a complete cluster, and at worst, out and out fraud and theft.
Going through it right now, being threatened with collections on a phantom $2900 bill that was long paid and has somehow come back from the dead in "seriously past due" status.
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"Fascism should more properly be called corporatism because it is the merger of state and corporate power." -- Benito Mussolini
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KrKHeavy Artillery For The Little GuyPremium
join:2000-01-17
Tulsa, OK Reviews:
·AT&T DSL Service
| reply to Fronkman
I don't know about that. Honestly, I think it's really just fraud.
I had a nurse give me an IV treatment one time and 3 bags of saline solution.
How did they bill it?
3 separate IV procedures, all around $300 each. No. It was 1 procedure and 3 bags.
Amazing.
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"Fascism should more properly be called corporatism because it is the merger of state and corporate power." -- Benito Mussolini
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FronkmanAn Apple a day keeps the doctor awayPremium
join:2003-06-23
Saint Louis, MO | reply to r81984
said by r81984:said by jjoshua: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.
Wrong if they code or submit the claim wrong then it is 100% on the doctors office, not the customer. If they did it right, customer pays nothing. Since they made the mistake they need to eat the cost. It is the doctors responsiblity to fill out forms correctly and make sure deadlines are met. That is why they pay for a good office staff and not some moron off the street. They cant screw up the process then expect to take you to collections. the single biggest mistake doctors ever made was to accept reimbursement directly from the insurance companies.
in the "old days" you went to the doctor, paid the doctor and then sent the bill off to the insurance company to be reimbursed.
this makes sense because when you go to the doctor you are agreeing to PAY for a service, the same way that going to a movie means that you are agreeing to PAY for that service.
in this situation people took ownership of their financial obligation to the doctor. the doctor is not seeing you out of the goodness of his heart nor is he an employee of the insurance company (in most cases). the doctor is a small business providing you with a service in exchange for a fee.
however, when the insurance company pays the doctor directly it removes this connection between the doctor and patient and turns it into a convoluted paperwork nightmare between the doctor and the patient's insurance company.
if you still had to pay the bill upfront you would never dream of taking months to pay it, nor would you generate dozens of forms for the doctor to fill questioning his practice of medicine, nor would you refuse to pay the doctor after you had seen him just because he coded your diagnosis of migraine headache with a 346.02 (migraine with aura, without mention of intractable migraine with status migrainosus) instead of a 346.03 (migraine with aura, with intractable migraine, so stated, with status migrainosus). however, that is what the insurance companies do. ALL OF THE TIME.
let's say you own a store that sells refrigerators and i buy a really nice $2000 fridge. lets say your phone line is down that day and you write down my credit card number so that you can run it in a few days when your phone service is repaired. lets say in the process you accidentally miss one of the numbers in the credit card. is it outrageous for you to call me in a few weeks and say, "hey give me your number again" or does the fridge become mine for free because you made an error?
let's extend it further to the insurance company example. lets say i buy the $2000 fridge and i tell you "i will give you $15 now, but in a few months my friend will give you the rest." then for the next two weeks, my friend sends you dozens of pages of forms to fill out justifying why i needed such an expensive fridge and why you couldn't have sold me a minifridge or a generic brand fridge instead. then, 6 months from now, what should you do when my friend only pays you $1000?
i do think that there should be a price list for various health care needs at your doctor's office. the price will be different in los angeles for instance, than it is in cedar rapids (the same way that gas and milk are different in those places). you could shop around and find the lowest priced doctor. however, you shouldn't be surprised if your ultra-cheap doctor works out about as well as cheap chinese watch from the dollar store.
better yet, we could have a single financial entity that covered all medical expenses for every person regardless of his or her wealth. this "insurance pool" would consist of every man, woman and child in the USA, the absolute best case of distributed risk. doctors would agree to fixed reimbursement for every conceivable test, procedure and exam. no one would go bankrupt due to health care debt. hospitals would never charge inflated prices for tylenol, IV fluids or CT scans. 30% of health care dollars would not be skimmed off the top as "administrative costs" (vs. 5% for the VA system, currently the best in the world). what a shocking and surprising idea that would be!
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Everyone should own a Mac! Go Bucks! |
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r81984Fair and BalancedPremium
join:2001-11-14
Katy, TX Reviews:
·AT&T U-Verse
·AT&T DSL Service
·row44
| Your analogies dont work.
The doctor is an in-network doctor and agrees to the insurance companies system and payments to accept their patients. They lookup the procedure codes in the system to make sure it is covered and any time they are in doubt they can phone in to get pre-approval to ensure they will be paid.
If they make a mistake that is on them not the patient.
For a doctors office "it pays to not make mistakes" and that is why they need good office staff.
As for your fridge anology, it would be more like I want to buy your $2000 fridge (and once it is installed it can never be removed without destroying it) do you take my insurance?
The store verifies the insurance will pay for it by giving the code for model FD3800-39. They permantly install it in your house and now it cant be removed.
Then the store finds out they made a huge mistake, they installed the wrong fridge model FD39000-38 and the insurance does not cover that so they will not be paid.
Since the fridge is permament they cant get it back and they lose money since they gave the wrong service.
The store has no ground to stand on now asking the customer for $2000 when the customer would have never gotten the fridge if it was not covered by the insurance and the store TOLD THEM it would be covered.
Since this is capitalism people are most likely going to choose the doctor that has their shit together and does not make them pay up front to be reimbursed later.
I do agree about a single payer type insurance pool system where everyone pays and you dont have to worry about coverage problems.
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r81984Fair and BalancedPremium
join:2001-11-14
Katy, TX Reviews:
·AT&T U-Verse
·AT&T DSL Service
·row44
| reply to Fronkman
Oddly enough this week a friend of mine is in this situation.
He daughter needed her wisdom teeth removed.
The dentist said it would be covered under medical insurance 100%. They called the insurance company on the phone and verified the wisdom teeth code and were told it was approved.
They told my friend it was approved so they had it done same day.
Then after the fact the doctors office said his medical insurance denied it so they put the claim in under his dental with only covered 80% and they wanted him to pay the difference.
All they had for verification was their internal pre-approval form that was not signed by Cigna Insurance, but they hand wrote the name "Craig" and the insurance phone number - no employee ID or email or fax for the approval.
They gave everything to my friend and he faxed in the appeal as the doctor did not volunteer to do it.
Later we called Cigna and they said the provider should of appealed for payment instead of the patient doing it.
In the end, I told my friend if Cigna still refuses to pay to tell the Dentist to screw off and not pay them 1 penny as they messed up somewhere and he should not have had to pay.
BTW he never would have had the procedure right now if it was not covered 100%. The Dentist talked him into it to do it right now instead of waiting and told him 100% was covered and it was all approved.
Based on writing the name "craig" makes it seem like they actually did not have any pre approval and they lied just to get him to OK the procedure for his daughter.
The amount they want him to pay is $400.
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