Hospitals and ER's putting the squeeze even on "in network" patients

[Rose Karuna]

I wanted to post this here, I think that one of the biggest problems with out health care system is that we can't get honest information from health care providers on what something is really going to cost or whether or not the hospital has "in network" doctors or other specialists (like labs). Even if you have insurance, you have to be be asking the questions and seriously, when you're ill and perhaps even incapacitated, that really sucks.

"I read 1,182 emergency room bills this year. Here’s what I learned."

Going to an in-network hospital doesn’t mean you’ll be seen by in-network doctors
On January 28, 34-year-old Scott Kohan woke up in an emergency room in downtown Austin, Texas, with his jaw broken in two places, the result of a violent attack the night before. Witnesses called 911, which dispatched an ambulance that brought him to the hospital while he was unconscious.

Kohan, who submitted his bill to our database, ended up needing emergency jaw surgery. The hospital where he was seen was in network; he Googled this on his phone right after regaining consciousness. But the jaw surgeon who saw him wasn’t. Kohan ended up with a $7,924 bill from the surgeon, which was only reversed after I wrote about his bill in May.

more ...

Before I started reporting this project, I knew from my decade as a health care reporter that America has sky-high medical prices. But what I didn’t know was that patients can face steep bills even if they don’t see a doctor or have their ailment treated. They can decline treatment and still end up with a hefty fee.

I learned about this from a bill sent to me by Jessica Pell. She told me about going to an emergency room in New Jersey after she fell and cut her ear. She was given an ice pack but no other treatment. She never received a diagnosis. But she did get a bill for $5,751.

“It’s for the ice pack and the bandage,” Pell said of the fee. “That is the only tangible thing they could bill me for.”

more snipping ...

What stands out to me is that in all these cases, it’s essentially the hospital that gets to decide whether it wants to negotiate or reverse a bill. And if a hospital says no? If it won’t change the facility fee code, or doesn’t offer a prompt payment discount? The patient is essentially stuck. The hospital has the trump card: It can send the bill to a collection agency, a move that could devastate a patient’s credit. In those situations, there isn’t anything a patient can do to stop them.

write your congressman ...

There are now two proposals in Congress that would make the types of bills I write about a thing of the past. One comes from Sen. Maggie Hassan (D-NH) and another from a bipartisan group of senators including Sens. Bill Cassidy (R-LA) and Claire McCaskill (D-MO).

 

[Khamon]

The facility to insurance scam was simple: overcharge; accept reasonable payments; profit from the reasonable payments, steal the tax write-offs and governmental supplements. But it became more expensive and complex as each component of the medical sector added their layer of the scam. The mechanism only increased our costs for the past few decades but has now reached a point of affecting our understanding of our condition and the associated treatment. It's virtually impossible now to track billings for the tests, medications, and personnel for a simple annual examination. And good luck getting any straight answer from the temp physician group intern on call that delivers your final diagnosis and orders your discharge.

 

[Kara Spengler]

The facility to insurance scam was simple: overcharge; accept reasonable payments; profit from the reasonable payments, steal the tax write-offs and governmental supplements. But it became more expensive and complex as each component of the medical sector added their layer of the scam. The mechanism only increased our costs for the past few decades but has now reached a point of affecting our understanding of our condition and the associated treatment. It's virtually impossible now to track billings for the tests, medications, and personnel for a simple annual examination. And good luck getting any straight answer from the temp physician group intern on call that delivers your final diagnosis and orders your discharge.

Yeah, I dread having to go to a doctor for pretty much anything but it is usually not an option. You wind up with separate bills from the facility, each doctor, radiology, the lab, the ambulance, and so on. Good luck trying to find out when you have reached the end of the bills too. Months and months can go by then someone finds they need to bill for something or other related to something that happened long ago.

 

[Tigger]

you know these occaisional posts and threads from USAians on the madness of their healthcare system always strike me like little horror stories.

 

[danielravennest]

I wanted to post this here, I think that one of the biggest problems with out health care system is that we can't get honest information from health care providers on what something is really going to cost or whether or not the hospital has "in network" doctors or other specialists (like labs). Even if you have insurance, you have to be be asking the questions and seriously, when you're ill and perhaps even incapacitated, that really sucks.

Something like this happened to me in 2010. I had a kidney stone, and was in excruciating pain. Got an ambulance ride to the hospital, CT scan, etc. When the various "independent contractor" bills arrived, one was for a doctor I never saw. I disputed that one, and kept asking for a statement of services from his office, which I never got. Blue Cross also never heard of him, and they were covering the main bills. Eventually it went to collections, but the bill collectors also could not prove the debt was valid when I asked for documentation (what services were rendered, and when?). I call it "drive by medicine". He may have walked by the ER room where they saw me, but he sure never came in to examine me or talk to me.

 

[Rose Karuna]

Something like this happened to me in 2010. I had a kidney stone, and was in excruciating pain. Got an ambulance ride to the hospital, CT scan, etc. When the various "independent contractor" bills arrived, one was for a doctor I never saw. I disputed that one, and kept asking for a statement of services from his office, which I never got. Blue Cross also never heard of him, and they were covering the main bills. Eventually it went to collections, but the bill collectors also could not prove the debt was valid when I asked for documentation (what services were rendered, and when?). I call it "drive by medicine". He may have walked by the ER room where they saw me, but he sure never came in to examine me or talk to me.

I had a similar issue with X rays that I had. The technician took the X rays and actually handed them to me in an envelope for my doctor. I took them over to my doctor (the labs and hospital and my doctors office are all in one big building). My doctor read them, made a diagnosis and we were done.

About six weeks later I got a bill from a doctor I'd never heard of for reading the X ray. I called my doctor and she was not aware of any other doctor reading them and had nothing in her files. I called the insurance company and told them because they paid this guy and he billed me for the delta. The insurance company didn't care and weren't going to fight it. I called his office numerous times and finally they turned it over to a collection agency where I requested proof of service. They finally dropped it but not without considerable hassle. Honestly, with all the time it took me it would have been easier and more profitable to have just paid the damn thing but for me it was the principle.

 

[Essence Lumin]

I had a frustrating experience being billed for a doctor's service that should have been covered in the hospital. The bill gave a phone number but it was an hour wait every time I called. Which I did, maybe ten times over a year. They kept saying they would check into the problem and fix it. Eventually they did I guess. What was I supposed to do? If they take forever, probably intentionally not answering the phone, then don't take any action?

 

[RealVioletWitch]

you know these occaisional posts and threads from USAians on the madness of their healthcare system always strike me like little horror stories.

Seriously. Like, our health care here (in Canada) ain't perfect, but it's pretty good. The idea of having to actually pay for seeing a doctor or lab tests or whatever is so wierd and alien to us.

Like in Sept. we had a surgery, after a couple rounds of ultrasounds and then a CT scan, and a few consults with the surgeon, resulting finally with a couple days in hospital for the procedure. Total out of pocket expense: Maybe $30 in parking fees overall. Oh and I think we splurged another $10 to get TV & internet service on the bedside terminal while we were recovering.

I hope someday you get a public healthcare system there. It's pretty cool.

 

[Zaida Gearbox]

Yeah, I dread having to go to a doctor for pretty much anything but it is usually not an option. You wind up with separate bills from the facility, each doctor, radiology, the lab, the ambulance, and so on. Good luck trying to find out when you have reached the end of the bills too. Months and months can go by then someone finds they need to bill for something or other related to something that happened long ago.

We've been getting bills from TWO different ambulance companies from my husband's heart attack - he only rode in one ambulance!

 

[Kara Spengler]

We've been getting bills from TWO different ambulance companies from my husband's heart attack - he only rode in one ambulance!

For some random reason I have had several of my seizures within feet of an ER entrance. Almost always they have had to call an ambulance for me, bizarre, but I can see there might be liability concerns if they just went out to the sidewalk with a gurney.

One was REALLY hilarious. I got billed by an advanced life support ambulance to bring me into the ER! I am guessing that just was what was in the ambulance bay at the time.

 

[Kara Spengler]

I had a frustrating experience being billed for a doctor's service that should have been covered in the hospital. The bill gave a phone number but it was an hour wait every time I called. Which I did, maybe ten times over a year. They kept saying they would check into the problem and fix it. Eventually they did I guess. What was I supposed to do? If they take forever, probably intentionally not answering the phone, then don't take any action?

Some bills I pay right away but others? I can only contact them to pay a bill during business hours and M-F. Umm, I am a tad busy then. Which means their $10 bill takes weeks to percolate through my todo list.

Then there are the ones who will ONLY accept payments by check in the mail. No calling to use a credit card. No website. Get with the 21st century people!