Medical billing issue-talk me down off the ledge of panic

[yoopermom]

(I've had three surgeries in three years on the same ankle/foot due to a serious fall and its complications, so I think I'm pretty savvy when it comes to doctors/insurances/etc, however....)

My maximum OOP has been reached for the year, so I've been happily checking my insurance website, watching the EOB with zeros on them for my part due. Yesterday, it suddenly showed over 8K in new charges due (half to surgeon, half to assistant surgeon). I called the insurance company immediately, and the rep said that the surgery was preauthorized, but one of the six coded procedures that he did was NOT preauthorized, so they denied it. My immediate thought was, "How can I be responsible for knowing this, I was sound asleep on the operating table!", but I know that that doesn't always matter.

I called the surgeon's office this am, and the billing department is "looking into it". I know I have to let the process take its time, but I'm just sick to my stomach. I made sure, ahead of time, that everyone was in network, and that the preauthorization had taken place. How can they hold me responsible for a decision that he made, especially one that was made while I was under? Can I hope that maybe it was just a coding error? Or??

TIA!
Terri

 

[jaybirdsmommy]

(I've had three surgeries in three years on the same ankle/foot due to a serious fall and its complications, so I think I'm pretty savvy when it comes to doctors/insurances/etc, however....)

My maximum OOP has been reached for the year, so I've been happily checking my insurance website, watching the EOB with zeros on them for my part due. Yesterday, it suddenly showed over 8K in new charges due (half to surgeon, half to assistant surgeon). I called the insurance company immediately, and the rep said that the surgery was preauthorized, but one of the six coded procedures that he did was NOT preauthorized, so they denied it. My immediate thought was, "How can I be responsible for knowing this, I was sound asleep on the operating table!", but I know that that doesn't always matter.

I called the surgeon's office this am, and the billing department is "looking into it". I know I have to let the process take its time, but I'm just sick to my stomach. I made sure, ahead of time, that everyone was in network, and that the preauthorization had taken place. How can they hold me responsible for a decision that he made, especially one that was made while I was under? Can I hope that maybe it was just a coding error? Or??

TIA!
Terri

That's so annoying. Hopefully the surgeon's office will fix it and it's just a coding error.

I had it happen to me one time. My son was in icu and apparently 1 of the parade of doctors treating him wasn't in our network. I got a similar response - "You are the one responsible for asking if the doctor is in network." That was the last thing on my mind at the time, and what if the doctor had come while I wasn't in the room? How would I have asked then?

 

[TCRAIG]

All my pre-authorized billing problems were due to various doc’s offices choosing the wrong code except for one which the doc’s office ended up covering because they were responsible for not making sure it was ok - hoping you have the same luck!

 

[SteveH]

One of my employees ran into something similar. Our Insurance Agent took the time to go over her bills and worked with her to get things worked out with the billing department. He is very experienced in the field but IMHO made me loyal to him as an agent that he personally helped her out. If you have an agent, contact them to see if they can help. If you got it through the marketplace, sorry can't be of much help.

 

[Bianca and Bernard]

That's so annoying. Hopefully the surgeon's office will fix it and it's just a coding error.

I had it happen to me one time. My son was in icu and apparently 1 of the parade of doctors treating him wasn't in our network. I got a similar response - "You are the one responsible for asking if the doctor is in network." That was the last thing on my mind at the time, and what if the doctor had come while I wasn't in the room? How would I have asked then?

When DH had his kidney removed (wow, 12 years ago!), we made sure we did everything through the insurance company (well, he did anyways). One doctor, who was some newbie ICU doc, wasn't covered...and we did not know. Not until his $12,000 bill came. We thought that was a little bit excessive, for 10 days in ICU (due to complications), as we had only gazed upon his shining face, once a day for about 10 minutes. He didn't even have anything to do with DH's care...the nephrologist, main ICU doc, and the surgeon were the ones who were making all the decisions about his care. We had no idea why the guy was even involved, and no one else did either.

I raised holy heck over that bill, and the insurance did not pay him a dime. We ended up owing the jerk $1200 in the end, and I paid him $25 a week, via a check. He's lucky I didn't take $25 in loose mixed change to his office every week. (We could have paid the whole thing at once, but we were overcharged for a service DH did not need or request, and this was our way of protesting, once we got it down to a more reasonable amount.) His wife was his office staff, so I didn't feel bad in the slightest by making her go to the bank every week (yep, he deposited it every week).

 

[DisneyHardin]

I raised holy heck over that bill, and the insurance did not pay him a dime. We ended up owing the jerk $1200 in the end, and I paid him $25 a week, via a check. He's lucky I didn't take $25 in loose mixed change to his office every week. (We could have paid the whole thing at once, but we were overcharged for a service DH did not need or request, and this was our way of protesting, once we got it down to a more reasonable amount.) His wife was his office staff, so I didn't feel bad in the slightest by making her go to the bank every week (yep, he deposited it every week).

That is so annoying. I was in the hospital for a week last year and a different lung doctor came in when the one I had been seeing had the day off. He had no idea why he was even seeing me and had me mixed up with another patient - I figured this out when he started talking to me about getting some tests scheduled that I knew I didn't need. He apologized for mixing me up with someone else and left. My part of his bill after insurance was $127. I was so pissed that I had to pay anything to him!! I don't even know what I would have done if I owed $1200 for a similar situation.

 

[pahoben]

(I've had three surgeries in three years on the same ankle/foot due to a serious fall and its complications, so I think I'm pretty savvy when it comes to doctors/insurances/etc, however....)

My maximum OOP has been reached for the year, so I've been happily checking my insurance website, watching the EOB with zeros on them for my part due. Yesterday, it suddenly showed over 8K in new charges due (half to surgeon, half to assistant surgeon). I called the insurance company immediately, and the rep said that the surgery was preauthorized, but one of the six coded procedures that he did was NOT preauthorized, so they denied it. My immediate thought was, "How can I be responsible for knowing this, I was sound asleep on the operating table!", but I know that that doesn't always matter.

I called the surgeon's office this am, and the billing department is "looking into it". I know I have to let the process take its time, but I'm just sick to my stomach. I made sure, ahead of time, that everyone was in network, and that the preauthorization had taken place. How can they hold me responsible for a decision that he made, especially one that was made while I was under? Can I hope that maybe it was just a coding error? Or??

TIA!
Terri

Don’t let them scare you or be scared thinking about it. Medical billing is a disaster and everyone knows it so just stick to what you think is fair. Often medical billing amounts includes consideration for other people with no insurance and with no intent of paying so be cool and never pay what you don’t think is fair. You shouldn’t have to pay because the surgeon operated on someone with no insurance and no intent to pay. Stick to what you know is right. In this case you are doing nothing at all wrong.

 

[frostedpink]

Just wanted to chime in on your thread since we’re going through similar things. I’m not a very patient person to begin with so this whole ordeal is really going to test my patience. I agree, we have to let things play out. In my case the procedure was intended to prevent a stroke and it’s what the neurologist thought was the safest bet. Of course I went along with it and it never occurred to me that it was considered investigative by the fda. Positive thoughts for you and I hope you get quick resolution

 

[Skippy918]

It took me 4 months to get a refund on a procedure that was fully covered by my plan but the doctor’s office didn’t think it was. Super frustrating with the back and forth.

 

[yoopermom]

Thank you, everyone. The hospital's billing department has said that they are submitting an appeal to the insurance with surgical records, and that it can take up to a month or more.

Every "normal" person who I've talked to has been incredulous, but they're not the ones making the decision. I'm still a wreck about it, but am trying to think positively.

Thanks for all the interesting thoughts, and viewpoints. I'll keep you informed.

Terri

 

[eva]

Dealing with medical bills stink! I had a physical last fall. My doctor sends me to a hospital every year to get basic labs done. I have a well being option on my Blue Cross Blue Shield. My labs, physical, and mammogram are completely covered every year. Well a new assistant in my doctors office order the tests as standard, not well being. They wanted over $800 for blood work. What a mess! It took 6 months to get that straightened out. You want to pull your hair out, but just stick with it.

 

[Disney Doll]

When DH had his kidney removed (wow, 12 years ago!), we made sure we did everything through the insurance company (well, he did anyways). One doctor, who was some newbie ICU doc, wasn't covered...and we did not know. Not until his $12,000 bill came. We thought that was a little bit excessive, for 10 days in ICU (due to complications), as we had only gazed upon his shining face, once a day for about 10 minutes. He didn't even have anything to do with DH's care...the nephrologist, main ICU doc, and the surgeon were the ones who were making all the decisions about his care. We had no idea why the guy was even involved, and no one else did either.

I raised holy heck over that bill, and the insurance did not pay him a dime. We ended up owing the jerk $1200 in the end, and I paid him $25 a week, via a check. He's lucky I didn't take $25 in loose mixed change to his office every week. (We could have paid the whole thing at once, but we were overcharged for a service DH did not need or request, and this was our way of protesting, once we got it down to a more reasonable amount.) His wife was his office staff, so I didn't feel bad in the slightest by making her go to the bank every week (yep, he deposited it every week).

You’re nicer than me. I’d have paid him $5/month.

 

[theluckyrabbit]

Hang in there! (Just keep swimming, just keep swimming...) I'm sure you already know this, but keep every single receipt, scrap of paper, stub, etc. and keep a record of every phone call (name, date and time, transaction number -- if available, etc.). Just in case you need it, it could really come in handy.
When we went through our billing "adventure," the hospital had the gall to bill us again after the insurance had paid. When we ignored the second bills because we knew the insurance had paid, the billing department got nasty and aggressive. Thank goodness, I had all the paperwork and records of the phone trails. When I finally got through to a hospital billing manager and told him all the invoice numbers, dates, times of phone calls and names of employees, etc., he was silent. Then his tone changed completely -- suddenly he was so sweet! OH! Ha, ha... we could just ignore any further communications from their office. No worries! (And no apology either.) Did he really think they could bill me over $12,000.00 TWICE? And maybe I wouldn't notice? Oddly enough, this same hospital was in the paper a short time later as the subject of an investigative report on shoddy billing practices. Hmmmm...