Medical charges ordeal - comment

[wanaberetiree]

I had two visits to see Dr. XXX who was recommended by My_Insurance as in-network doctor.

First visit focused on getting a referral to have my low back X-Ray and MRI done and the second was about discussing the tests results. Both visits took under 15 minutes and no additional tests or procedures done during those visits. (I paid for X-Ray and MRI out-of-pocket)

Prior to my visits I did my best to make sure verify that there would be no additional charges.

I reached out to my insurance provider My_Insurance (via website and asked a rep in chat) prior to scheduling visits and they told me that Dr. XXX's name is on my network providers list and $20 copay is expected with no additional fees or charges.

I also asked Dr. XXX’s stuff the same question during my appointment setup time and got the same answer.

If My_Insurance would have suggested any additional “facility” changes, I could simply find a specialist somewhere else, who did not have extra charges as it was not my goal to see this particular specialist.

My_Insurance claims they "... quoted correctly that the provider is in network and claims were processed as in network. My_Insurance has no way of knowing that a facility is going to bill separate charges in addition to what the doctor will bill.”

Two doctors visits resulted in $20 copay x 2 plus $166 plus $99 - $305 !!!


My_Insurance is paid by my employer and self-insured, that is is not under my state jurisdiction.



I don't plan pay those charged, but want to get this group's wisdom on possible negative impact if I go thru collection process etc...



Maybe some advise on how to fight this, would be helpful



Thx

 

[Jerry1]

Is the $166 and the $99 the full charge or is that a discount off of charges? I understand that is what they billed you, but is that the full charge or did they give you a discounted price?

If it's not discounted, I think you'll have a good chance of success to get the amount reduced. Assuming it is a discounted number, I think you should pay it and move on. While it's understandable how you feel, it's unlikely you would have been able to get the service anywhere without a facility fee. It's very common. In Michigan, most any facility even remotely associated with a hospital will charge the facility fee. The providers that don't are completely independent from a hospital and usually go so far as to advertise as much.

Still, with an x-ray and an MRI, there are two parts. The professional piece (the Dr reading and interpreting the results) and the equipment piece. You learned a medical billing lesson for not too much. Next time you will ask better questions, like, what will the total cost of this service to me? Please put that in writing. Between your insurer and the provider, they should be able to do that. The error might be in not knowing if you've hit any deductible or co-pay maxes, but that should go in the right direction if they are incorrect on that point.

 

[wanaberetiree]

Is the $166 and the $99 the full charge or is that a discount off of charges? I understand that is what they billed you, but is that the full charge or did they give you a discounted price?

If it's not discounted, I think you'll have a good chance of success to get the amount reduced. Assuming it is a discounted number, I think you should pay it and move on. While it's understandable how you feel, it's unlikely you would have been able to get the service anywhere without a facility fee. It's very common. In Michigan, most any facility even remotely associated with a hospital will charge the facility fee. The providers that don't are completely independent from a hospital and usually go so far as to advertise as much.

Still, with an x-ray and an MRI, there are two parts. The professional piece (the Dr reading and interpreting the results) and the equipment piece. You learned a medical billing lesson for not too much. Next time you will ask better questions, like, what will the total cost of this service to me? Please put that in writing. Between your insurer and the provider, they should be able to do that. The error might be in not knowing if you've hit any deductible or co-pay maxes, but that should go in the right direction if they are incorrect on that point.

It is a full charge.


Just not to confuse things, X-Ray and MRI were not part of the bill. I actually paid it out of pocket because it was cheaper then insurance deductible.


When would you negotiate discount? After they submit to collection ?

 

[Ready]

That exact situation happened to me a few years ago. I called the doctor's billing department and explained the situation to them and they agreed to write off the entire amount of the charge.

I would try that first, and put something in writing responding to the invoice. But I would not ignore it and let it go to collections. You need to demonstrate that you attempted to resolve the dispute in good faith. Just document the conversations that took place and request the charges be written off. Let them respond next.

 

[Teacher Terry]

Once your insurance company processes the claim the amount you will be responsible for will be greatly reduced.

 

[wanaberetiree]

That exact situation happened to me a few years ago. I called the doctor's billing department and explained the situation to them and they agreed to write off the entire amount of the charge.



I would try that first, and put something in writing responding to the invoice. But I would not ignore it and let it go to collections. You need to demonstrate that you attempted to resolve the dispute in good faith. Just document the conversations that took place and request the charges be written off. Let them respond next.

I have everything documented and got thru all appeals.
Up to the state insurance commissioner. The problem with commissioner is that my company is self-insured. So I’m thinking what steps to take.

 

[Bamaman]

Medical doctors mark'em up, take what the insurance company pays and marks off the difference--not including your deductible and co-pay. Insurance companies and especially Medicare work in mysterious ways. (My doctor absolutely refuses to see Medicaid patients.)

Doctors shoot for the stars--hoping someone will pay'em more than they're supposed to be paid. And I'm often appalled at the pittance Medicare pays for minor testing and other charges. No wonder our doctors are working into their 70's--without ER in sight.

 

[Katsmeow]

What kind of Dr was Dr XXX? Was he/she a radiologist? Or was this simply a primary care doctor or specialist who just referred you to the facility that did the X ray and MRI?

I have never been charged a facility charge by a doctor who wasn't doing some procedure on me and who had, say, an office operating room (and the one time that occurred it was for a plastic surgeon and nothing was covered by insurance any way).

For just an ordinary primary care doctor or specialist who was just doing an office visit and exam I have never been charged a facility charge.

So -- did the doctor do any kind of procedure? Was it just an office visit/exam? This just sounds odd to me if it is. I mean if I go to see a doctor who is just a regular doctor I wouldn't even think to ask if there was a facility charge.

 

[wanaberetiree]

What kind of Dr was Dr XXX? Was he/she a radiologist? Or was this simply a primary care doctor or specialist who just referred you to the facility that did the X ray and MRI?



I have never been charged a facility charge by a doctor who wasn't doing some procedure on me and who had, say, an office operating room (and the one time that occurred it was for a plastic surgeon and nothing was covered by insurance any way).



For just an ordinary primary care doctor or specialist who was just doing an office visit and exam I have never been charged a facility charge.



So -- did the doctor do any kind of procedure? Was it just an office visit/exam? This just sounds odd to me if it is. I mean if I go to see a doctor who is just a regular doctor I wouldn't even think to ask if there was a facility charge.

That was an orthopedist

 

[wanaberetiree]

Once your insurance company processes the claim the amount you will be responsible for will be greatly reduced.

I’m not worried about the amount, I think to pay for something you did not get is wrong. And entire medical billing sounds like you get a sandwich and then find out that it cost $200

Is it right ? Aren’t we paying those charges actually encourage them ?

 

[Katsmeow]

That was an orthopedist

Did the doctor just do an exam? Was there an X ray or other procedure done at the doctor's office?

OK -- apparently this is increasingly common when the doctor works for a clinic owned by a hospital even if the office is no where near the hospital. Does a hospital own the practice?

https://www.the-alliance.org/upload...ss/Understanding_Facility_Fees_TA114-0116.pdf

https://clearhealthcosts.com/blog/2...e-facility-fees-101-or-what-you-need-to-know/

 

[wanaberetiree]

Did the doctor just do an exam? Was there an X ray or other procedure done at the doctor's office?

Only exam and 2d time review of results

X-ray and MRI were done by other provider

 

[Jerry1]

When would you negotiate discount? After they submit to collection ?

This VVVV

That exact situation happened to me a few years ago. I called the doctor's billing department and explained the situation to them and they agreed to write off the entire amount of the charge.

I would try that first, and put something in writing responding to the invoice. But I would not ignore it and let it go to collections. You need to demonstrate that you attempted to resolve the dispute in good faith. Just document the conversations that took place and request the charges be written off. Let them respond next.

You don't want it to go to collection. It's just not worth it. Start negotiating asap (first bill) and if after a verbal conversation if you do not get this resolved, then make sure what you do is in writing.

The problem is that it doesn't seem that the provider of the service being billed is one of the entities you discussed the potential bill with. In other words, they're not the ones that wronged you. Still, if it's the full charge, see what the bill is after it's processed and hopefully it will not be big enough for you to be concerned about. If it stays at the full charge, try for 50% reduction if they won't write it off completely. 50% is not at all uncommon. You should probably start at 75%. In my case, I got a bill for $125 (the full charge) that I knew the insurance would pay $18 for. So it took a bit of work, but they finally accepted the $18.

 

[wanaberetiree]

You don't want it to go to collection.

Why not?

Got your other point.

 

[Jerry1]

Once it goes to collection, you're no longer dealing with the provider. You're dealing with a collection agency that will have no incentive to work with you. It will be a legal black and white at that point. You got a service, you got a bill, there was technically nothing wrong with the transaction . . . You'll lose. You'll also spend a lot of time to save $265. Is your time worth nothing?

 

[Katsmeow]

Only exam and 2d time review of results

X-ray and MRI were done by other provider

Then I bet it is the situation I posted the links on. Apparently the facility charge is common when the practice is owned by someone else, particularly if it is owned by a hospital. If the provider didn't disclose this to you maybe you could get them to at least reduce it. I gave links to a couple of articles about these charges but there are a lot more articles out there so it might be worthwhile to look at them and see what suggestions are given.

 

[wanaberetiree]

Once it goes to collection, you're no longer dealing with the provider. You're dealing with a collection agency that will have no incentive to work with you. It will be a legal black and white at that point. You got a service, you got a bill, there was technically nothing wrong with the transaction . . . You'll lose. You'll also spend a lot of time to save $265. Is your time worth nothing?

Well I will try.
Not sure if hospital will be willing to reduce the bill.

Also I was thinking that negotiating with collections might be easier. Wrong ?

What will "You'll lose" look like ? Credit history negative record? Assuming I did not pay.

 

[Rianne]

Explanation of Benefits. My very first go to for any medical bill. I get that very quickly after an appointment of any kind. It explains everything. The actual invoice from the hospital/doctor usually follows a month later.
You will see the discounted rate, what the doc/hospital/tests/meds charged. From the Explanation of Benefits you can negotiate, it does not pay to negotiate from the invoice from the provider.

 

[Jerry1]

Well I will try.
Not sure if hospital will be willing to reduce the bill.

Also I was thinking that negotiating with collections might be easier. Wrong ?

What will "You'll lose" look like ? Credit history negative record? Assuming I did not pay.

The hospital is way more likely to work with you than the collection agency. For a last ditch request, ask them to give you the Medicare rate. Start with asking for it to be forgiven, but hold on the Medicare rate.

I’m not sure on the credit report. I’ve heard that they keep a different set of books for medical financial issues versus consumer credit. Still, I think it’s pretty easy and the collection company will likely do it, to put a lien on your assets or garnish your wages. They’ll have to get a judgement, but they do that all the time so it’s not sweat off their back. Just don’t think you want to go down that rode. Oh, you will also likely be “asked” to come to court to talk to the judge. Just not worth it IMHO.

 

[zinger1457]

What will "You'll lose" look like ? Credit history negative record? Assuming I did not pay.

You should look into possible late fees that you could be charged if the bill is not paid on time.

 

[EarlyBirdly]

Try and negotiate it away...Be Nice.

Failing that, DO NOT waste time,resources, personal integrity, or credit worthiness by allowing it to go to collections.

This type of bill is levied without an express contract stating payment period, amount or otherwise. Legally, you may owe the money but, it is at your discretion as regards payment. There are no agreed upon terms.

Set up a recurring random amount monthly for payment. Something fun like, $3.21 and allow that bill to be paid over a several year period. Remember this is interest free so, why not?

Legally, you are showing intent to pay with timely payments, as your finances allow and there's not much that can be done about it on their part because there were no specified terms at the time the debt was incurred.

It will cost them more to collect than the total bill itself after mailings, handling, processing etc.

If enough people do something similar, it may cause them to reconsider their quasi-fraudulent billing practices.


Basically it goes like this:


" SURPRISE...Here's your Bill! "


" SURPRISE...Here's how I'm going to pay you! "



Or, you could build a Pipe Bomb as an alternative method of satisfaction...But personally, I wouldn't go that route.





BirdMan

 

[EarlyBirdly]

" You should look into possible late fees that you could be charged if the bill is not paid on time."

No worries.

There is no "on time". There is no contract in effect, verbal or otherwise, unless something was signed by an individual in the voluminous piles of paperwork thrown at them during visits to Dr's Offices/Medical Facilities.

I am familiar with the above because:

A) Mom worked in Collections for a group of Attorney's for many years.

B) Personal experience.


BirdMan

 

[Sue J]

Ughh. Facility charges. I'm also dealing with this.

One of our local hospital systems was bought out by Cleveland Clinic a few years ago. I'm seeing a specialist group from the old hospital system that is now part of Cleveland Clinic. Every time I have an office visit there is the fee associated with seeing the doctor and then there is also a "facility fee" of $183. Both are discounted by my insurance to the allowed amount. The facility fee gets discounted to $160. So I have to pay for the visit with the doctor and also an additional $160 for the use of the building. One of these visits was a follow up with the Certified Nurse Practitioner. $86 to see her and $160 for the use of the exam room. This wasn't an updated high tech advanced exam room, it was your typical small room with a chair and table and charts on the walls and a blood pressure cuff. This one didn't even have a hand washing sink, there was a hand sanitizer dispenser on the wall. $160.00

During my visit I mentioned the $160 facility fee to the CNP. She said that she hears this from many patients, it's a standard charge for everyone using the practice since the associated hospital system was bought by Cleveland Clinic.

She also told me that her own family is dealing with a similar charge every time they use the local children's hospital and practices associated with it.

I find this just awful. But I'm dealing with it, and paying the bill like I'm supposed to, because I need to keep seeing the specialist. Hopefully I won't need them for too much longer.

Counting down.....I have 345 days until Medicare!!!!

 

[imoldernu]

Thankful we're on medicare. Given that, though, moments terror. Earlier this year, a problem that led to four trips to the emergency room, a total 10 days in the hospital and an operation. All cured and am fine.

But... about four weeks after returning home, a bill for $46,000, that had been reduced to $13,000... Jeanie says... "don't worry they'll take care of the difference." OMG... the bill doesn't say that... and it does show what medicare paid.

The billing was obscure, and didn't make sense to me, but the end result on the bill said your insurance paid $33,000 and you may be responsible for $13,000.
From my dear wife..."don't worry, they'll pay it all." Worried nights and one month later, a bill that came in with $o.oo due. She was right. One time I was glad she was right.

Too soon old and too late smart!

 

[sengsational]

What will "You'll lose" look like ? Credit history negative record? Assuming I did not pay.

I think trying to work out something reasonable to all parties is a good idea. When I tried that with a case of "supposed to be in-network but, oops, not in-network" things. The billing person got snippy and threatened to send it to collections. I said I'd pay the in-network rate, right here, right now, but not paying anything now without your agreeing that the in-network rate would be payment in full. Click. And they didn't even wait 90 days. I got the collections letter a few weeks later. I wrote a "drop dead" letter, with signature confirmation saying I was disputing the debt, that I had source documentation proving that, and I would take them to local small claims court (a right provided by the federal Fair Debt Collection Practices Act) if I saw anything on my credit report. I never heard another peep out of them. And nothing on the credit report.


But they could get a judgement against you, and that would be "bad". So if you ever get anything in the mail about a court date, make sure you address it.