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Old 09-11-2012, 11:56 AM   #21
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As to the anesthesiologists charges, makes me wonder whether the referring physcians get a kickback
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Old 09-11-2012, 12:00 PM   #22
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At our insurance company website, I can look at "pending claims". It is shocking to see what providers charge vs what the insurance co. pays. Often, less than 10 cents on the dollar.

I haven't been w/o insurance for 40 years. Are the uninsured expected to pay the provider charge? Seems terribly backwards to me. The person with the least ability to pay- pays the most. The person with the better ability- pays the least.
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Old 09-11-2012, 12:19 PM   #23
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Just had baffling experience myself during my annual physical.....

I thought my lab work (blood draw and analysis) would be completely covered by insurance based on Obamacare preventative regulations. Apparently not all of it was covered. They performed 4 tests based on the same blood sample. Only one was completely covered while the other 3 were only partially covered.

I made 6 calls in all (2 to insurance, 2 to Dr office who bills, and 2 to the lab). Each gave me different answers on the coverage. Insurance kept telling me it should all be covered and that the billing codes used were outdated. The billers told me the codes were all current and there was nothing to change.

After getting totally frustrated and getting nowhere for 2 weeks, I gave up and paid the entire #$%@ bill.
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Old 09-11-2012, 05:12 PM   #24
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Quote:
Originally Posted by DFW_M5
As to the anesthesiologists charges, makes me wonder whether the referring physcians get a kickback
Ive read some nasty stories on how people attempt due diligence and make sure the doctor and facility are in network, and then they find out afterward that the anesthesiologist was out of network, and get smacked with a higher cost. Do you have to call everyone including the custodian who cleans up the mess to verify he is in network,too? My only one encounter with an anesthesiologist was my one knee scope. He asks where I want the injection. I said, how the hell am I supposed to know? Aren't you the doctor?
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Old 09-11-2012, 06:28 PM   #25
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.......... Do you have to call everyone including the custodian who cleans up the mess to verify he is in network,too? ......
Apparently so, including the labs that are involved. Of course you will never get this information in advance.
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Old 09-11-2012, 06:28 PM   #26
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Even though I've read many stories about billing abuses, my interaction with MDs has been mostly finding them as allies, helping us find ways to get around the obstacles. Not so with labs or specialized clinics.
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Old 09-11-2012, 06:43 PM   #27
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Ive read some nasty stories on how people attempt due diligence and make sure the doctor and facility are in network, and then they find out afterward that the anesthesiologist was out of network, and get smacked with a higher cost. Do you have to call everyone including the custodian who cleans up the mess to verify he is in network,too? My only one encounter with an anesthesiologist was my one knee scope. He asks where I want the injection. I said, how the hell am I supposed to know? Aren't you the doctor?

A few years ago I had to have my gall bladder out. I really called around before hand to make sure the anesthesiologist was in network. They were not. Unfortunately, none of the anesthesiologists were in network at any hospital my surgeon practiced at. And, I was told by the hospitals that this was true for every hospital in the area. However, someone told me that sometimes the health plan makes an exception for anesthesiologists. I looked and indeed it provided that if the surgeon and hospital were in network then they would pay (I think) anesthesiologists, radiologists and pathologists who were out of network and I would not be liable for the extra amount.

After the surgery, I remember the insurer paid my surgeon something like $600 on a $6000 surgery fee and paid the anesthesiologist, etc. However, there was a charge for an asst surgeon that was out of network and they paid something like $300 of his $3000 fee telling me I was liable for the remaining $2700. I screeched since no one had told me about the asst surgeon (I found out these are assigned by the hospital and my surgeon had no choice in it and none of them are in any network). I argued to the insurer they should treat them like anesthesiologists even though they weren't on the list. Thankfully, the insurer agreed to do so. I don't know what they worked out with the asst surgeon but I never received a bill from anyone so apparently the insurer did work it out.
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Old 09-11-2012, 08:08 PM   #28
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Sometimes the fee schedule is just silly. Disclaimer: I live in Canada and someone else pays.

Many years ago I was pruning bushes in my yard early one Sunday morning. Like the fool I am, I was using a utility knife. I gave my finger a nasty cut. Since I lived about 2 blocks from a hospital I walked over and the intern on ER duty sewed it up, 4 or 5 stiches, I think. Anyway he told me to see my regular GP to remove them. A month or two later I get a "summary of services provided" by the "organization who pays", aka govmint, I think it was a bit of an audit check. Stiching me up cost $15, removing the stiches (which I could have done myself) $25. Go figure.

About the same time, I arrive 5 minutes late at my dentist, now I'm paying the shot. All I need is one small filling. He's a casual friend and comments he's due in his partner's chair in 15 minutes and the freezing etc. may make him late for the rest of his patients, I don't think he was whining. I tell him "don't freeze, just drill". He does, I'm out early. Bill is the same as any other filling that included freezing. What's wrong with this picture?

Anyway, these were pretty trivial in the grand scheme of "life the universe and everything" so I couldn't bring myself to get too excited. Sillyness happens. If you are paying via your insurance premium, getting vocal is only likely to affect your voice. If you are paying directly and the number is small, getting vocal will mostly affect your blood pressure. Other situations suggest other responses.
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Old 09-11-2012, 09:56 PM   #29
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Originally Posted by Katsmeow

A few years ago I had to have my gall bladder out. I really called around before hand to make sure the anesthesiologist was in network. They were not. Unfortunately, none of the anesthesiologists were in network at any hospital my surgeon practiced at. And, I was told by the hospitals that this was true for every hospital in the area. However, someone told me that sometimes the health plan makes an exception for anesthesiologists. I looked and indeed it provided that if the surgeon and hospital were in network then they would pay (I think) anesthesiologists, radiologists and pathologists who were out of network and I would not be liable for the extra amount.

After the surgery, I remember the insurer paid my surgeon something like $600 on a $6000 surgery fee and paid the anesthesiologist, etc. However, there was a charge for an asst surgeon that was out of network and they paid something like $300 of his $3000 fee telling me I was liable for the remaining $2700. I screeched since no one had told me about the asst surgeon (I found out these are assigned by the hospital and my surgeon had no choice in it and none of them are in any network). I argued to the insurer they should treat them like anesthesiologists even though they weren't on the list. Thankfully, the insurer agreed to do so. I don't know what they worked out with the asst surgeon but I never received a bill from anyone so apparently the insurer did work it out.
That is just plain crazy. You shouldn't have to do all that. It should all be between hospital and insurance co. fighting it out over the bill with you on the hook for nothing. All anyone should have to do is make sure the hospital and your immediate surgeon is in network, and they should be responsible to assign and make sure that all other people are in network medical performers unless you specify differently. Why it has spiraled out of control over the years is just insane. I mean who is supposed to know you need an asst. surgeon and other possible minions in the room and make sure they are fully covered by your insurance? Glad you didnt get stuck with the bill!
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Old 09-12-2012, 06:24 AM   #30
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That is just plain crazy. .......
Yea, I'd say that about covers it.
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Old 09-12-2012, 08:03 AM   #31
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Even though I've read many stories about billing abuses, my interaction with MDs has been mostly finding them as allies, helping us find ways to get around the obstacles. Not so with labs or specialized clinics.

While there are many well meaning Drs, they are often buffered by office managers/personnel who are not very helpful.
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