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Something to watch out for
Old 12-10-2015, 09:10 PM   #1
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Something to watch out for

I had a nice little surprise with my short emergency and observation room stay in a network hospital. Most bills were paid in network benefits. But a couple Doctor who visited me or looked over charts billed and were not paid, They were out of network! in the in network ER. Okay I looked into this and am filing an appeal because Emergency is supposed to be covered even for out of network Doctors.

But if you go have surgery or any other procedure, if a out of network is used in your in network facility. Tough Luck to you. You are responsible. I have had hmo for years and being not having run into this before mostly because luckily have not had health issues.

This is ridiculous and basically out of your control, it will be hard to make sure everyone only in network is used when you are not the one sending to labs or a dr looks at your charts and on and on. Just giving this for others to beware!
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Old 12-10-2015, 10:24 PM   #2
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I understand what you are saying. It is not a pleasant thought. I am trying to figure out what to do in such a situation, should it arise.
I wonder if one can have it noted in his/her file that if a provider is not a provider with Insurance Co A, then do not provide any services.
Hopefully others will chime in with some good information.
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Old 12-10-2015, 10:47 PM   #3
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Some of those docs walk in , ask how you are feeling and walk out. Then they bill for it.
Basically its medical fraud as they did nothing.

You should fight paying them, as its really fraud. Perhaps writing complaints to the government (not the AMA - medical assoc as its a self serving union).

I noticed this too, but lucky for us the "visiting strange useless doctors" were in-network so didn't cost us anything.
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Old 12-11-2015, 12:39 AM   #4
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I understand what you are saying. It is not a pleasant thought. I am trying to figure out what to do in such a situation, should it arise.
I wonder if one can have it noted in his/her file that if a provider is not a provider with Insurance Co A, then do not provide any services.
Hopefully others will chime in with some good information.

I have thought about carrying such a piece of paper on my person, something like, "I only consent to be treated and billed by in-network physicians. I will not be responsible for any out-of-network charges without my express consent."

But with electronic health records where would they store it, how would they communicate it to said physicians and would I be lucid enough to whip out the paper to show them?


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Old 12-11-2015, 07:30 AM   #5
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A friend on FB once posted that he carried printed labels that read, "I (name), agree to be responsible for all bills to the extent that they are covered by my Medicare policy No. #### and my Medicare Supplement with Company X, Policy Number #####". He then signs it and pastes it on the document he signs. (Once he was given forms to sign after they locked his eyeglasses in a locker before a procedure and he wrote it out on the form.) He swears this has worked. YMMV.


I think I'd use a cell phone camera to take a picture of the page with my signature and the extra notation on it.


This year I was insured with Coventry and they sent me a letter telling me that in 2016 my current coverage was no longer available and they provided a link to another policy I "might like". It provided zero coverage for out-of-network except for emergencies. Umm, no thanks. I switched to a BCBS policy with a 40% out-of-network copay.


Another huge problem with out-of-network: even when you have coverage, it's x% of "usual and customary". The benefits people at my last employer said that one employee was hit with huge charges after a serious illness because the out-of-network coverage, even though it was 80% of "usual and customary", left them liable for 100% of the excess over U&C. Nasty.
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Old 12-11-2015, 09:34 AM   #6
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I will definitely be signing every consent form I am given!
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Old 12-11-2015, 09:38 AM   #7
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Originally Posted by athena53 View Post
A friend on FB once posted that he carried printed labels that read, "I (name), agree to be responsible for all bills to the extent that they are covered by my Medicare policy No. #### and my Medicare Supplement with Company X, Policy Number #####". He then signs it and pastes it on the document he signs. (Once he was given forms to sign after they locked his eyeglasses in a locker before a procedure and he wrote it out on the form.) He swears this has worked. YMMV.


I think I'd use a cell phone camera to take a picture of the page with my signature and the extra notation on it.


This year I was insured with Coventry and they sent me a letter telling me that in 2016 my current coverage was no longer available and they provided a link to another policy I "might like". It provided zero coverage for out-of-network except for emergencies. Umm, no thanks. I switched to a BCBS policy with a 40% out-of-network copay.


Another huge problem with out-of-network: even when you have coverage, it's x% of "usual and customary". The benefits people at my last employer said that one employee was hit with huge charges after a serious illness because the out-of-network coverage, even though it was 80% of "usual and customary", left them liable for 100% of the excess over U&C. Nasty.
I did aca the options without HMO were limited and very expensive. Even our employee covered healthcare was an HMO. So many don't have the choice. But I get what you are saying
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Old 12-11-2015, 09:56 AM   #8
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We are both on Medicare with great supplemental insurance. The big thing we watch for is making sure the first provider takes Medicare. Then we ask if there will be any other services (anesthesia, lab work, other procedures, etc) and if there is, we contact them to make sure they accept Medicare.

On an emergency situation, which we have experienced, we are kind of at the mercy of the local hospital (DW has COPD and we have had ER runs).
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Old 12-11-2015, 10:02 AM   #9
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If/when that happens to me, I promise you that I will not pay the bill.
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Old 12-11-2015, 10:08 AM   #10
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I just ran into this situation last week. I went in for a colonoscopy. They had a piece of paper listing the anesthesia group they use. I asked the nurse about them. I said I know that the GI doctors are in network but don"t know anything about the anesthesia group. She said not to worry. That they will work with my insurance about payment. Right. Had no choice at that point. Will see what happens with the insurance.
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Old 12-11-2015, 10:12 AM   #11
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I don't know how people are expected to get healthcare covered by their current insurance when every doctor, every hospital, every therapist, etc. requires you to sign a form essentially saying that if they decide to do something your insurance doesn't cover or if the insurance doesn't pay all, you will assume the cost. Signing the forms feels like handing blank signed checks to the receptionist. I was surprised to find that doctors locally wanted the signatures even when they accepted Medicare assignment. Since I moved back to the west coast I don't remember a single doctor giving me a form to sign without some sort of waiving of my control over costs. Sometimes they want to update the signatures yearly.


When I went for my cataract surgery, I checked that both the doctors and the facility accepted assignment. The 5 page small print form given to me for signature on the day of surgery included a disclosure on about the middle of page 4 that they used contractors in the surgery (anesthesia, some nurses). I went to the front desk and asked if these contractors accepted assignment. They didn't know; no one had ever asked; etc. Someone came back later and said they asked the contractor on my case and he said he accepted assignment. I noticed the others in the waiting area were interested in this exchange. I might have been the only one who read the document.


Am I the only one that thinks this is a ridiculous way to run health insurance?
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Old 12-11-2015, 10:17 AM   #12
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Some of those docs walk in , ask how you are feeling and walk out. Then they bill for it.
Basically its medical fraud as they did nothing.
Love my current PCP, but he can be a stickler about stuff.

My insurance pays 100% for a yearly checkup. But woe to one who mentions anything other than "I'm fine, doc" at that checkup. If I even say I have an ache every now and then, and doc manipulates my knee, he'll write up an extra procedure code that is outside the yearly checkup.

This has become standard with most docs now. They are packing in procedures like nobody's business.
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Old 12-11-2015, 10:21 AM   #13
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Our local emergency room physicians don't work for the hospital, and they direct bill every patient. And they're out of network. It always riled me when I paid $300 emergency room co-pay for my daughter and a deductible for her medicines. I'd see the Medicaid people also in the E-Room at the pharmacy, and they never had to pay a penny to the hospital or to get their meds. And the E-Room physicans' bill might be $350 for 3 minutes of their time.

My mother was in and out of the hospital the last few years of her life, and she had great insurance. She had a revolving door of healthcare professionals coming in giving little or no services, and they were all billing Medicare and her Supplement. We had to have someone with her at all times keeping a log on who treated her and what medicines she was given. Needless to say, her hospital bills had many erroneous charges that had to be questioned--downright fraud.

Changes in healthcare are required--but not expected. We patients just have to be pro-active when put into compromising positions.
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Old 12-11-2015, 10:29 AM   #14
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When I went for my cataract surgery, I checked that both the doctors and the facility accepted assignment. The 5 page small print form given to me for signature on the day of surgery included a disclosure on about the middle of page 4 that they used contractors in the surgery (anesthesia, some nurses). I went to the front desk and asked if these contractors accepted assignment. They didn't know; no one had ever asked; etc. Someone came back later and said they asked the contractor on my case and he said he accepted assignment. I noticed the others in the waiting area were interested in this exchange. I might have been the only one who read the document.


Am I the only one that thinks this is a ridiculous way to run health insurance?
No, it is getting more ridiculous. With respect to the anesthesia service providers, I have taken the time to get their phone number and call them to ask if they accept Medicare. That is our plan going forward if we are put into that situation.
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Old 12-11-2015, 10:41 AM   #15
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No, it is getting more ridiculous. ........
I totally agree and this seems like an opportunity for someone like an anesthesiologist to double or triple their yearly income by simply popping into network hospitals and charging full bore on the now sleeping patient.
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Old 12-11-2015, 11:33 AM   #16
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I am so glad to be covered by Kaiser's Medicare Advantage program.
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Old 12-11-2015, 01:49 PM   #17
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My mother was in and out of the hospital the last few years of her life, and she had great insurance. She had a revolving door of healthcare professionals coming in giving little or no services, and they were all billing Medicare and her Supplement. We had to have someone with her at all times keeping a log on who treated her and what medicines she was given. Needless to say, her hospital bills had many erroneous charges that had to be questioned--downright fraud.

Changes in healthcare are required--but not expected. We patients just have to be pro-active when put into compromising positions.
A coworker told me that he went through the itemized bills after his elderly mother's final illness and one item was "scan of pregnant uterus".

After the first of the year, I'm getting a colonoscopy through colonoscopyassist.com, which has been highly recommended here- they tell you the cost, all-in before the procedure. (Mine will be diagnostic due to previous minor nasties, so not covered as preventative). After that I plan to write to the two places I'd called about this who couldn't give me a straight answer about costs (one my previous doc, the other one recommended by my PCP) and tell them why I didn't use them. With my high deductible, it's 100% out of pocket although I can itemize on my taxes. They're going to need to learn that we don't write blank checks.


Quote:
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I just ran into this situation last week. I went in for a colonoscopy. They had a piece of paper listing the anesthesia group they use. I asked the nurse about them. I said I know that the GI doctors are in network but don"t know anything about the anesthesia group. She said not to worry. That they will work with my insurance about payment. Right. Had no choice at that point. Will see what happens with the insurance.

I hope this isn't TMI, but I have mine without anaesthetic. I've had menstrual cramps that were worse than that. I really like getting up afterwards and resuming normal activity without feeling drugged.
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Old 12-11-2015, 03:02 PM   #18
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At my PCP annual physical I have refused to sign the waiver, and they took me in anyway. As far as PPO being any better than HMO for out-of-network, seems like being billed 20% of some huge number is almost as bad as bad as being billed 100% of some huge number. i.e., I would refuse to pay either one. Maybe we're getting to the point of just refusing to pay, and living with whatever consequences come from that, since doing everything one can to prevent out-of-network providers does not always work. At my recent visit to the eye doctor, they gave me a plastic form to sign with an erasable felt tip pen. I wrote "copay only" next to the financial part, and asked for a xerox copy They acted like I was the only one to ever ask for a copy, but they did give me a copy.
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Old 12-11-2015, 03:10 PM   #19
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Single payer. End of story, I'm sorry but I've had so many of these BS situations that maybe the rest of the world is right. [Mod Edit]
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Old 12-11-2015, 03:32 PM   #20
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I am so glad to be covered by Kaiser's Medicare Advantage program.
Same here - except the regular (vs medicare) version. I make sure to go to a Kaiser facility and am assured the practitioners - all of them - are in network. Emergency room visits to a non-Kaiser facility are covered as well. Basically everyone is out of network at a non-Kaiser facility - but they cover at their HMO rates. And in CA they can't balance bill. Since I'm satisfied with the Kaiser Docs/NPs/PAs... it's a winner for me.
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