Hospital charges for services not rendered!

[EastWest Gal]

Health care expense fiasco. Do we report to the state?

DS broke his left calcaneous bone (heel) snowboarding 2 months ago. Even though it was processed through insurance, the bill from the ER was about $4000. Insurance denied payment on a bunch of it.

Frankly, the care the ER provided was well-awful. Anyway, I had him request the records from the visit. I stayed with him for half and my husband stayed with him for the other half.

Most of the record was a lie and there were inappropriate charges for services not rendered on the bill. This is blatantly illegal and my son’s medical record now contains absolute lies.

I helped him contact him the entities involved, and figure out how to protest the bill. This happens to be the place where both of us do contract work-yikes.

I think this happens systematically in medicine. In my field (pediatrics), we are likely to undercharge, but everywhere else, overcharging seems to be the fashion, the law be damned. 12 years ago, we were billed for critical care by the ER for a broken arm. I got that changed.

This makes me wonder if there is something systematic going on.

Be vigilant with your medical records and your medical bills. Just sayin’....

We’ll be reporting to the state.

What else should we do?

 

[MRG]

Health care expense fiasco. Do we report to the state?

DS broke his left calcaneous bone (heel) snowboarding 2 months ago. Even though it was processed through insurance, the bill from the ER was about $4000. Insurance denied payment on a bunch of it.

Frankly, the care the ER provided was well-awful. Anyway, I had him request the records from the visit. I stayed with him for half and my husband stayed with him for the other half.

Most of the record was a lie and there were inappropriate charges for services not rendered on the bill. This is blatantly illegal and my son’s medical record now contains absolute lies.

I helped him contact him the entities involved, and figure out how to protest the bill. This happens to be the place where both of us do contract work-yikes.

I think this happens systematically in medicine. In my field (pediatrics), we are likely to undercharge, but everywhere else, overcharging seems to be the fashion, the law be damned. 12 years ago, we were billed for critical care by the ER for a broken arm. I got that changed.

This makes me wonder if there is something systematic going on.

Be vigilant with your medical records and your medical bills. Just sayin’....

We’ll be reporting to the state.

What else should we do?

Last time I reported improper care to the facility. That was funny.

I was hospitalized for concerns about my heart. They gave me an IV that was not in the vein. Reported it when it happened and to 6 other nurses who treated me. No one would replace it and when they pushed saline in it my arm bulged upstream from the IV.

Finally on day 3, two folks are administering a chemical stress test and guess what? They have to replace the IV cause it's not in a vein.

The hospital sent me to their risk management department. I heard what a horrible person I must be to complain about a stupid IV being placed incorrectly. I'd still complain next time. Actually I might pay an attorney to write a letter. Might not change anything but...

 

[John Galt III]

Health care expense fiasco. Do we report to the state?

DS broke his left calcaneous bone (heel) snowboarding 2 months ago. Even though it was processed through insurance, the bill from the ER was about $4000. Insurance denied payment on a bunch of it.

Do you mean that the hospital wants you to pay $4,000 out of pocket, in addition to what the insurance paid them? Your EOB from the ins co may say that you do not owe the $4,000.

 

[MichaelB]

mod note - This has gone from a peeve to a full discussion on a personal situation and some apparently shady practices, so a new thread topic was created to continue the discussion.

 

[EastWest Gal]

Health care expense fiasco. Do we report to the state?

DS broke his left calcaneous bone (heel) snowboarding 2 months ago. Even though it was processed through insurance, the bill from the ER was about $4000. Insurance denied payment on a bunch of it.

Do you mean that the hospital wants you to pay $4,000 out of pocket, in addition to what the insurance paid them? Your EOB from the ins co may say that you do not owe the $4,000.

Yes. The insurance denied a $1770 charge and paid next to nothing on the other charges. DS is calling the insurance company today for the 4th time. I'm ok with them denying the charges, but it must be for the right reasons, which hasn't occurred.

 

[travelover]

..........This makes me wonder if there is something systematic going on..............

American medical care is now over $8000 per person per year, the most expensive in the world. So, yea, I'd say something systematic IS going on.

 

[MichaelB]

I've read that medical billing coding has evolved from coding & billing services rendered to coding & billing the highest rate services that might or could have been rendered. This situation by EWGal looks like that.

Yes. The insurance denied a $1770 charge and paid next to nothing on the other charges. DS is calling the insurance company today for the 4th time. I'm ok with them denying the charges, but it must be for the right reasons, which hasn't occurred.

If there is a need to escalate, documentation of the previous efforts to resolve is important. Your son should keep a detailed record of each call - names, dates, summary of discussion, action items. If you are unable to resolve this with the hospital, I would suggest the state insurance commission (complaint about the insurer) and the state Attorney General (consumer fraud).

 

[jonat]

In many states, the state medical licensing board has a process for filing complaints about a facility.

 

[spncity]

We’ll be reporting to the state.

What else should we do?

You might consider telling the hospital president. You don't even have to talk to the president. Do it through his/her executive assistant. That can often get a lot of attention / correction of a problem... as they may wish to get it corrected before the state comes in to check it.

 

[CountryGal]

Wow! I am currently reading a book that describes this strategy to a T. I haven't gotten to the last part where they tell you what to do about it.

If you want a total eyeopener about the money making profession of health care, read the book "American Sickness". I thought I knew about a lot of the greed and dirty tactics.... this will truly open your eyes!

 

[lwp2017]

We were turned over to a collection service by our local hospital without notice. DW got a very nasty call from the collection service which she let scare & upset her.

I immediately called hospital billing. It was a mistake, ironically we got a reimbursement of $987 because we prepaid too much. Hospital administrator profusely apologized.

 

[Z3Dreamer]

Knew a nurse who had a daughter that had surgery. Detailed bill included charges for a Doctor who did nothing. Reason given was that the hospital needed the Doctor to be available if the primary specialist could not perform the procedure/surgery. This was 20 years ago and the charge was around $700. My friend, the nurse, was outraged.

 

[EastWest Gal]

The hospital and physician’s group have heard from us and are delaying their bill pay deadline a month while the charges were reviewed. My son, husband and I all sent letters describing the events. Fortunately DH and I texted and called back and forth while my son’s injured foot was dangled in a wheelchair-the ER didn’t even provide basic first aid while we waited 5 hours. So our information is time stamped. My letter included the words “fabrication” and “false” a few times-the physician’s note had a timed signature that was 3 hours before he was seen, with a history and physical exam that was never done.

My letter quoted the American Academy of Orthopedic Surgeons regarding proper coding. I explained what was wrong with the coding and what should be done with it, but I’m also incensed that there are lies in my son’s medical record.

We’ll see how they respond. Fortunately, one of the interns I trained is now an administrator for the ER and we have maintained a connection. I know who I’ll be calling if it goes badly.

 

[Winemaker]

When I was employed by our self insured company, HR wanted us to report any discrepancy to our insurance company, who did all the paperwork. Quarterly newsletters always had an article about overcharges, and a list of different employees who caught the errors and the amounts.

 

[Lakewood90712]

The experience you are describing is S.O.P in a large portion of the industry. With you being in the industry, I am surprised that you are surprised L.O.L.

Of course it is systemic. The Subscribers, Insurers and the Providers each want to shift the burden on to anyone else. Been going on for 30 years.

In California , The Department of Insurance has much bigger teeth than the Medical Board IMO.

Complaints about patient care are common, but unless permanent harm or true malpractice occurred, and I am sure you have a good handle on that, I would not expect much action.

The Department of Insurance has the power . Ever heard of Insurance Fraud ? That is a road that the providers don't want to go down.

Someone other than the OP mentioned " Risk Management Department " That is the function to try and avoid lawsuits, by any means , including having a " Customer Service Specialist " lie and try to bully the patient. That goes on in government and a lot of industries.

Hope your DS is getting the best care and recovering.

 

[Bestwifeever]

I stupidly paid two bills for doctors’ visits for covered services when a third came in for a different visit and DH called Medicare and our plan G company—the bills had been rejected because they were coded wrong, and by the time we got them the resubmitting window had closed. I’m sure it was an honest mistake that the docs got about ten times more from us than MC and our plan G would have paid.

 

[pb4uski]

I never pay a medical bill before I get the EOB from our insurer... the insurer is my first line of defense.

 

[ncbill]

Old boss got hospital charges for heart surgery and NICU when his last kid was born.

His newborn didn't have surgery or spend time in the NICU.

 

[MRG]

Long time ago(1980's) my buddies wife had a baby Christmas eve in a small local hospital. Despite the hospital's directive of no non-emergency procedures to be done on Christmas, due to reduced staffing, her doctor performed a tubal ligation on Christmas day.

The doctor didn't believe that she only had one ovary, one had been removed years prior. He found and cut two tubes. She bleed to death Christmas day in the small hospital. He cut a vein, cause she only had one ovary! I remember in the deposition he testified "he wasn't very familiar with the female anatomy".

I remember being at my buddies house when a new bill arrived, the stack of bills he had collected was amazing. I don't know what ever happen to any of her bills. I knew it was upsetting him and suggested he forward them to an attorney.

 

[hopefullyoneday]

Every time I go to the doctors I get a billing problem. Went for a MRI and they wanted me to pay 3500 up front for the MRI, turned out I only had to pay 1200. Had another MRI done years later (different place)and they over charged me. I called them months later after I recovered and went thru my bills and they said yes you have a credit here do you want your money back. Had multiple chiropractors charge for services not rendered. Seams like most in the field are crooks.

 

[Montecfo]

When you have a system where neither the recipient of services nor the provider of services knows the price of those services, and where the cost of those services is paid by a 3rd party, you will certainly have this problem.

I recently found i was being billed for a service which was not submitted to insurance. It was not large dollars, but was a fairly large portion of the bill, percentagewise. Do most people just pay that? I plan to ask them to submit it to my insurance or remove it from the bill.

 

[EastWest Gal]

Update: After several long letters and discussions with the patient representative, we had a good outcome. My son disputed his medical record for the falsehoods. The head of the ER stood by the record, but my son was able to place in his own file his own notes about the errors in the documentation. Not perfect, but acceptable.

The billing update: My son wrote a letter quoting the AmericanAcademy of Orthopedics explaining the error. His explanation of why the charges were incorrect based on incorrect coding, a global care code resulting in the $1770 charge instead of a simple splint code, was fully accepted. He called every two weeks and was reassured that correcting the bills was a long process and that he was ok. Yesterday, two corrected bills arrived.

Physician service bill: $5.30. This was corrected by several hundred dollars and the bulk had already been paid.

ER facility bill: $108.

It seems to me the hospital actually lost a lot of money by having to waste their resources fixing the mess.

My son paid the bills the very same day.

 

[MichaelB]

Glad your perseverance paid off.

 

[MRG]

Thanks for posting. Glad it worked out.

 

[John Galt III]

Congratulations, EastWest Gal and thanks for the update !