I didn't want to buy the machine

[Rich_by_the_Bay]

I was able to access my EOB this morning.

My insurance company was in fact billed for $32,220, and after the network savings, they paid the medical facility $11,201.40.

I'm speechless.

I don't know how altruistic you are feeling these days, but if the facts are as they appear to you it is probably worth reporting. Not sure where to start, but perhaps the carrier or the state regulatory agency. Something is wrong, and everyone pays in the end.

I assume you didn't have a biopsy, breast MRI, or other procedure performed, just a diagnostic mammogram. Even the negotiated fee is 20x higher than reasonable.

 

[bssc]

If they gave you the Mammo machine, you would have gotten a good price. Checked with my wife and the new Digital Mammos go for anywhere from 450K to 600K.

 

[calmloki]

My warranty submitting honey says "what is the code"? Pure and simple it has to be a typo, and if the wrong code is punched in for the mammogram then the insurance company will pay based on the code submitted, which may not be the code for your proceedure.

 

[Gail]

I just spoke with my insurance company. FINALLY, I got someone who looked at the amount and said "Whoa!" and started laughing. She assured me that they would look into it. She said it would probably take 7-10 days.

She checked the code used and it was coded correctly for my procedure. What happened after that is not clear.

It's also not clear to me how this was not caught before they paid. I can't believe that you would not notice that a code that usually gets paid at $200 suddenly is billed at $32,000. Maybe I'm giving the person responsible for payment approval too much credit? Or, and this is what really bothers me, maybe this is not that unusual?

 

[OAG]

Probably not that unusual. I remember handling my Mother's medical when she was in the Hospital and later in Skilled Nursing and over that about 90 day period I found SEVERAL errors too high cost, duplicate billings, etc. As you found out my best source of help was also the insurer BC/BS of FL - I think they all got credited or reversed during the period. I have always wondered, when I hear the rising cost of medical care, how much of the rise can be attributed to these types of problems THAT are NEVER resolved. I do not know how much work it is to investigate overcharges but I suspect payers do not do it often enough.

 

[bbbamI]

Kudos to you Gail and others that take the time and energy to fix these problems!

 

[Meadbh]

Gail, I think they should offer you a j*b as Chief Financial Officer.

 

[toofrugalformycat]

Good on you Gail for being persistent.
Now imagine someone who is truly ill, or in severe pain, or at end of life, or with mild senility, or has no insurance, having to deal with something like this.

Animal crackers.