Hospital bill for 25k not covered by Medicare

[Tadpole]

I came back to this thread to show what a patient visiting a Peaceheath facility is expected to sign prior to treatment. This is the document I called a blank check. Peacehealth presumably accepts Medicare assignment and people visiting the desk are first asked to sign this onto their computers sight unseen. You can see it if you ask to see the document you are signing. Note the blank check you are signing especially with respect to the last two bullets.

Note the lack of responsibility on their part to negotiate with me first concerning the existence, much less the billing, of non-insurance covered services. This is what makes it a blank check.

I have an appointment with a Nurse Practitioner and they will want me to sign this sight unseen when I check in for the appointment.

Since Peacehealth buys up the competition and already is the only choice for most hospital and specialty services, they are locking this area into a zone of insurance uncertainty with the cards all in the Peacehealth hand.

I thought it was illegal to ask Medicare patients to sign agreements like this if the organization listed themselves as accepting assignment. This agreement, once signed, makes it impossible to know how much your bill for a throat swab might be and they don't have to tell you or negotiate a price.

PEACEHEALTH MEDICAL CENTER and PEACEHEALTH MEDICAL GROUP

Consent for General Treatment:
I understand and agree that as a patient I will receive general medical services and treatment, including HIV testing. I understand I have the right to ask questions about and refuse these services.

I acknowledge that my health care providers may be independent contractors not employed by PeaceHealth. Health care students may also treat me. I understand if special procedures or operations are needed, my health care providers will discuss this with me and my additional consent may be required.

I authorize the hospital and all clinical providers who provide care to me, along with any billing services or other agents who may work on their behalf, to contact me on my cell phone and/or home phone using automated telephone dialing systems, email messages, text messages or other computer assisted technology.

Financial Responsibility Agreement:
• I understand that in consideration of the services provided I agree to pay charges according to PeaceHealth regular rates and terms.
• I understand and agree that PeaceHealth may make inquiries regarding insurance coverage and my financial responsibility from third party payors or other responsible parties. In addition, I give consent for these payors and/or references to release information to PeaceHealth.
• I understand that PeaceHealth reserves the right to require proof of my ability to pay and may require a payment prior to service. I further understand that payments collected will be applied to my total bill owed.
• I authorize direct payment to PeaceHealth and/or health care providers during this period of medical care any third party, insurance, or liability benefits otherwise payable to me. I also authorize direct payment to the surgeon and/or physician or anesthesiologist any third party/insurance benefits which may be due under this claim.
• If I am applying for payment under Medicare, Medicaid, Champus, or TRICARE, I certify that the information I give is correct. I request benefit payments be made directly to PeaceHealth.
• I further agree to pay for services denied or not covered by my insurance regardless of the reason for denial or non-coverage.
• I understand I will be billed separately for services provided by non-employed providers such as Emergency Room Physicians, Anesthesiologists or Radiologists.

Financial Assistance Program: PeaceHealth provides financial assistance to all persons meeting income eligibility criteria. Charges may be waived or reduced only after all other financial resources have been applied for and exhausted and if the patient is eligible for PeaceHealth Financial Assistance Programs.

Non-Discrimination Policy: PeaceHealth provides services to all people. It does not discriminate against any patient because of race, religion, national origin, gender, sexual orientation, disability or insurance program such as Medicaid or Medicare. PeaceHealth provides emergency services regardless of the patient’s ability to pay for those services.

Personal Property and Valuables – Patient Waiver of Liability: PeaceHealth is not responsible for loss or damage to personal property or medications brought to the hospital. Patients are advised to leave valuable items at home or to send valuables home with a responsible person. Only medically necessary devices may remain at the bedside.

Patient Rights and Responsibilities: I acknowledge receipt of information regarding Patient Rights and may accept or refuse care at any time.
I am the patient or the patient’s agent or authorized representative. I acknowledge that I have read this agreement and understand its purpose and contents. By signing here, I consent for health care services and accept the terms of the financial agreement.

(bolding mine)

 

[RetMD21]

They make you sign this bs but they can't enforce it for Medicare

 

[pb4uski]

I understand I will be billed separately for services provided by non-employed providers such as Emergency Room Physicians, Anesthesiologists or Radiologists.

Since this doesn't talk about rates I don't necessarily see it as troublesome.... I have no issue with these providers billing me separately as long as they bill medicare rates or the negotiated rate from my insurer.... since it is silent to rates, I could fight any excessive billing. But if it were a paper copy, I would pencil in at negotiated rates or something along those lines.

 

[Octogirl]

Lstansbury: thank you for providing some good info.

My 90 year old mom was hospitalized for emergency surgery last year and when they tried to discharge her before she could even walk, I was glad to be there as her advocate.

Sadly, many older people do not have an advocate or think if the hospital says "go", then they have to leave. NOT SO.

 

[Tadpole]

Since this doesn't talk about rates I don't necessarily see it as troublesome.... I have no issue with these providers billing me separately as long as they bill medicare rates or the negotiated rate from my insurer.... since it is silent to rates, I could fight any excessive billing. But if it were a paper copy, I would pencil in at negotiated rates or something along those lines.

I guess my problem with this is that I might be in a clinic where the doctor is under the clinic's Medicare assignment acceptance but, not known to me, his nurse is a contractor whos contracting organization doesn't have insurance agreements. I would never know that his nurse's organization was going to bill me an amount 10x the allowed Medicare amount or, perhaps, for services the nurse added to tack on profits that Medicare doesn't allow. It's the lack of pre-negotiated price that is the problem, not the separate billing. When it comes to people like anesthesiologists, not knowing they don't accept Medicare assignment pricing could be costly.

 

[Tadpole]

They make you sign this bs but they can't enforce it for Medicare

I thought so too but last time I was there I insisted that they weren't supposed to make Medicare recipients sign on to agreements like this. They weren't deterred. Here it is once again. I don't think it, in any way, would qualify as an ABN agreement for a service not covered by Medicare since that service is not specified as even existing. If they have some way of getting it accepted as an Advance Beneficiary Notice of Noncoverage (ABN), the patients are in trouble. (The ABN Booklet seems to assume the service that Medicare isn't covering is reported along with the agreement. If so, this turns the blank check into a check with a recipient but a blank for the amount.)

I seem to have a case where I just sign it and cross my fingers or resign myself to an argument at the reception desk each time I visit a Peacehealth facility.

Thanks for your comment. I hope I never need to test the agreement.

 

[pb4uski]

I guess my problem with this is that I might be in a clinic where the doctor is under the clinic's Medicare assignment acceptance but, not known to me, his nurse is a contractor whos contracting organization doesn't have insurance agreements. I would never know that his nurse's organization was going to bill me an amount 10x the allowed Medicare amount or, perhaps, for services the nurse added to tack on profits that Medicare doesn't allow. It's the lack of pre-negotiated price that is the problem, not the separate billing. When it comes to people like anesthesiologists, not knowing they don't accept Medicare assignment pricing could be costly.

I think I would say that what I signed was that I agreed to be billed separately, but that I didn't agree to pay more than Medicare rates... so I'll pay what Medicare assignment would pay and that is all.... since I never agreed to pay more then they have no legal basis to charge more since I don't have a contract with those providers.... see you in court.

 

[RetMD21]

It's not an ABN so you are clear. They are insisting that you sign something dumb but it is easier to sign it. I wouldn't worry. It isn't just a matter of accepting assignment or not it is participation in Medicare. Even if the hypothetical DNP isn't accepting assignment you would only be on the hook for 15% additional minus the sequestration adjustment. If he/she isn't participating in Medicare I think you needed to sign an ABN.

 

[fh2000]

It's not an ABN so you are clear. They are insisting that you sign something dumb but it is easier to sign it. I wouldn't worry. It isn't just a matter of accepting assignment or not it is participation in Medicare. Even if the hypothetical DNP isn't accepting assignment you would only be on the hook for 15% additional minus the sequestration adjustment. If he/she isn't participating in Medicare I think you needed to sign an ABN.

Will purchasing Medigap Plan G help covering the excess cost in cases like this?

 

[Tadpole]

Well, since I know my husband will sign anything to avoid a confrontation, I guess I will just sign it and quit acting like a scared puppy. I just wanted, in fairness to Peacehealth, to share the actual text of the agreement I mentioned before.

RetMD21, Concerning the 15% - Does Medicare price things they don't cover to establish the base price or is this just for things they cover?

 

[RetMD21]

For things that Medicare doesn't cover (like cosmetic surgery) I think you are on your own for pricing. Balance billing is billing the difference between what Medicare paid and what you wanted. It is illegal. I am pretty sure that if you get a procedure not covered by your Medicare Advantage Plan it is the hospital or other entity that is out of luck. I know that with the local "non-profit" hospital nothing gets done for an MA patient w/o approval if required. I don't think they would be so careful if the patient could be billed.

If you have traditional medicare you really want a medigap plan. I talked to a patient recently who didn't buy a supplement when he started Medicare thinking that he could pay cash for outpatient things like office visits. Now he is facing a $100,000 (list price) procedure. He'll get the Medicare discount but he'll have to pay the rest which he can afford.

 

[Tadpole]

For things that Medicare doesn't cover (like cosmetic surgery) I think you are on your own for pricing. Balance billing is billing the difference between what Medicare paid and what you wanted. It is illegal. I am pretty sure that if you get a procedure not covered by your Medicare Advantage Plan it is the hospital or other entity that is out of luck. I know that with the local "non-profit" hospital nothing gets done for an MA patient w/o approval if required. I don't think they would be so careful if the patient could be billed.

If you have traditional medicare you really want a medigap plan. I talked to a patient recently who didn't buy a supplement when he started Medicare thinking that he could pay cash for outpatient things like office visits. Now he is facing a $100,000 (list price) procedure. He'll get the Medicare discount but he'll have to pay the rest which he can afford.

Thanks, that's pretty much what I would have guessed. I have a plan that pays all of my part of Medicare A & B bills with Medicare as the primary. So, in my case, Medicare determines coverage and price. I always try to make sure the facility and doctors all accept assignment but it is getting harder and harder as contractors are used, sometimes for expensive procedures.

 

[EastWest Gal]

Well, since I know my husband will sign anything to avoid a confrontation, I guess I will just sign it and quit acting like a scared puppy. I just wanted, in fairness to Peacehealth, to share the actual text of the agreement I mentioned before.

RetMD21, Concerning the 15% - Does Medicare price things they don't cover to establish the base price or is this just for things they cover?

They all ask you to sign without giving you the form. Last time I had to sign the little box I wrote after my signature, “did not read”. They balked when I asked to be given the document to read first!

 

[RetMD21]

For medicare nonparticipating physicians you are at most on the hook for less than 15% of the medicare list price. For non medicare they can charge whatever they ant and you may have to fight it out. For the 1% of physicians who have opted out of medicare, the sky is the limit but they are responsible for notifying you.

I don't work for a hospital but the policy at my affiliated place is that you sign the form or don't get the service. Still it is ridiculous to ask people to sign w/o reading.