February 10th, 2012, 11:29 AM #1
Excessive Medical Bills--Their Diagnosis and Cure?
What to do, especially when you had no choice as to the doctors or the procedures?
Ever hear of an endovascular embolization ?
Neither had we.
First a dye is released into a tumor under flouroscopy to trace its vascularization. Then, microsopic balls are released to travel as far into the tumor as they go and an reactive substance is released to "glue" the material into the tumor. The overall intent of this procedure is to cut off blood supply to a tumor and therby shrink it as well as cut off blood supply for when the tumor is surgically removed. This increases the chances of a favorable outcome and while you may have never heard of it before entering the Hospital by way of the Emergency Room, you are certainly grateful for it afterwards.
Ther are many such procedures that may take place when a patient in a Hospital and often you have no choice as to who performs them or eeven as a practical matter whether they are performed due to the advances in medical technology.
You may be aware that just about anything done in a Hospital costs more than when done outside of a Hospital. For example, an MRI done in an outside Radiological Imaging place on my back is reimbused about $600--outside a Hospital. The same produre done in the AMbulatory --not INpatiatient-- Radiology unit inside a local Hospital is reimbursed $3,500, about seven times as much. I was amazed by this discrepency.
One Assistant Surgeon billed several times what the lead Surgeon billed and their Billing insisted "WE don't make mistakes".
When it was pointed out that a) it exceeded the lead Surgeon even though the assistant under contract is paid one sixth the lead B)the part was greater than the whole on several bills, which is a breach of logic C) three bills repeated other bills in amount down to the last penny which from a probablelistic point of view exceeds the chances of being hit by Haley's Comet. Never trust people who tell you they never make mistakes.
But this is what bothers me:
If a vascular surgeon bills $6,000 per hour for 5 hours =$30,000 and the Insurance Company pays $2,200 X 5 hrs. =$11,000, who is to pay the remaining $19,000? We were chided that the reimbursement was($11,000) was very small compared to the Bill ($30,000). Perhaps the bill was very large compared to the reimbursement.
In any event, how is that arrived at when the nature of the service does not allow for comparison shopping and one is grateful for a satisfactory outcome? Many doctors do accept what the Insurance Companies pay and hopefully we can negotiate such an outcome, although dealing with the Billing Services doesn't inspire confidence.
What about other such bills that exceed reimbursements?
Who is to decide when a bill is excessive, especially when one had no choice as to selecting the Physician or in selecting one who accepts one's Insurance versus one who doesn't?
What can one do about it without destroying one's credit rating?
MegalosSlylakiFIRST TEN YEARS ANNIVERSARY HONOR ROLLthis April 18th, 2014 and will be Officially Celebrated That Day! SEE http://www.techimo.com/forum/imo-com...ml#post1070600
February 10th, 2012, 12:50 PM #2
Could ya let me know when the movie comes out
Your insurance companies pays on "allowable" amounts. They pay their share and you pay yours.
Anything over the allowable amount is written off. (or should be)The propeller is just a big fan in front of the plane used to keep the pilot cool. When it stops, you can actually watch the pilot start sweating.
February 10th, 2012, 01:01 PM #3
First of all, I'm in California so the rules may be different.
If you have something "pre approved" done, the insurance company has already negotiated the price. The 30K - 11K discrepancy is written off. It's not really there anyway except in the bookkeeping department in the "Capitation" account. "Capitation" represents something like "a pool of dues money" is the best analogy I can come up with. Think of "capitation" as something like a Costco membership. You have to pay to join to get good deals.
In California you can't be made to pay the difference between what the insurance company pays and the hospital bills. (There used to be a "customary charge" clause that the insured would get stuck with - IE insurance company "short paying".) Your insurance company pays 11K minus your copay.
The difference in cost is mostly in overhead. Hospitals have to care of a lot of indigent people that clinics don't. They have a bigger building and more staff, and a higher paid staff at that.
And depending on the protocol for the procedure, some procedures require a certain amount of support to 'stand by'... IE you have a stroke and need immediate brain surgery that a clinic can't do. Plus, a hospital is likely to have more experienced radiologists on the spot, whereas the clinic has to send them out for a second review.
Hopefully, someone on this board works in medical billing and can explain this better."The world burns while Obama Tweets."
February 11th, 2012, 05:24 PM #4
Insurance companies base reimbursements on "reasonable and customary" fees based on market surveys. So in NYC, it's pretty much a given that the reimbursement rates will be higher than other parts of the country.
There are people who fly to places like Texas or even Latin America to get expensive procedures done. Even after airfare, they save a lot of money.
February 11th, 2012, 07:21 PM #5
Places like Texas? Are you kidding osprey?
February 11th, 2012, 09:36 PM #6
I know here in Missouri if your insurance company only pays 15,000 bucks on a 20,000 buck procedure the hospital or doctor still wants the rest of the money..been there done that.
February 11th, 2012, 10:36 PM #7
February 12th, 2012, 02:40 AM #8
I think a lot of it depends on wether the provider is a network member or not. Usually network members will not go after the difference, but non-network members will as they do not get reimbursed as much by the insurance company.
I have been lucky and have always been able to talk with the billing department of the provider when I can not pay what they ask for. Almost every time they have been able to come down on the price, extended the due date, or something else to help me out.
As an example I was billed $600 for my CPAP machine after the insurance company paid the sleep center $1500. If I bought the machine direct from Philips it would have only cost me $820. The sleep center already recieved $1500 for an $820 machine, yet they wanted another $600 from me. I called and told them that and they lowered the price to $150.
I've done something similar with my Rheumatologist a couple times. Just recently my knee swelled up and I had to go in for an emergency visit to my Rheumatologist to get it drained before I damaged something in my knee. The last time I did this they billed me over $200. I told my doctor that I am in school, am flat broke, and would not be able to make my car payment if I had to pay for this procedure. So he agreed to tell the billing department to put a note on my account saying that I can pay the bill within a year, and he took $100 off. The last bill from them I ended up getting a final notice because I couldn't pay it off either, so he understood that I really couldn't pay it off. He has done that twice in the past and it really helps.
As for hospitals, I have no idea how that works. Luckily I have only ever been to an emergency room once, but I was 10 at the time and so I have no idea how much that cost. I only know that it cost my parents a lot. (Several X-Rays and a CT scan to check for a concusion as I had blacked out for a minute after hitting my head)One by one the penguins steal my sanity.
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