OT: Doctor Billing.

[GloryDawg]

My wife and I both have had health issues this year. I had a biopsy and going back for a MRI. My wife has had two surgeries. My doctor who did my biopsy is one of my wife doctor who did one of the surgery. Here is where it gets crazy. I really follow doctor bills and my EOB for insurance and try to stay on top things. However I got bombed with doctors bills and hospital bills. When she had her first surgery I paid the 1000.00 deductible plus the 20%. When I had my biopsy I paid 1000.00 deductible and plus the 20%. Later I got an additional bill and paid it. My wife got a additional bill and I paid it. She got two more bills and I paid the larger of the two thinking that should be it. All from same doctor. (Big mistake. I Assumed) Last week I got letter from collection agency on my wife's bill. I called the doctors billing to find out what's up. They said that she had three different bills. So I paid the one to them that went to collections. So I got worried and asked do I owe any money. She looked and said no but I had a $321.00 credit. What's jacked about it, they can send all these bills but they can't notify you that you have a credit. They have been sitting on that credit for four months. Not a word from them.

Rant over but I am contacting my State Rep that this should be address. As hard it is to follow doctor bills and insurance or to understand what is going on, the doctor offices should not sit on money. They should notify the patient that there is a credit. It really isn't that hard to send a letter. I don't blame the doctor. I blame the people who own the clinic and those who run the billing office.

 

[johnson86-1]

My wife and I both have had health issues this year. I had a biopsy and going back for a MRI. My wife has had two surgeries. My doctor who did my biopsy is one of my wife doctor who did one of the surgery. Here is where it gets crazy. I really follow doctor bills and my EOB for insurance and try to stay on top things. However I got bombed with doctors bills and hospital bills. When she had her first surgery I paid the 1000.00 deductible plus the 20%. When I had my biopsy I paid 1000.00 deductible and plus the 20%. Later I got an additional bill and paid it. My wife got a additional bill and I paid it. She got two more bills and I paid the larger of the two thinking that should be it. All from same doctor. (Big mistake. I Assumed) Last week I got letter from collection agency on my wife's bill. I called the doctors billing to find out what's up. They said that she had three different bills. So I paid the one to them that went to collections. So I got worried and asked do I owe any money. She looked and said no but I had a $321.00 credit. What's jacked about it, they can send all these bills but they can't notify you that you have a credit. They have been sitting on that credit for four months. Not a word from them.

Rant over but I am contacting my State Rep that this should be address. As hard it is to follow doctor bills and insurance or to understand what is going on, the doctor offices should not sit on money. They should notify the patient that there is a credit. It really isn't that hard to send a letter. I don't blame the doctor. I blame the people who own the clinic and those who run the billing office.

I wish they would just mandate that there be one billing center for any visit. No getting separate bills from the doctor, lab, anesthesiologist, and facility. You walk into a surgery center, and either all the bills go through the doctor doing the surgery or the surgery cetner. Same thing with the emergency room or hospital or outpatient facility. No more of the quadrouple dipping ******** where the doctor and hospital send you separate bills and one may be in network and the other not. Only two times I had to deal with that I would always make it as painful as possible for that ********. Ignore the bills until they give you a notice that you have 30 days to dispute. Respond in writing asking for details. Make them provide evidence from the actual doctor (for the surgery center) or hospital for emergency room. I'm sure they ahve probably fixed their intake forms to where you basically agree to just pay any healthcare professional or facility that sends you a bill without any documentation, but I actually read what I signed and made them get supporting documentation. It's amazing to me that they apparentlly routinely get people to pay bills issued by labs and/or anesthesiology groups that they've never heard of.

 

[ronpolk]

I hear Drebin is posting good medical advice from Facebook today, maybe he can help**

In all seriousness, medical billing is an absolute cluster 17. I really don’t know how hospitals and doctors offices make money.

 

[dorndawg]

I hear Drebin is posting good medical advice from Facebook today, maybe he can help**

In all seriousness, medical billing is an absolute cluster 17. I really don’t know how hospitals and doctors offices make money.

From what I see, they're doing alright. Completely agree its a cluster17.

 

[ronpolk]

From what I see, they're doing alright. Completely agree its a cluster17.

You’re right. Most do fine. It is mind boggling though when most have receivable days of 100+. If they got billing straight, they could at least be getting paid sooner.

 

[SyonaraStanz]

Are you saying you paid the $1,000 and 20% co-insurance up front or after review of the EOB? I don't pay anything until I've reviewed the EOB and verified it against the doctor's bill. Medical billing and all that they charge for is a clusterf**k, and to top it all off, they usually outsource to a billing center which wreaks of incompetence.

 

[ZombieKissinger]

I’m a doctor and know how it works, and I still found myself totally unable to navigate the system when a billing issue came up. Wrote a paper on it a couple weeks ago for a class I’m in, and I was encouraged to publish, but I don’t want my name on it because it’d make my old system mad. Agree, it’s a mess. I think many systems are intentionally obstructive with payment/billing issues though many issues are due to the complexities of the system

 

[wsjmsu75]

I hear Drebin is posting good medical advice from Facebook today, maybe he can help**

In all seriousness, medical billing is an absolute cluster 17. I really don’t know how hospitals and doctors offices make money.

Tell me about it. What pisses me off is when you as the patient get caught right in between the insurance company (or Medicare) and the provider on a denied claim that the insurer says you are not responsible for, but yet the provider continues to bill you for, threatening to turn it over to collections. And of course, as I said it all falls on you as the patient to try to straighten it out, because the insurance company and the provider do not communicate with each other. I am currently dealing with such an issue between Medicare and UMC. I've made about 5 calls so far about it and nothing has changed yet.

 

[UpTheMiddlex3Punt]

I hate the whole "we'll bill you later" part when I know good and well that it's a $25 copay. I want to pay it now because I know exactly how it is and that the only form of payment when I get the bill is a check by mail. Not even an online billing portal.

Health care seems to lag the most behind other industries.

 

[oxfordrebel22]

I’m certainly no expert, but I have experience dealing with medical bills due to some family situations. My wife and another family member also work in the field.. I say all that to say this, which is my advice, and it’s based on experience:

Nicely question and challenge EVERYTHING. I have been shocked and I guess I should say appalled at the things that doctors and insurance will all of a sudden say was an oversight, when you just simply ask for clarification. I’m a pretty level headed guy (outside of being an Ole Miss fan, of course) and I’ve become convinced that it’s the worlds greatest racket. It’s sickening the things hospitals and insurance companies get away with.

I’ve got a couple personal examples that have led me to this conclusion.. but I’m just telling you man, they will screw you over without blinking. They don’t give a **** about you.

 

[GloryDawg]

Are you saying you paid the $1,000 and 20% co-insurance up front or after review of the EOB? I don't pay anything until I've reviewed the EOB and verified it against the doctor's bill. Medical billing and all that they charge for is a clusterf**k, and to top it all off, they usually outsource to a billing center which wreaks of incompetence.

No. The 1000.00 plus 20% was the day of surgery. The EOB came later. After the first surgery and Biopsy I did not pay anything until the bills came. I am out of pocket 3000.00 individual and 6000.00 total for family.

 

[Bulldog Bruce]

On mine Max Out-of-Pocket is different than deductible. Deductible is an up front amount for a calendar year and does go towards the Out-of-Pocket but then your 20% go towards the OOP. For example I have always had something like a $500 deductible with $2000 max OOP. So once I pay the $500 I only pay towards the $2000 (actually $1500 with $500 removed) out of 20% payments I am making. It is not $500 per surgery.

 

[Go Budaw]

Its all a damn racket. Got the NICU bill for one of our kids not long ago. The billed amount to insurance was $143,000. Insurance said yeah no, actually you’re only going to charge $3,000. Then they paid 90% of the $3,000 and we had to pick up the rest. So basically if I had no insurance, I was going to get charged a 4700% mark-up on what the hospital actually needed to be profitable. Just completely baffling how that whole industry does business.

 

[CoastTrash]

Absent reform, more government involvement in healthcare is inevitable.

 

[RocketDawg]

My wife and I both have had health issues this year. I had a biopsy and going back for a MRI. My wife has had two surgeries. My doctor who did my biopsy is one of my wife doctor who did one of the surgery. Here is where it gets crazy. I really follow doctor bills and my EOB for insurance and try to stay on top things. However I got bombed with doctors bills and hospital bills. When she had her first surgery I paid the 1000.00 deductible plus the 20%. When I had my biopsy I paid 1000.00 deductible and plus the 20%. Later I got an additional bill and paid it. My wife got a additional bill and I paid it. She got two more bills and I paid the larger of the two thinking that should be it. All from same doctor. (Big mistake. I Assumed) Last week I got letter from collection agency on my wife's bill. I called the doctors billing to find out what's up. They said that she had three different bills. So I paid the one to them that went to collections. So I got worried and asked do I owe any money. She looked and said no but I had a $321.00 credit. What's jacked about it, they can send all these bills but they can't notify you that you have a credit. They have been sitting on that credit for four months. Not a word from them.

Rant over but I am contacting my State Rep that this should be address. As hard it is to follow doctor bills and insurance or to understand what is going on, the doctor offices should not sit on money. They should notify the patient that there is a credit. It really isn't that hard to send a letter. I don't blame the doctor. I blame the people who own the clinic and those who run the billing office.

Turn your $321 over to a collection agency to get it refunded with interest or some sort of penalty. If they bug you, then you bug them.

 

[JungRebel]

AFAIK medicine is the only service in the States that is allowed to decide how much you owe ex post facto without giving you a clue up front.

 

[GloryDawg]

On mine Max Out-of-Pocket is different than deductible. Deductible is an up front amount for a calendar year and does go towards the Out-of-Pocket but then your 20% go towards the OOP. For example I have always had something like a $500 deductible with $2000 max OOP. So once I pay the $500 I only pay towards the $2000 (actually $1500 with $500 removed) out of 20% payments I am making. It is not $500 per surgery.

You and I are on the same page. The most I can pay out of pocket each is 3000.00 and 6000.00 max for family. I under stand how the insurance works. It's just message board words get misunderstood.

 

[jdbulldog]

My wife and I both have had health issues this year. I had a biopsy and going back for a MRI. My wife has had two surgeries. My doctor who did my biopsy is one of my wife doctor who did one of the surgery. Here is where it gets crazy. I really follow doctor bills and my EOB for insurance and try to stay on top things. However I got bombed with doctors bills and hospital bills. When she had her first surgery I paid the 1000.00 deductible plus the 20%. When I had my biopsy I paid 1000.00 deductible and plus the 20%. Later I got an additional bill and paid it. My wife got a additional bill and I paid it. She got two more bills and I paid the larger of the two thinking that should be it. All from same doctor. (Big mistake. I Assumed) Last week I got letter from collection agency on my wife's bill. I called the doctors billing to find out what's up. They said that she had three different bills. So I paid the one to them that went to collections. So I got worried and asked do I owe any money. She looked and said no but I had a $321.00 credit. What's jacked about it, they can send all these bills but they can't notify you that you have a credit. They have been sitting on that credit for four months. Not a word from them.

Rant over but I am contacting my State Rep that this should be address. As hard it is to follow doctor bills and insurance or to understand what is going on, the doctor offices should not sit on money. They should notify the patient that there is a credit. It really isn't that hard to send a letter. I don't blame the doctor. I blame the people who own the clinic and those who run the billing office.

Send a certified letter to the providerl instructing them to withdraw your account from collections and that you will pay the bill but that you will expect a refund of the credit owed to you. Also advise that you expect them to fix this misunderstanding so that it has no negative impact to your credit rating.

 

[greenbean.sixpack]

I was in Australia several years ago and had to seek medical attention for one of my troops. At the pharmacy (in a Shire with a small US military contingent), they wouldn't take Tricare because they said it didn't pay. I explained it was just a insurance game we play in the states, Tricare would eventually pay. She said in Australia when you get a bill you pay and when someone owes you they pay you, I thought that must be nice.

 

[Apoplectic_Objurgator]

I never pay until it comes from the collection agency***

 

[idog]

You’re wrong.

Tell me about it. What pisses me off is when you as the patient get caught right in between the insurance company (or Medicare) and the provider on a denied claim that the insurer says you are not responsible for, but yet the provider continues to bill you for, threatening to turn it over to collections. And of course, as I said it all falls on you as the patient to try to straighten it out, because the insurance company and the provider do not communicate with each other. I am currently dealing with such an issue between Medicare and UMC. I've made about 5 calls so far about it and nothing has changed yet.

it’s your responsibility to know your policy and you’re liable for what isn’t covered. Check your policy. Insurers deny covered services all the time to make more money off beneficiaries. I see it nearly everyday. Do you work for free? Then don’t expect your doctor to. We need insurance, not healthcare reform. That doctor bill isn’t your biggest expense of your life, let alone year. Add up your auto, home,life, healthcare etc policies.

 

[idog]

AFAIK medicine is the only service in the States that is allowed to decide how much you owe ex post facto without giving you a clue up front.

It’s your job to know how much you owe, not your doctors office. It’s your policy. Any info up front is a courtesy. If they aren’t collecting properly at the time of service they are losing money bc patients don’t pay bills…Primarily bc they think the cheapest, highest deductible plan they could find should cover 100%.

 

[dorndawg]

I was in Australia several years ago and had to seek medical attention for one of my troops. At the pharmacy (in a Shire with a small US military contingent), they wouldn't take Tricare because they said it didn't pay. I explained it was just a insurance game we play in the states, Tricare would eventually pay. She said in Australia when you get a bill you pay and when someone owes you they pay you, I thought that must be nice.

It's almost like there's a far better way to deliver medical care.

 

[Dawgtini]

Absent reform, more government involvement in healthcare is inevitable.

Government involvement is how we got here.

 

[johnson86-1]

it’s your responsibility to know your policy and you’re liable for what isn’t covered. Check your policy. Insurers deny covered services all the time to make more money off beneficiaries. I see it nearly everyday. Do you work for free? Then don’t expect your doctor to. We need insurance, not healthcare reform. That doctor bill isn’t your biggest expense of your life, let alone year. Add up your auto, home,life, healthcare etc policies.

When doctors can tell how much they are going to charge in advance, they can complain about people not paying their bills. Some of them do this and it seems to work out well for them. They just have to do some work up front.

 

[johnson86-1]

It’s your job to know how much you owe, not your doctors office. It’s your policy. Any info up front is a courtesy. If they aren’t collecting properly at the time of service they are losing money bc patients don’t pay bills…Primarily bc they think the cheapest, highest deductible plan they could find should cover 100%.

This is possibly the dumbest thing ever posted on this board, and that's saying something. Is there any other provider of goods or services you can think of that doesn't know their prices and can't quickly provide them if asked?

 

[johnson86-1]

Government involvement is how we got here.

It is but unfortunately, having a functioning market in healthcare is not really an option politically. Nobody ever even discusses releasing the stranglehold on the number of doctors licensed in the US. If they even talk about the supply side at all, it's about allowing more freedom for people like nurse practitioners and optometrists.

 

[dorndawg]

It is but unfortunately, having a functioning market in healthcare is not really an option politically. Nobody ever even discusses releasing the stranglehold on the number of doctors licensed in the US. If they even talk about the supply side at all, it's about allowing more freedom for people like nurse practitioners and optometrists.

YEP.

 

[WilCoDawg]

So you have $10,000 laying around to pay for your surgeries until insurance pays you back. Must be nice.

 

[WilCoDawg]

One would have to have a lot of money laying around to pay the initial cost of prescriptions here. Imagine the elderly or poly-pharmacy patients. The poor would definitely be the biggest losers here in that situation.

 

[dorndawg]

So you have $10,000 laying around to pay for your surgeries until insurance pays you back. Must be nice.

LOL

 

[WilCoDawg]

There does need to be some sort of regulation, but what type? Our HC system has shown that it doesn’t play nicely without a leash sadly. Maybe requiring transparency from hospitals would be a great start. Tell patients what the cost is upfront in plain English. What a novel idea!

 

[johnson86-1]

There does need to be some sort of regulation, but what type? Our HC system has shown that it doesn’t play nicely without a leash sadly. Maybe requiring transparency from hospitals would be a great start. Tell patients what the cost is upfront in plain English. What a novel idea!

It's not that our healthcare system doesn't play nice. It's that you can't essentially establish a government protected cartel and then expect it's members to not make a **** ton of money.

The main regulation the healthcare system needs is for emergency treatments. They need some sort of regulated pricing for when treatment can't be shopped for. Maybe something like 115% of the median collected for any procedure.

Other than that, require agreement on pricing up front for it to be collectible. Maybe unforeseen issues identified during surgery get 50% of median collected to encourage doctors to address potential issues going into surgery.

If you have that, and release the stranglehold on supply, then there are lots of different levels of regulation that would be possible without breaking the pricing mechanism. But we are politically nowhere near a system that allows the pricing mechanism to work. The best we might could do is have something like Medicaid for all (with virtually all patient interaction other than surgeries with NPs and PAs or even just RNs), and then a cash/true insurance system layered on top of that for people willing to pay for higher quality and/or more timely treatment.

 

[sandwolf.sixpack]

Its all a damn racket. Got the NICU bill for one of our kids not long ago. The billed amount to insurance was $143,000. Insurance said yeah no, actually you’re only going to charge $3,000. Then they paid 90% of the $3,000 and we had to pick up the rest. So basically if I had no insurance, I was going to get charged a 4700% mark-up on what the hospital actually needed to be profitable. Just completely baffling how that whole industry does business.

Yea, this is has always blown my mind. Why do they do this? Are they able to write the $140k off as a loss?

 

[horshack.sixpack]

Pro tip: pay nothing until it is at least in the "Past 60 Days" category. They MIGHT have the actual amount figured out by then.

 

[MagnoliaHunter]

I just received a collection agency bill for $4.96 last week. I think it was for the janitor. This was for surgeries that my son had November/December 2019. We too had called several times to ask if we still owed anything because this had happened before. And we had a credit of over $500, but they couldn't apply the credit toward the bill and turned the $4.96 over to collections. Plus we had never been notified of the credit either.

 

[johnson86-1]

Yea, this is has always blown my mind. Why do they do this? Are they able to write the $140k off as a loss?

A lot of third party payers like to price off of what is charged to/paid by other parties. So inflating the nominal charge could in theory increase the payments from third party payers. As far as I can tell, a lot of the messed up billing practices are just leftover from previous gaming of the system. So a third party payer agrees to pay 75% of the average charged to other patients. So providers start jacking up charges to artificially inflate the price that is "charged" to increase their payments from that third party payer. THe third party payer figures out their gaming it, so they change tweak their agreement the next year so it can't be easily gamed, but they either don't do it in a way that allows the provider to stop artificially inflating the "charge" (that they have no expectation of collecting on) or they do, but the provider never bothers to go back and make their charges realistic because of how it interacts with their internal processes.

There is also the issue of DSH payments. I think at one time, writing off these inflated charges did impact DSH payments. Not sure about now. Obamacare reduced DSH payments a good bit I believe, but think this issue was somehwat addressed before obamacare (but again, not in a way that encouraged or allowed providers to start tying prices charged to reality).

 

[NewTweederEndzoneDance]

Pro tip: pay nothing until it is at least in the "Past 60 Days" category. They MIGHT have the actual amount figured out by then.

This. Your bill is very likely to change each month on what you actually owe for the first few months post treatment. Definitely pay before they send it to collections, and if you get a letter from collections, contact the actual provider immediately and pay directly to them while asking them to make sure that the collection agency knows that the bill has been paid and that they are to cease any collections activity. Collections isn't supposed to report any collection actions until they have provided you notice and given you the proper time to respond.

 

[wsjmsu75]

it’s your responsibility to know your policy and you’re liable for what isn’t covered. Check your policy. Insurers deny covered services all the time to make more money off beneficiaries. I see it nearly everyday. Do you work for free? Then don’t expect your doctor to. We need insurance, not healthcare reform. That doctor bill isn’t your biggest expense of your life, let alone year. Add up your auto, home,life, healthcare etc policies.

No, I am not wrong. Medicare has repeatedly told me that the claim was denied because it was a duplicate charge, and that I am not responsible for it. I have repeatedly told UMC billing what Medicare said, and they just keep on billing me for it.

 

[KentuckyDawg13]

HB (hospital billing) and PB (professional billing), to coordinate both, it's usually best to wait a few weeks before paying. Some billing services take longer to go through all the steps, especially if said provider uses Epic.