And the bills start rolling in.......

[The Walk of the Penguin Mich]

My hip replacement was about 5 (2/1) weeks ago and the bill wrangling begins.

Lemme preface this by saying I received my surgery approval letter from my insurance company on 2/8/11. Approval requested 12/17/10 - when I scheduled the appointment with the surgeon. So it only took my insurance company nearly 8 weeks to approve surgery. At least they approved it, even if it was after the fact.

So the day before the scheduled surgery, I go into the hospital for my pre-op appointment and to register. This is pretty much a cursory medical exam, questionnaire and where they take my insurance info. At the time, they have this nifty little machine that takes the info off my insurance card and scans it into the system. No chance of transpostion errors, right?

Well, not so. Yesterday I receive the anesthesiologists bill for nearly $1500 (I'm not going to bitch about this, my anesthesiologist was awesome since she also did my pain management). However, my insurance denied it. Huh?? How can my insurance deny anesthesiology for surgery?

Well, it appeared that anesthesiology (who bills separately from the hospital) cannot seem to read hospital records. NONE of the info they had on me was correct. No, I do not have Medicare (which explains why they denied me). Yes, I'm employed. Yes, I have insurance (and very good insurance). This is my ID number and the group number.

So now I'm wondering how many more of these phone calls I'm going to have......

Lest anyone think that maybe the hospital records were incorrect, I've already been billed and have received EOBs from my insurance company for my durable medical equipment (crutches and grabbers). Pacific Medical managed to get the correct info from my medical records.

[NancysSummerSip]

Had the same thing happen for two of my three surgeries. The insurance companies paid, but I had to shell out for the anesthesiologist.

On the third surgery, the surgery itself was denied at first, and I filed a grievance. The insurance company wound up paying some of it, and all the cost of the anesthesiologist.

Yup. I don't get it, either.

[Apple]

Ugh, I hate dealing with the bills afterward. I got a bill from the hospital for all the "adjusted amounts" balance, where the insurance pays up to a cap that is not as high as the original charge. My doctor is a preferred provider so I don't owe this balance. I also only pay 10% after my deductible. I called the hospital first to go back over my insurance info and remind them I don't owe this balance. The lady insisted that since insurance didn't pay it I had to. So I called insurance to reaffirm I was correct--I was. Called the hospital back and the lady said I had to pay it or it would go to collections.

I called my insurance company back and let her go do the fighting for me--she won. I'm so glad my insurance was on my side with this!

I don't know where the mix-up between hospital records and anesthesiology records happens, but I usually have to call them up and straighten things out too. Twice they've sent me a bill (separate surgeries) for the full amount--no record of my having insurance at all.

[pig]

Good luck! That stinks.

[KaraBoo]

I work at a hospital (but not in billing, thankfully) and this is probably one of the biggest complaints I hear.

I have the same problem with any surgery I have to deal with. I usually wait about 6 months for the insurance and the hospital to get their information straight before I pay my portion (if I don't have a copay up-front).

When my son had to have back surgery a few years ago, I did this and since I had duel insurance on him at the time, the insurance companies fought between themselves over who was primary. I finally received a final bill around 8 months later of $98.00. Paid it and went on my merry little way. 3 months later, I received a refund check from the hospital of $78.00 for over payment.

Right now, I'm fighting with an ER for emergency stitches my step-son needed when we were out of town last July. They keep billing me for the entire amount ($1600.00), when I'm only supposed to pay $150. I've double checked this with the insurance. The hospital keeps insisting that they've billed insurance and the $1600 is my portion. The hospital has since sent me to their collection agency, but I'm not paying until they bill me for the proper amount. When that happens, I'll pay, but not before then.

I finally received an EOB in February for this procedure, but the hospital is still claiming I owe $350.00. Nope - not gonna pay it until you bill me correctly!!

[NomoreDramaQ1015]

My sympathies. I HATE hospital billing in any form because nobody seems to talk to anybody, just like you said Mich.

I also hate how they come in drips and drabs. I don't expect them to come on the same day but MONTHS between the next bill?

[kadee]

I would suggest that you get an itemized bill from the hospital too! After my last surgery I found out I was charged for things I didn't receive.
Also found out that my pre-surgery prep included a pregnancy test....I was over 60 yo and had been thru menopause!

[Bluerobin]

A doctor once told me that if the insurance company can avoid paying for 180 days, it is no longer required to pay. That could be part of the problem.

[spartyparty]

This is why I'm a helicopter parent....too expensive to use your insurance and best just to stay outta the hospital in the first place.

[unrepentant_spendthrift]

I'm in the military.....Gotta love the socialized medicine that is Tricare...... haven't seen a medical bill in 8 years

[Deleted]

Anesthesiologists, Radiologists and Pathologists are not employed by the Hospital, they're independent contractors. They do their own billing (or use billing agencies).

[wvugurl26]

Better watch out, increased patient contributions for Tricare are one thing the govt is considering to make up the deficit. Not that I agree but it seems anything is fair game now.
I had two primary care visits in January. This provider always, always comes back and bills me another $10. I got an EOB from my insurance company (first one I've ever seen) and I figured it out. They are sending me a bill for the difference between my copay and the maximum amount the insurance company says they can bill me for. The EOB looks like the doctor charged me for 2 things on the same day. I figure I'll wait till I get a bill from the doctor's office to fight with them.

[The Walk of the Penguin Mich]

Anesthesiologists, Radiologists and Pathologists are not employed by the Hospital, they're independent contractors. They do their own billing (or use billing agencies).

In the bill I received, I'd be paying it to the hospital. I did ask about this and the anesthesiologist was hired by the hospital - but bills out separately from the hospital bill.

[The Walk of the Penguin Mich]

This is why I'm a helicopter parent....too expensive to use your insurance and best just to stay outta the hospital in the first place.

Quite frankly, the alternative was worse for me than hospital bills.

[Peace Of Mind]

Mich, and everybody - thanks for the heads up. DH has surgery on the 18th so I'm going to make sure he tries to nip some of these problems before hand. It's always something or somebody screwing everything up...

[Sharon]

I don't know what it is about Anesthesiology bills they are the worst to try and get paid. When DD was born by C-section the insurance denied the Anesthesiology bill as "Un-necessary procedure". Um excuse me -- took me six months to get it paid.

[Miss Tequila]

My dd had her kidney out a few years ago and the only thing I was billed for was our $250 deductible. I had no problems at all with our insurance or the billing practices of the hospital.

Mich, I hope you get this straightened out soon

[rovo]

I believe the hospitals and some of the support staff are trying to scam the patients. I recently got a bill from a hospital requesting about 1,400 for the last colonoscopy. The insurance company covers this but only pays the agreed amount to the hospital. Since the hospital billed more than what the insurance paid they forwarded me a bill for their unpaid balance.

Now when the hospital enters into the contract with the insurance company, they agree to accept the insurance payment as payment in full.

I had the same problem about 5 years ago and the insurance company ended up suing the provider to stop the additional billing. It worked for a while but they are trying again.

They sent my bill to collections within weeks of mailing it to me so I suspect they realize they will not be paid and the collections people pay, probably, 15 cents on the dollar for the bills.

[wvugurl26]

Good job in reading the bills and knowing what you are liable for. Honestly if the old and poor people would read their bills, there'd be a helluva lot less fraud for me to chase down.

[TD2K]

When DD was born by C-section the insurance denied the Anesthesiology bill as "Un-necessary procedure".

Did you offer to come down to their office, cut open their abdomen with a rusty butter knife) and see if they still felt anesthesia is "un-necessary"?