Medical insurance is SOOOOO screwed up!

Discussion in 'All Other Discussions' started by annsni, Jul 21, 2010.

  1. annsni

    annsni
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    So hubby had a compound dislocation of his baby toe in October. Yeah - that meant he hit his toe hard enough to have the bone dislocate and for the rest of it to come out of the skin.

    So we finally go the bill for it. $5814.71 OK - let's see how much the insurance company will pay. We got the notification that the insurance company paid...get this...$13, 162.98!!!!! I called the insurance company because they WAY overpaid and they said that amount is what they are contracted to pay for the services done. HUH???? But the bill is only $5800! Nope - that's what they pay.

    So a few weeks later, we get a bill from the hospital for $348.13. HUH? What's THAT for? We have a high deductible insurance plan. We have to pay $6000 a year before the insurance company will pay anything. We still had $348.13 left on our deductible so the hospital SHOULD have gotten $13,511.11 but they were shorted the $348.13 that was our deductible so we have to pay them that amount. Seriously?? You got $7,696.40 overpaid and you want our $350?? Something is SOOOO wrong. They won't fold on this so now we're in collections. I'm tempted to pay them $2 a month for the next lifetime. ARRGGG!!!! We're still paying off the surgeon on this injury! I'm SO paying him before I pay them.
     
  2. Gina B

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    Do you have a local television channel that has a short segment of "On your side" or something similar? When outrageous things like this happen, they will go to bat for you and expose the problem. The people being idiots then have a tendency to rapidly backtrack and do the right thing. Check it out with your local news stations!

    People doing shady things hate publicity, so give them lots of it.
     
  3. rbell

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    Unfortunately, most TV stations have insurance companies as advertisers. Often times, they're not willing to do pieces critical of their sources of revenue.

    But, that may not be true everywhere.
     
  4. rbell

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    THIS is the big difference in the last few years.

    Now, these bozos do the collection thing almost immediately. Sad. They're willing to ding your credit...even if it's a legitimate mistake, mis-billing, double-billing, or something that could be worked out.

    Just be aware that your credit will take a huge hit, quick. Sometimes, the principle of the thing is worth it. Sometimes not.

    For us, I threw a fit, but when it came down to it...we ran the risk of getting nailed beyond belief over a $245 bill. It wasn't worth the risk.

    Hope it works out.
     
  5. billwald

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    The problem is the name. "Medical insurance" is no longer insurance. It doesn't conform to any insurance principles. It is a pre-paid medical service plan and/or a government welfare program.
     
  6. billwald

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    Did anyone talk to a human at the hospital billing department?
     
  7. annsni

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    I did this morning. I spoke to someone and he said that the deductible needs to be paid (the $350 that we had left on our deductible). I asked him why since the bill has been paid in full and then more than that amount as well and he said that we're still responsible for the deductible. I asked him if we get a credit on the $7700 extra that was paid. Nope. We still have to pay the $350. But the $5814.71 is paid. Doesn't matter. We still have to overpay them even more. Does that make ANY sense??????
     
  8. just-want-peace

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    I would ask for a detailed statement of both charges and payments and see if the overpayment shows up. If so write a Letter-to-the-Editor detailing what you have here.

    If not, show them the statement from the Ins co., and tell them either to reimburse the Ins co., refund the overpayment to you, or drop the deductible charge.

    If they do none of the above, go the LttE route.

    Probably won't make a lot of difference, but you will know you've done 'bout all you can save going to a lawyer; which I would forget!
     
  9. annsni

    annsni
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    My guess is really that there's not much we can do. There's a "contracted amount" that the insurance company pays and they are OK with that. However, the hospital got $350 less than the full contracted amount so are coming after us. It's SOOO stupid and SOOOOO messed up but I'm betting there's not much that can be done. Hubby will call them this week to see if he can move up the ranks a bit and see if they will forgive the $350.
     
  10. rbell

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    If your husband will claim he doesn't speak English, it might get forgiven. :D

    And, after all...you are from New York...that technically would be true...you speak Yankee...

    :eek: :D
     
  11. annsni

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    LOL - SOOO true!
     
  12. FriendofSpurgeon

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    You're probably right. Your insurance company/HMO probably has a contracted amount for the corresponding DRG. In other words, they are legally contracted to pay a predetermined amount to the hospital for that procedure.

    Why would they do such a thing?? In most instances, it works to the insurance company's favor (and yours) as the contracted amounts are almost always lower than the amount billed. On a total basis, the contracted amount is probably 40-70% of the billed amount. Also, on an individual claim basis, it removes the probably of a claims spike -- giving the insurance company more certainty in claims - and thus their rates.

    However (and seemingly there's always a however), there can be individual claims that are actually lower than the contracted amount. Unfortunately, your husband's claim falls into that category.

    The good news is that you were going to hit your $6000 deductible anyway, right? In any event, I hope this is helpful.
     
  13. Gina B

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    As long as you're moving higher, just go as far up as you can. Tell them what happened in short, concise terms, tell them who you tried to work with so far and that it failed, and tell them what you want to see happen.

    I've found that things at the top are much different and less frustrating. Plus you know you have nowhere else to go if you get a no from the top. Saves time and frustration.

    Just don't try this at AT&T. I still haven't cracked the secret of getting access to the top people. Shoot, I can't even get someone who speaks intelligible English half the time. Maybe we can do a conference call and have the AT&T people talk to the hospital people. If nothing else, just to record it and put it on you-tube because that would probably be one hilarious conversation!
     
  14. annsni

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    Yep - the baby toe made us hit the deductible.

    Actually, in talking to a friend of mine, we're thinking the hospital miscoded the bill for the insurance company. She said that there is NO way that what was done in those less than 24 hours in the hospital would total $13,000 especially since hubby never had "surgery" in an operating room with anethesia. He just had the bone put back in in the ER room. I was there during the whole surgery and hubby was awake. So I'm going to call the hospital and ask for an itemized bill along with their coding each item so I can see if it was properly billed. We'll go from there.
     
  15. Gina B

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    Surgery can be defined as most anything.

    I was once called to drive 30 minutes from work to my daughter's school to take out a splinter. Removing a splinter is classified as surgery, and the school couldn't legally perform surgery.

    I went into surgery fully armed with a pair of tweezers. My daughter came out of the surgery just fine, and was amazingly able to go right back to class within seconds of the procedure. I didn't think to bill her $13,000 for it, but I'll take care of that RIGHT now! :laugh:
     
  16. FriendofSpurgeon

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    There's a chance that's true. The hospital could have up-coded, which (unfortunately) is not uncommon. You may have better luck with the insurance company than the hospital, since they are the ones that will be saving the money. In any event - regardless of the amount, it looks like you're out the $348.
     
  17. annsni

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    I'd rather be out the $348 when the hospital isn't overpaid. If they get reimbursed for their fees and I have to pay the deductible, I'm fine. I'm NOT fine with the bill paid twice and still having to pay the $348. Ya know??
     
  18. matt wade

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    If the hospital and the insurance company have a contract that the services provided cost X, then that is what should be paid. In this particular case the insurance company is paying more than you would out of pocket. In many other cases the insurance company pays less than you would out of pocket. This is how the contract was designed.
     
  19. billwald

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    Don't pay it. let them sue you or drop it.
     
  20. annsni

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    The problem is that apparently this goes on your credit report.

    A friend of mine got a hospital bill of zero dollars. Yep - the insurance company paid for it all and they received a bill stating that they owed zero dollars. They later were sent to collections for the zero balance and when they called the collector, they realized the mistake and cleared it up. 3 years later when they went to get a mortgage, they had a mark on their credit that they had this debt that was over 120 days late. Fortunately they had a letter to show the mortgage company that the debt was zero dollars and it was satisfied.

    So I'd really rather not mess up our credit, you know?
     

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