Posted on 08/30/2008 5:02:53 AM PDT by decimon
As health-care costs continue to soar, millions of confused consumers are paying medical bills they don't actually owe. Typically this occurs when an insurance plan covers less than what a doctor, hospital, or lab service wants to be paid. The health-care provider demands the balance from the patient. Uncertain and fearing the calls of a debt collector, the patient pays up.
Most consumers don't realize it, but this common practice, known as balance billing, often is illegal. When doctors or hospitals think an insurer has reimbursed too little, state and federal laws generally bar the medical providers from pressuring patients to pay the difference. Instead, doctors and hospitals should be wrangling directly with insurers. Economists and patient advocates estimate that consumers pay $1 billion or more a year for which they're not responsible.
(Excerpt) Read more at news.yahoo.com ...
bttt
Good article
... and how do we KNOW we aren’t responsible to pay these “balance bills”? Are ALL balance bills illegal or jsut some?
The story wasn’t clear to me at all.
Prepaying services can also save a TON of money, like births (gee you have about 9 months heads up) and minor surgeries. If you call ahead and arrange a prepay, they often discount a big amount.
Last, medical debt is settled for roughtly 10 cents on the dollar. If you owe $3000 call and offer $300 if you pay now and they put the acceptance in writing.
JM2C
They tried it with us. It took a year to get them off our backs.
Regardless of how ‘good’ medical care supposedly is in the US, there is too much money and greed involved.
Well, the article can't speak to your or my individual experience. I think it did well in making us aware of a potential problem.
Several years ago I had a minor surgery and got bills I didn't understand. I reluctantly paid them for having no experience with such things. Wasn't pleased to pay thousands on top of my medical insurance.
Watch out. We have recieved bills in the past from doctors we never heard of, who seem to data mine hospital records, wait almost a year, never sent a bill, and turn it quietly over to a collection agency.
Pay nothing, question and dispute everything. In some cases the "Doctors" were not even listed on the Board of Registration State database. In one case I involved the Police and the Postal Inspectors and things just seemed to suddenly evaporate.
It may not be doctors. Some particular areas of hospital employment do not attract the best types of people. You have encountered them, no doubt.
When my former employer offered a comprehensive HMO, I paid the extra (lots extra) to know I wouldn't get caught short should the time come for an unplanned hospital stay.
It’s pretty simple, if you work w/ EOB’s everyday....
Office Visit = $200.00
Ins Participant Allowed Fee = $100.00
Ins. Payment = $100.00
Office Writes Off Remaining $100.00 because they are a participating Dr. with your insurance carrier. Now there is a zero balance.
The article is stating instead of Dr.’s writing off that $100.00 they agreed to, they are instead billing the patients for it and even sueing for the money.
From my own experience and from talks with others “inadvertant” double or more billings from our vaunted “not for profit” health care institutions is SOP. It is only a fig leaf away from what is starting to be exposed about the naked fraudulent billing practices they are perpetrating upon the taxpayer.
Amen to that! Due to much, much incompetent medical care over the years I hated doctors. When I went to work for a family medicine residency program and the only thing the soon-to-be-docs could talk about was how much money they were going to make in private practice I came to DETEST them.
I only go to one now if I absolutely have to.
You have to look carefully at what your insurance plan covers.
For instance, if your provider is a participating provider with your insurance company and charges $1,000 for a procedure that your insurance company says is only worth $800 (the usual and customary fee, sometimes called the allowable amount) and if you have met your deductible if any and are covered 100% for that procedure then the provider has to accept the $800 payment from your insurance company and can’t bill you for the $200 difference.
However if you insurance company only pays 50% of the allowable amount then they will pay $400 and you are responsible to pay the remaining $400 (the co-insurance amount) but the provider can’t bill you for $600.
Your insurance company will send you an Explanation of Benefits (EOB) that shows what was charged, less the non-allowable amount, less any the deductible amount, what the insurance company paid and any amount you are responsible for.
When your provider sends you a bill, you have to make sure they are not billing you more than what your insurance company’s EOB says you are responsible for. Never pay any doctor or hospital bill before you’ve received an EOB from your insurance company and never pay more than what your insurance company says you are responsible for.
Of course you should also make sure that the EOB is correct, that you actually received the services from your provider what they are billing your insurance company for and that your insurance company has correctly accounted for your deductible, etc.
The answer is just some.
The problem is the horrid state of the medical billing industry. Most firms are literally mom and pop operations, using exel programs. They bill for everything, knowing that some bills will be paid in error, especially after they throw the bills into collection.
Getting your money back from these folks can be a harrowing process.
Many people also have “unpaid” medical bills on their credit reports that they don’t even know about. My credit is beyond spotless, and it was the only negative on mine. I had never seen the bill on the report.
I turned my mother’s doctor in for Medicare fraud. He was billing all his patients this way. I was at my mother’s and watched her send him some money on a balance of about $500. I said do you pay the deductible when you go in? She said yes but that she always got a bill later.
I told her not to pay another dime, went to his office and had a fit with the billing gal then left and called Medicare.
Of course I switched her doctor that day too.
It was a little strange when I was in a conference call with my clinic insurance representative and my health insurance provider when the provider's representative refused to discuss certain payment issues with the patient present! Note I would be the one responsible for paying the difference, but my health insurance plan didn't want me in on the discussions. When I informed them that I would at that point immediately be filing a complaint with the state Insurance Commission and be bringing a lawsuit for contract violations they became more cooperative and resolved the issue.
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