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Medical Bills You Shouldn't Pay
Business Week ^ | August 28, 2008 | by Chad Terhune

Posted on 09/06/2008 8:56:26 AM PDT by DeaconBenjamin

In a controversial practice known as "balance billing," health-care providers are going after patients for money they don't owe

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.

Yolanda Fil, a 59-year-old McDonald's (MCD) cashier in Maple Shade, N.J., got tangled up with balance billing after gall bladder surgery in 2005. She and her husband, Leon, a retired state transportation worker, have coverage through Horizon Blue Cross Blue Shield of New Jersey. Horizon made payments on Fil's behalf to the hospital, surgeon, and anesthesiologist. Then, in 2006, Vanguard Anesthesia Associates billed Fil for an unpaid balance of $518. Soon, a collection agency hired by Vanguard started calling Fil once a week, she says. Although she thought her co-payment and insurance should have covered the surgery, Fil eventually paid the $518, plus a $20 transaction fee. "I didn't have any choice," she says. "They threatened me with bad credit."

(Excerpt) Read more at businessweek.com ...


TOPICS: Business/Economy; Culture/Society
KEYWORDS: billing; collections; healthcare; medical; medicalbilling; medicalbills
Editor's note: For a CBS Evening News report on balance billing that was made in collaboration with BusinessWeek, go to: www.cbsnews.com/stories/2008/08/29/eveningnews /main4398133.shtml.
1 posted on 09/06/2008 8:56:26 AM PDT by DeaconBenjamin
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To: Temple Owl

ping


2 posted on 09/06/2008 8:57:22 AM PDT by Tribune7 (How is inflicting pain and death on an innocent, helpless human being for profit, moral?)
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To: Tribune7

Bump


3 posted on 09/06/2008 8:59:49 AM PDT by greyfoxx39 (“I fear all we have done is awaken a sleeping giant and fill him with a terrible resolve.” DBM)
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To: DeaconBenjamin

With the Federal Blue Cross/Blue Shield they tell you that you don’t have to pay the balance because they have paid the agreed amount when the doctor/dentist signed up with them.

Had some of the places try to collect, threaten a bill collector, and then I tell them to check with Federal BC/BS and give them the number and then call the local Federal BC/BS — their calls and letters stop.

They do it to my Mom all the time and I refuse to pay her bills like this but if I wasn’t handling it, I am sure she would pay.

We had one that threatened to ruin my Dad’s credit so he couldnt’ buy a car last year and he died in May ‘97. ou should have heard my comment to that remark. Believe they prey on senior citizens.


4 posted on 09/06/2008 9:03:51 AM PDT by PhiKapMom ( VOTE FOR McCAIN/PALIN2008! McCainNow.com; LetsGetThisRight.com)
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To: americaprd

Now this is the kind of stuff conservatives should make issues about w/regard to health care!


5 posted on 09/06/2008 9:04:54 AM PDT by Tribune7 (How is inflicting pain and death on an innocent, helpless human being for profit, moral?)
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To: DeaconBenjamin

Last year I put too much eye cream on my eyes....they puffed up and I ended up going to emergency thinking I would get quartazone or something.....Emergency room wait 2 Hours....Bill was covered.....Seeing the doctor for 15 minutes telling me your eyes will heal themselves....$380.00....I ended up paying $75.00 because I have 2 coverages.....Oh and I’m still paying for the one night stay back in “06” and Hunterdon Medical Center for 1/2 of my thyroid being removed...the bill was $13,000....my balance $1,000......Unbelieveable......


6 posted on 09/06/2008 9:05:40 AM PDT by geege
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To: DeaconBenjamin

It should be pointed out, however, that patients are only exempt from paying the balance IF the provider has signed a contract with the insurance company whereby he/she agrees to accept the insurance benefit as payment in full.


7 posted on 09/06/2008 9:06:29 AM PDT by Designed
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To: DeaconBenjamin

if the anesthesiologist was not a contracted provider of the health insurer, then the balance due is owed by the patient.

when having any kind of medical examination or procedure, the patient needs to verify that ALL of the participants in the procedure are contracted providers of the health insurer.

sometimes, the primary care physician is a contracted provider but the other members of team are not.

this puts an unreasonable burden on the patient who is not in a position to determine the status of all the providers.

IMHO


8 posted on 09/06/2008 9:09:14 AM PDT by kralcmot (my tagline died with Terri)
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To: DeaconBenjamin

A co-worker had a similar problem with a dental group. She ended up getting a lot back once she figured out what they were doing. She had to get our insurance carrier involved.


9 posted on 09/06/2008 9:09:37 AM PDT by w1andsodidwe (Jimmy Carter(the Godfather of Terror) allowed radical Islam to get a foothold in Iran.)
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To: DeaconBenjamin
By the way, if this happens to you. Insist that the practice send you through the mail, a signed invoice and a letter describing why you have to make up the difference in the bill.

If they do so, and they are prohibited from doing so by law, then they have just committed mail fraud. This gives you VERY good leverage to get them to back down.

10 posted on 09/06/2008 9:11:59 AM PDT by taxcontrol
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To: Designed
Oh and I’m still paying for the one night stay back in “06” and Hunterdon Medical Center for 1/2 of my thyroid being removed...the bill was $13,000....my balance $1,000......Unbelieveable....


That actually seems to be a fair deal. 1/13th of the total bill and 12/13 covered by some one else. I wish I could only pay 1/13 of my electric bill or mortgage.

It always suprises me that people who call themselves 'conservatives' want socialism in medical care. They want the best doctors/hospitals to take care of their medical woes for free and then turn around and sue if the slightest problem happens.
11 posted on 09/06/2008 9:12:12 AM PDT by WaterBoard
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To: DeaconBenjamin

In my state (New York) balance billing is legal as long as you do not participate in an insurance plan (Medicare excepted - see below).

For example, I see a patient in the office as an out-of network patient (i.e. I am not participating in their insurance plan). My bill is for $500.00. The insurance pays the patient $400.00 - what they “allow” for my services. Because the patient has the contract with the insurance company, not me, I legally bill for the balance of $100.00, and the patient is legally bound to pay it.

Now, if I participate with the patient’s insurance, I am legally bound to accept the insurance plan’s payment (of course, if there is a deductible or a co-pay, the patient must pay that).

Medicare is different inasmuch Medicare limits what a doctor can charge for a given service. So, of my usual $500.00 fee, Medicare my say that I can only charge $250.00 - so I write off the other $250.00. Of the $250.00 that Medicare allows, most plans pay 80% (unless the annual deductible has not yet been met). Medicare requires that I bill the patient for that 20% and any deductible, and the patient is bound to pay that, either out-of-pocket or by secondary insurance.

Moreover, Medicare requires that a patient sign a waiver at every time of service, indicating that if Medicare rejects a claim as being non-covered, that the patient will be responsible for the bill.

This applies to things like Travel consultations and immunizations - if I don’t get that waiver signed, I cannot legally bill the patient for the consultation, and any vaccines administered (yellow fever, typhoid, polio, hepatitis A, etc), even though I have provided the service in good faith.

Medicare rules apply to all beneficiaries, no matter their income - the pensioner on a fixed income pays the same as the retired CEO with 5 homes and 4 cars.


12 posted on 09/06/2008 9:13:45 AM PDT by paterfamilias
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To: DeaconBenjamin

thank you for posting this thread. I had never heard of the practice before..... I have heard of billing patients prior to billing the insurance company though. I heard that was a big no no too.


13 posted on 09/06/2008 9:18:10 AM PDT by Freedom2specul8 (Please pray for our troops.... http://www.americasupportsyou.mil/)
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To: Designed
It should be pointed out, however, that patients are only exempt from paying the balance IF the provider has signed a contract with the insurance company whereby he/she agrees to accept the insurance benefit as payment in full.

This needs to be in BOLD letters.

Read your insurance contracts!!!!!! This generally applies to PPO's and HMO's. You are otherwise responsible for all charges your insurance does not cover.

As for anesthesiologists, and many radiologists that may provide services to you, a lot of them do not contract with any insurance companies. They are usually independent from any hospital or clinic in which they practice. So if you get a bill from them, you probably owe it. Look at your insurance contract, and call them if there is any questions, they will help you sort it out.

14 posted on 09/06/2008 9:19:10 AM PDT by codercpc
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To: kralcmot

Anesthesia and certain other things are sometimes not covered or may be “out of network”. When I had my kids some 20 years ago we had BC/BS of Central NY, and they paid everything (I don’t even recall a copay) except the anesthesiologist. I paid them $300 out of my own pocket.


15 posted on 09/06/2008 9:25:23 AM PDT by visualops (portraits.artlife.us or visit my freeper page)
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To: DeaconBenjamin

The above case I don’t know why the woman didn’t just call her insurer, they would have explained it and told her whether she owed anything or not.


16 posted on 09/06/2008 9:26:38 AM PDT by visualops (portraits.artlife.us or visit my freeper page)
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To: DeaconBenjamin

This whole credit rating thing is nothing but a 21st Century Mafia scam, intimidation and extortion scheme. Live frugally, eliminate your debt and tell them to stick it where the sun doesn’t shine.


17 posted on 09/06/2008 9:32:32 AM PDT by ghostrider
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To: WaterBoard

“That actually seems to be a fair deal. 1/13th of the total bill and 12/13 covered by some one else. I wish I could only pay 1/13 of my electric bill or mortgage.”

You could, if you paid for electric bill or mortgage insurance. That’s who the “some one else” is that pays 12/13 of the medical bill...it ain’t free.


18 posted on 09/06/2008 9:34:25 AM PDT by Magic Fingers
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To: WaterBoard
Since Aug 10, 2008

Welcome to FR.

No, we don't expect socialism in healthcare. In fact, we just DEMAND that doctors and insurance quit playing fraudulent games with the public.

We PAY for health insurance. It is not "socialism" to expect to get what we have contracted for.

It is this insurance/doctor gamesmanship, along with ridiculous malpractice awards, that has driven the costs of healthcare through the roof.

19 posted on 09/06/2008 9:38:48 AM PDT by clee1 (We use 43 muscles to frown, 17 to smile, and 2 to pull a trigger. I'm lazy and I'm tired of smiling.)
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To: DeaconBenjamin

My cousin a GP in New Mexico says that ‘balance billing’ is simply charging the difference between the paltry amounts insurance or medicaid pays and the ACTUAL charge. She gets about $47/hr medicaid — compared to her plumber who gets $100 (cash with no paper work or office staff)!


20 posted on 09/06/2008 9:46:36 AM PDT by dodger
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To: geege
You aren't going to like my answer...but you presented yourself to the E.R. for IMO, a very minor problem...that probably could have been treated with come over the counter medicine.
21 posted on 09/06/2008 9:52:49 AM PDT by Osage Orange (MOLON LABE)
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To: WaterBoard
Aspirin at the drugstore costs about two cents for a 325mg pill; hospitals routinely charge 100 times or more, as much. That sort of practice is closer to theft than it is to profit margin markup.

Took my neighbor to the ER with what turned out to be a kidney stone, he waited for two hours for the staff to find special filters for him to take home and strain his urine to verify the passage of the stone; when they handed him a small packet of them he laughed out loud, they were the identical filters he used at work every day - you see, he is a bodyshop mechanic/painter.


22 posted on 09/06/2008 9:57:22 AM PDT by Old Professer (The critic writes with rapier pen, dips it twice, and writes again.)
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To: Osage Orange

I looked like a monster and yes I learned my lesson.....It did take a few days to go down....uhhhhhhhhhhhhh


23 posted on 09/06/2008 9:58:59 AM PDT by geege
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To: WaterBoard

I’m not looking for a handout in medical care.....if was a hefty balance for me and I’m still paying my $25.00 a month.....


24 posted on 09/06/2008 10:01:25 AM PDT by geege
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To: DeaconBenjamin
A few years ago, I was in the emergency room waiting room for 8 hours, and was "attended to" for a half hour. Total bill?

$6500

My health insurance provider actually sent me a letter advising me not to pay any additional invoices.

I would love to be able to demand an itemized bill from that hospital, just like I can from that $100-an-hour plumber.

Illegals don't have to deal with any of this, by the way, and they use emergency rooms as the family doctor. The word gets around. If it works, why not?

I do know that I have paid income taxes for 46 years, and "welfare" of all kinds are included already. I don't really feel guilty about not paying another $6000 "contribution" on a $500 visit.

25 posted on 09/06/2008 10:42:37 AM PDT by Publius6961 (Change is not a plan; Hope is not a strategy.)
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To: Osage Orange; geege
"but you presented yourself to the E.R. for IMO, a very minor problem...that probably could have been treated with come over the counter medicine."

Not only could she have diagnosed and treated herself, she could have performed thyroid surgery on herself too. /s

Unfortunately, that's what medical practice is coming to. I just buy the drugs on the internet now and skip the doctors.

"The doctor who treats himself has a fool for a patient." -Mom

26 posted on 09/06/2008 10:46:28 AM PDT by DannyTN
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To: DannyTN

Or just never get sick.....


27 posted on 09/06/2008 10:58:43 AM PDT by geege
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To: DannyTN
I dunno if you missed my point or not....but IMO, the poster presented to the E.R. for a very minor thing. And then complained about it.

I see people go to E.R.'s all the time for non-emergent care. That's not what E.R.'s are made for......

You would be amazed.....at the stories I could tell you.

28 posted on 09/06/2008 12:29:53 PM PDT by Osage Orange (MOLON LABE)
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To: Osage Orange

Well, that’s true. But I think you might have missed mine.

A lot of people don’t have enough medical knowledge to diagnose whether it’s something serious or not. Your eye lids are swelling up, do you risk your vision and hope an over the counter medicine will help it, or to go see a doctor as soon as possible, even if it means the ER?

And unfortunately, there is often not an alternative. Wait two to three days to see your doctor or go to the emergency room. Walk-in clinics have helped, but I don’t think my insurance covers them.

There is another group of people that can’t afford to see the doctor, so they go to the emergency room because they know they will not be denied care. That’s a structural problem with care delivery. I don’t know why hospitals haven’t set up 24 hour clinics for non-emergency care. But a lot of what hospitals do is structured by the way they get reimbursed. Government needs to give them more flexibility.


29 posted on 09/06/2008 5:25:43 PM PDT by DannyTN
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To: DannyTN
Well, that’s true. But I think you might have missed mine.

A little yes....but you've cleared it up with this post.

A lot of people don’t have enough medical knowledge to diagnose whether it’s something serious or not. Your eye lids are swelling up, do you risk your vision and hope an over the counter medicine will help it, or to go see a doctor as soon as possible, even if it means the ER?

Well...firstly I wasn't speaking about other people. Secondly I think I said it was my opinion. Not trying to be contrary here....just rehashing what I said about this particular poster's story. Thirdly, IMO....just from what I was told by the poster....she didn't need to see a doctor....A simple call to a PharmD could have prevented a E.R. visit. OR, a phone call to a friend to help them look up info...OR, some plain common sense.

And unfortunately, there is often not an alternative. Wait two to three days to see your doctor or go to the emergency room. Walk-in clinics have helped, but I don’t think my insurance covers them.

You would be amazed at the "free" info that is out there....that can help those that can read, and understand....if they would take the time.

There is another group of people that can’t afford to see the doctor, so they go to the emergency room because they know they will not be denied care.

Emergent care, yes. Other care....nope, you are incorrect. Many E.R.'s deny some care....

That’s a structural problem with care delivery. I don’t know why hospitals haven’t set up 24 hour clinics for non-emergency care.

Many hospitals have.

But a lot of what hospitals do is structured by the way they get reimbursed. Government needs to give them more flexibility.

On this we agree........

30 posted on 09/06/2008 5:42:31 PM PDT by Osage Orange (MOLON LABE)
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To: long hard slogger; FormerACLUmember; Harrius Magnus; hocndoc; parousia; Hydroshock; skippermd; ...
Socialized Medicine aka Universal Health Care PING LIST

FReepmail me if you want to be added to or removed from this ping list.


31 posted on 09/07/2008 2:57:37 PM PDT by socialismisinsidious ( The socialist income tax system turns US citizens into beggars or quitters!)
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To: clee1

No, it is the cost of business, insurance, taxes, technology that drives the cost of business. Doctors annual salaries and insurance reimbursements have been declining since the advent of managed care.

Most hosptials these days are losing money and many doctors are retiring early because the problem.

Good look getting an onocologist or specialist care in your retirement. You will be waiting in a very long line.

The only game is that people expect 1st rate care, the insurance does not pay reasonable rates, and the patient does not want to pay the remainder. This is the reason even the Mayo Clinic will no longer accept Medicare patients insurance.


32 posted on 09/07/2008 4:44:01 PM PDT by WaterBoard
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To: geege

I can’t tell from the tone of your post. What do you find unbelieveable about your balance?


33 posted on 09/07/2008 9:56:36 PM PDT by Pan_Yans Wife
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To: Osage Orange

I think you missed the point, she is not a doctor- how did she know it was a minor thing before she went to the ER and was checked out? I would have went to the ER too if I couldn’t get in to my doctor’s office.

This is what galls me about medical professionals- they go to school quite a while to learn about illness and injuries- and then expect their patients to know exactly when to go to the Dr. or to the ER. To me it is one of the most challenging decisions when I or someone else in my family has an issue. Over the years I have had doctors scoff at my concerns (several times they turned out to be wrong) and I have also been chided by them for not going sooner.

I do agree that sometimes people go to the ER when they really shouldn’t- but many times they go with scary symptoms and are made fun of if it turns out to be nothing. All medical professionals need to remember that few of thier patients have any medical training- so they should not want them to diagnose themselves.


34 posted on 09/07/2008 10:18:30 PM PDT by Tammy8 (Please Support and pray for our Troops, as they serve us every day.)
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To: WaterBoard

There are a couple of MD’s in my town that have gone to a “new model” with their practice(s)

They have gone “bareback”; meaning that they carry NO malpractice insurance. They have made their practices LLC’s in order to insulate their personal property from lawsuits, and have signs in their waiting rooms and have patients sign waivers acknowledging this fact.

Secondly, they have rejected ALL insurance: office visits are $30 cash on the barrel-head. All necessary tests are outsourced to insurance-taking hospitals or labs. Necessary procedures patients are put on a payment plan, or they pay cash at time of service.

The MD’s in question have been able to cut office staffs radically due to the reduced paperwork from NOT having to file insurance (a major PIA). The get paid at/near time of service, and don’t have to wait for 3-6 months to get paid by 3rd parties.

It must be popular; both MD’s that I know that have gone to this model stay packed.


35 posted on 09/08/2008 2:02:41 AM PDT by clee1 (We use 43 muscles to frown, 17 to smile, and 2 to pull a trigger. I'm lazy and I'm tired of smiling.)
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To: clee1

Reminds me of going to the MD as a child. Small office, one nurse and Mom paid cash when we left.


36 posted on 09/08/2008 2:11:52 AM PDT by NoExpectations
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To: Publius6961
We had a similar problem April of 2007.

My husband has a family history of diabetes but had never tested positive himself.

One Saturday, I noted he was drinking water at an astonishing rate and was in the bathroom 4-5 times an hour. He kept saying nothing he did would quench his thirst and he felt like he had to urinate continually.

Knowing the symptoms of diabetes sometimes caused this, I called out next-door neighbor and asked to borrow her glucometer. I tested him three times over a 30 minute period and each time his sugar levels were too high for the meter to read.

I placed an emergency call to our GP and was advised to take him immediately into the ER.

12 hours later we were taken into a room in the ER where his blood was drawn and a urine sample collected. At this time, my DH was sweating, turning white and cold/clammy to the touch. A quick reading on a glucometer showed his sugar level had dropped to 71.

They brought him in OJ and told me to find a 24 hour fast food place to get him some food since the kitchen was closed. I left the ER, found a donut place open and got him a sandwich on a bagel.

Four hours later a doctor came in, looked at the results of the labwork and told hubby to make an appointment with our GP Monday morning. No medicine, no glucometer, no insulin, nothing. We were given “discharge” instructions and sent home. It was then that we noticed the hospital had listed my husbands hypertension NOT hyperglycemia. DH’s blood pressure has always been normal whenever checked.

Then the bills came rolling in. Since the ER put down hypertension, a non-emergency by our insurance carrier, we were originally told our responsibility was to pay 80% of the bills, bills which came to a total of $14,800.

It took me over a year of fighting and in the end we paid only $50, our co-payment for an ER visit.

How anyone could begin to justify almost 15k for sending me out to get him food, telling us to get an appointment and providing him with no treatment is beyond me but they did.

Hubby is now a diagnosed diabetic and in complete control of his glucose levels through diet and exercise. I will admit, our tempers were not in the best control during the year we fought the hospital and our insurance carrier over this mess.

37 posted on 09/08/2008 2:28:36 AM PDT by Brytani ("The First Amendment doesn't say anything about giving you a hug if you're offended.")
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To: NoExpectations

Yeah, me too.

However, my Mom had a job that had a “new” perk: 100% employer-paid health insurance.

What happened was this: Mom would go, or take us, to the Doctor. She would pay, or make arrangements to pay, the doctor on the way out. She’d take her receipt to work, get a form thereat, and file with the insurance company herself. A month or so later, she’d get a check from the insurance company to pay for their contracted share of the bill. Worked like a charm.

All this “managed care” crap has done is drive up the cost of healthcare services due to increased compliance costs; those costs are mostly due to goobermint interference, since private insurance companies have fallen in line with the compliance requirements of Medicare - and they barely pay more than Medicare anyway.


38 posted on 09/08/2008 2:29:39 AM PDT by clee1 (We use 43 muscles to frown, 17 to smile, and 2 to pull a trigger. I'm lazy and I'm tired of smiling.)
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To: Tammy8
I think you missed the point, she is not a doctor- how did she know it was a minor thing before she went to the ER and was checked out? I would have went to the ER too if I couldn’t get in to my doctor’s office.

I ABSOLUTELY knew she wasn't a doctor for crying out loud. Ha!! Ah...how about common sense? The poster applied too much of cold cream?? Or something...I can't remember now. Anyway with liability the way it is...don't you think the box/tube had warnings on it? And possibly what could happen if applying too much?

This is what galls me about medical professionals- they go to school quite a while to learn about illness and injuries- and then expect their patients to know exactly when to go to the Dr. or to the ER. To me it is one of the most challenging decisions when I or someone else in my family has an issue. Over the years I have had doctors scoff at my concerns (several times they turned out to be wrong) and I have also been chided by them for not going sooner.

It generally galls the heck out of me...when patients don't follow directions, then want their Doctor to "fix" them. Then there's the pts. that take ZERO responsibility for understanding their illness..but complain about everything. Sure, there are some people that just can't manage their own affairs. But I'm not referring to those people.

I do agree that sometimes people go to the ER when they really shouldn’t- but many times they go with scary symptoms and are made fun of if it turns out to be nothing.

Really? You know this happens "many times". Or is this just your personal experience/history?

All medical professionals need to remember that few of thier patients have any medical training- so they should not want them to diagnose themselves.

Well...we obviously don't agree...I don't expect everyone to have complete knowledge....but I do expect reasonably intelligent people to make reasonable decisions about their health needs. There is so much info out there about so many disease processes....and bodily functions..that's it's irresponsible of most of our population to not have some basic knowledge about THEIR bodies.

Once again....it was my opinion...that the poster needlessly presented herself to the E.R. and then complained about it. And that was my point. And you disagree. Fine...so be it.

FWIW-

39 posted on 09/08/2008 8:15:27 AM PDT by Osage Orange (MOLON LABE)
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To: Osage Orange

The first thing that struck me is how happy I am that you are not my doctor with your attitude. WOW you have the very arrogant attitude that I mentioned.

I realize she admitted she put on too much eye cream, but the resulting swelling of her eyes sounds like a scary symptom to me- one that needs to be checked out ASAP, the eyes are not something I would want to wait before getting medical attention.

Many illnesses and injuries are caused by the patient not following directions- so they shouldn’t seek medical attention if they may have caused the problem? If a man uses a power tool in a way he shouldn’t and causes great injury then he shouldn’t go to the ER, because it was his fault to begin with?

I think if patients didn’t go to doctors for anything they caused- doctors might starve- between bad judgement, avoidable accidents, and poor or risky lifestyle- much of what happens to people could be their fault in one way or another.

I do see a large group of people that fill ERs with common colds, flu, and other minor illnesses- and I don’t think they belong there, and they should know they don’t belong there- but to say someone with eye swelling shouldn’t get checked at the ER- no matter what caused it is amazing.


40 posted on 09/08/2008 10:02:02 AM PDT by Tammy8 (Please Support and pray for our Troops, as they serve us every day.)
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To: DeaconBenjamin
"Medical Reform" too often is seen as a question of who pays the crooks - rather than how to make medical delivery better and more efficient.
41 posted on 09/08/2008 10:17:41 AM PDT by GOPJ ("Vegetarian" - Old Indian word for "bad hunter")
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To: paterfamilias

Bump


42 posted on 09/08/2008 10:36:20 AM PDT by AmericaUnite
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To: Tammy8
The first thing that struck me is how happy I am that you are not my doctor with your attitude. WOW you have the very arrogant attitude that I mentioned.

Actually you know nothing about me....but I respect your feelings.

I realize she admitted she put on too much eye cream, but the resulting swelling of her eyes sounds like a scary symptom to me- one that needs to be checked out ASAP, the eyes are not something I would want to wait before getting medical attention.

It wasn't swelling of her eyes. It was the eyelids. Great difference. There you go again.

Many illnesses and injuries are caused by the patient not following directions- so they shouldn’t seek medical attention if they may have caused the problem?

I never exactly said that, did I?

If a man uses a power tool in a way he shouldn’t and causes great injury then he shouldn’t go to the ER, because it was his fault to begin with?

Okay......obviously we can't have a conversation. I can think of many things to say here...But let's just end this here.

Thanks

43 posted on 09/08/2008 10:51:35 AM PDT by Osage Orange (MOLON LABE)
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To: Old Professer

That does look just like the filters we use to strain urine! The hospital costs of all items have to include employee costs from purchase, delivery to Central Supply, filling each floors Pyxis System.

http://www.cardinal.com/us/en/providers/products/pyxis/


44 posted on 09/08/2008 10:51:45 AM PDT by AmericaUnite
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To: AmericaUnite

So does the paint supplies store.


45 posted on 09/08/2008 11:08:44 AM PDT by Old Professer (The critic writes with rapier pen, dips it twice, and writes again.)
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To: PhiKapMom
With the Federal Blue Cross/Blue Shield they tell you that you don’t have to pay the balance because they have paid the agreed amount when the doctor/dentist signed up with them.

Had some of the places try to collect, threaten a bill collector, and then I tell them to check with Federal BC/BS and give them the number and then call the local Federal BC/BS — their calls and letters stop.

They do it to my Mom all the time and I refuse to pay her bills like this but if I wasn’t handling it, I am sure she would pay.

We had one that threatened to ruin my Dad’s credit so he couldnt’ buy a car last year and he died in May ‘97. ou should have heard my comment to that remark. Believe they prey on senior citizens.

I just now noticed this thread.

It is not just insurance write-offs ("adjustments") that are relevant here, either. This past March, I received a bill from a provider for about $1,200 in unpaid charges. However, I had the pertinent EOBs, which I collect and enter into a medical spreadsheet: They indicated that the provider had been tardy in filing with BC/BS for reimbursement (the carrier allows 180 days); therefore, neither they nor we are responsible for the charges.

I sent a copy of the pertinent EOBs (there was a total of five services involved) to the provider, and that resolved the matter.

46 posted on 12/24/2008 8:45:12 PM PST by AmericanExceptionalist (Democrats believe in discussing the full spectrum of ideas, all the way from far left to center-left)
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To: AmericanExceptionalist

I do the same thing with bills and what they submit so I can go back and check on them when they come calling about some deliquency that is their fault not ours.

What bothers me are the people that don’t understand what is happening. There would have been $2500+ paid out this year if I didn’t track everything. The billing departments for medical have gotten so much worse over the last few years.


47 posted on 12/27/2008 4:49:37 PM PST by PhiKapMom ( BOOMER SOONER! Sam Bradford Heisman! LetsGetThisRight.com RED STATE Oklahoma Republican)
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To: PhiKapMom
I do the same thing with bills and what they submit so I can go back and check on them when they come calling about some deliquency that is their fault not ours.

What bothers me are the people that don’t understand what is happening. There would have been $2500+ paid out this year if I didn’t track everything. The billing departments for medical have gotten so much worse over the last few years.

You are to be congratulated for checking your bills (and your mom's bills) carefully before paying them. Like you, I believe in paying my legitimate obligations promptly; but paying for other people's mistakes is quite another matter.

Some people make the mistake of believing that whatever a bill says must be correct. But the people who work in billing departments are not infallible. And there is an old saying that is certainly applicable here: No one else will look out after your interests the way you will.

And you are surely correct in your observation that billing departments, by and large, have become more aggressive in recent years. My guess is that those who work in these departments have been instructed to bill the customer for all unpaid charges--even if the billing department was delinquent in filing the claim, and therefore at fault--in the belief that many will not notice, and will compliantly pay the amount for which they are billed.

48 posted on 12/28/2008 9:40:32 AM PST by AmericanExceptionalist (Democrats believe in discussing the full spectrum of ideas, all the way from far left to center-left)
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To: paterfamilias
I see a patient in the office as an out-of network patient

Let me ask you this. You bill my insurance company, lets say Blue Cross Blue Shield, $276.00 for services to me. Blue Cross determines that the allowable amount is $166.00 They then pay you $149.00 and I pay my coinsurance of $17. End of story.

Now let me ask you this. Lets say I don't have any insurance coverage at all. Are you going to bill me the same $276.00 or are you going to bill me the $166.00 which is what the insurance company would normally have paid you ?

49 posted on 12/28/2008 10:06:37 AM PST by Hot Tabasco (Today is just a little more special than yesterday.)
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