Posted on 05/11/2015 9:15:43 PM PDT by nickcarraway
One in three Americans with private health insurance has been hit with a surprise medical bill, according to a new survey by Consumers Union. The study of 2,200 individuals also found consumers overall are confused when it comes to how to fight a surprise bill.
Among the surprises: bills that were for higher amounts than customer’s expected, bills for out-of-network services that customers believed were in-network, and bills from doctors they did not expect would send them a bill.
Betsy Imholz of Consumers Union says few people who receive surprise bills ever file a complaint with a state agency. “Nobody got that far at all, in fact, almost zero,” Imholz told KPIX 5 ConsumerWatch.
Earlier this year, California’s Insurance Commissioner imposed two emergency regulations that now require hospitals to disclose if any part of a patient’s treatment will be out-of-network. It also requires insurers to pay some out-of-network costs when an in-network provider cannot be found in a “timely manner.”
But, Imholz and the State’s Department of Insurance say without complaints, state regulators can’t hold insurers or providers accountable.
Consumers Union has set up a tool that directs consumers to the appropriate agency where they can file a billing complaint.
If you have an HMO, the only time you’re liable for out-of-network bills is if you need a emergency treatment - but then you will covered as soon as transfer can be arranged to an HMO hospital.
If you have an HMO, the only time you’re liable for out-of-network bills is if you need a emergency treatment - but then you will covered as soon as transfer can be arranged to an HMO hospital.
HMO should get a referral. PPO need to know who they are seeing. The report just explains why we need another bureaucrat to help us with our stuff.
HMOs are required, like other Obamacare plans, to reimburse out-of-network hospitals for emergency care (at what the plan considers a “reasonable rate”). But the hospital can pursue ‘balance billing’ against the patient unless state regulations prohibit.
You need to be really careful. I saw an interview with one woman who had some kind of abdominal surgery. Six weeks after the surgery, she got this huge bill. It turned out that the assisting surgeon and one of the surgical nurses were out of network. That’s not something you’d think to ask when you’re on the operating table.
Gee, this Owebowma care thing is great ain’t it!?
Yep. They just walk by the room your in and send you a bill.
In March I went to the ER to get x-rays as a precaution when I hurt my hand. Yesterday I get a “bill”... for the balance not covered by my health insurance and nowhere on this thing is there a date that the amount is due by.
“You need to be really careful. “
Very true. I had abdominal surgery at a local in-network hospital. My surgeon was in-network. Since I was using an in-network hospital and surgeon, it never occurred to me to investigate the anesthesiologist and radiologist which were selected by the hospital. Both turned out to be out of network and I received bills from them for the difference between what the insurance company paid and what they billed the insurance company. I
n fact, the anesthesiologist’s total bill was more than the surgeon’s total bill. After insurance payment, the amount the anesthesiologist demanded was $8000 for a 45 minute procedure the surgeon billed $5200. The anesthesiologist was attending multiple patients during the procedure, so was collecting from multiple patients, while the surgeon was focused on one.
In fighting the charge I discovered all of the anesthesiologists and radiologists in the region have declined to join any network so there is no way to have surgery at any of the six hospitals (3 groups) in the region with in-network anesthesiologists and radiologists. They routinely bill the patient for the difference between insurance reimbursement and their inflated bills. If the patient cannot pay, the bills are given to a collection agency and ultimately legal action is taken. Apparently Medicare and Medicaid patients are not subjected to this billing procedure but private insurance patients are billed.
Consider the tens of thousands of surgical patients in my area discovering this problem after the fact and finding themselves owing thousands of dollars to hidden out of network providers. While the anesthesiologists and radiologists today are laughing all of the way to the bank, they are creating advocates for a government run single payer healthcare system with every patient they fleece as are the hospitals enabling this scam through lack of transparency.
put an ad in local paper looking for victims of this price fixing scam and contact the attorney general in your state, then sue the bas8888s
Just yesterday,billed for visit14 month’s ago.
BTTT
Dealing with them now ,may file complaint.
CBS doing their best to keep pushing Single Payer down the track...
“Yep. They just walk by the room your in and send you a bill.”
My first wife was hospitalized once for nine days and the doctor billed her for a visit every day even though he took a long weekend off and didn’t show up or send anyone else to look in on her for three or four days. The insurance company was going to cover one hundred percent of the doctor’s bill but she called them and told them about the false billing. The company said in effect, “Oh, don’t worry, no big deal, happens all the time, we’ll pay him anyway.” She told them that if they paid him she would find an attorney to file suit against the insurance company, they decided not to pay him for those days.
How about finding the squeaky wheel
and make an offer ?
“Discovery” won’t be on your side. CRNA’s “check out” the drugs needed for each and every operation. Those drugs are not just checked back “in” afterwards; due to federal and differing state regulations those drugs that keep you under are destroyed afterwards (more times than not LOTS of it because it is not doled out in minor proportions). Those costs add up and quickly and their is a secondary and tertiary witness to that destruction of valuable chemicals). If you want to sue anyone, look at the congresscritters who have been duped by the “big pharma” first. That is who you want to sue. The CRNA’s are not price fixing you or scamming. Hell, they have lots of bodies on the table daily; they just want to go home and forget about seeing the inside of your body. It is regulation that is driving that cost up. The waste is disgusting but they are forced to do it or they lose their licenses. Before you bash them, learn a bit more about what you are bitching about.
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.