Important information about Medical Billing that could cost you thousands!
Did you know that if a doctors from your practice that are covered by your insurance can add onto your bill other doctors from your practice, who are not covered, and you get stuck with the bill?
Did you know that if you are in the hospital, and you are walked to the bathroom by a physical therapist that you thought was a nurse, the hospital will charge you for that therapist?
Did you know that you are allowed under ACA, to bring your own meds to the hospital and that the hospital can't force you to use their meds?
Here is an long but very informative read about all the insurance scams that both doctors and hospitals have figured out to charge you more out of pocket expenses. It is shocking. Be a well informed consumer and read this:
After Surgery, Surprise $117,000 Medical Bill From Doctor He Didnt Know
Before his three-hour neck surgery for herniated disks in December, Peter Drier, 37, signed a pile of consent forms. A bank technology manager who had researched his insurance coverage, Mr. Drier was prepared when the bills started arriving: $56,000 from Lenox Hill Hospital in Manhattan, $4,300 from the anesthesiologist and even $133,000 from his orthopedist, who he knew would accept a fraction of that fee.
He was blindsided, though, by a bill of about $117,000 from an assistant surgeon, a Queens-based neurosurgeon whom Mr. Drier did not recall meeting.
In operating rooms and on hospital wards across the country, physicians and other health providers typically help one another in patient care. But in an increasingly common practice that some medical experts call drive-by doctoring, assistants, consultants and other hospital employees are charging patients or their insurers hefty fees. They may be called in when the need for them is questionable. And patients usually do not realize they have been involved or are charging until the bill arrives.
The practice increases revenue for physicians and other health care workers at a time when insurers are cutting down reimbursement for many services. The surprise charges can be especially significant because, as in Mr. Driers case, they may involve out-of-network providers who bill 20 to 40 times the usual local rates and often collect the full amount, or a substantial portion.
The phenomenon can take many forms. In some instances, a patient may be lying on a gurney in the emergency room or in a hospital bed, unaware that all of the people in white coats or scrubs who turn up at the bedside will charge for their services. At times, a fully trained physician is called in when a resident or a nurse, who would not charge, would have sufficed. Services that were once included in the daily hospital rate are now often provided by contractors, and even many emergency rooms are staffed by out-of-network physicians who bill separately.
Patricia Kaufmans bills after a recent back operation at a Long Island hospital were rife with such charges, said her husband, Alan, who spent days sorting them out. Two plastic surgeons billed more than $250,000 to sew up the incision, a task done by a resident during previous operations for Ms. Kaufmans chronic neurological condition.
In the days after the operation, a parade of doctors came by saying, How are you, and they could be out of network or in network, Mr. Kaufman said. And then you get their bills. Who called them? Who are they?
Surgeons from other specialties also team up: After Gunther Steinberg of Portola Valley, Calif., had a needle biopsy of an eye lesion in 2010, he discovered that his insurer had paid about $10,000 to the eye surgeon who performed the outpatient procedure and $10,700 to a second ophthalmologist in the room.
Unexpected fees are routinely generated outside the operating room as well. On the wards, a dermatologist may be called in to examine a rash and perform an expensive biopsy. The person in scrubs who walks a patient to a bathroom for the first time after hip surgery may turn out to be a physical therapist billing $400.
To read the full article:
http://www.nytimes.com/2014/09/21/us/drive-by-doctoring-surprise-medical-bills.html
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The way american medicine is practiced is for the big buck in many fields. In others, like family practice, the doctors are having a hard time paying of med school. There is a huge dichotomy between fields of medicine and that is a big problem. Another is the insurance companies. It is a for profit business and that isn't a fit for something that is a need when it comes to life.
Dishonest creeps. This is ridiculous!
Thanks for the article! It's a great one!
The moral to this story is that you must ask your doctors who is operating on you and that you don't want other out of network doctors present and everyone who deals with you in the hospital who they are. Do not assume anything!
Your joking right?
Dang Perrie I agree with you again! Even if you ask there is no guarantee that the doctor you expect will actually do the whole surgery he is just in charge.
Good article Perrie. Know your plan, know your doc's, excellent advice. The fees and over-charges mentioned here are nothing to sneeze at...but insurance companies are the ones to blame here IMO. Not only have they forced Doc's to resort to questionable practices, but they are directly trying to rip off uneducated consumers to boot.
Did you also know that you have the right to contest any and every Explanation of Benefits (EOB)? When ever the insurance company denies benefits in an EOB, challenge them. My insurance company has tried many times to deny coverage that we are due. We paid for it and they deny it, hoping we will give up and they keep the money we are owed. It's not us trying to get something for nothing, it's paid for by us.
One time they denied a benefit, saying that we had not met one of those confusing deductibles. After my better half looked at it, she proved without a doubt that we had met the deductible and the insurance company still refused to pay. Call after call, manager after manager and still they refused payment. After my wife finally stepped back from it, to try and figure another way through this debacle, the bill was paid in full. Without as much as an explanation. Just the EOB saying it was paid.
All hail nurses who understand the plans, especially mine. I wonder how many other denials the insurance industry has made profit from? They are truly sick bastards. Pun intended.
One,
I used to work for Prudential, so I know all the old tricks and scams, but these are a whole new lot fo them.
We have had the same thing happen with our insurance trying to tell us something wasn't covered when it was. Also doctors tend to send in the wrong codes and many times, these are also not accepted by insurance. They will try not to pay whatever they can.
Health care has become a brutal business and in some cases, a matter of life and death.
It's the old code switcheroo...My ins. co. just did that last year. The confusion that followed created some of those denials. I think it was on purpose, so they could shift the blame to the providers.
I just heard on CNBC that there are starting to be more insurers and plans. It should be good for the consumer, I think.
RM,
You can demand under ACA that the doctor is the one that you picked and be informed of any extra costs. My parents and I did our homework before my mom had her surgery in Texas, since we had our concerns about it being out of state for her operation.
Competition is always better for the consumer.
Good for you jwc!
Part of the lesson to be learned is that we have to be in control over our medical services and part of that is taking the time to read our bills. So many folks just get them and pay for them.
Americans don't like to confront the fact or believe that almost everything in their lives is dictated by greed.
This shows the disconnect between healthcare and the for profit medical industry.
This shows the disconnect between healthcare and the for profit medical industry.
I thought healthcare WAS the for profit medical industry.
You mean there is a part of the healthcare system that's not for profit?
The term healthcare presumes caring for health. The for-profit medical industry cares about health only to the extent that adverse outcomes do not affect the bottom line and that the premium on procedures is maximized.
The practice of billing illustrated in the article can be curbed fairly easily by putting the power with the patient. What I mean is the patient should be advised before hand how much the services will cost.
I consider anyone who makes 117k in a few hours to be a highway robber. The term price gouging comes to mind. Most people want to be healthy, and when they are sick they want to be well, and the sicker they are the more they want to be better. The for-profit medical industry takes advantage of this fact, as well as the fact that insurance hides and obfuscates the process of billing. It's a rig, Dig?
If the patient is really sick and in pain or facing death, at that time they really don't care what the cost is, they just want to get better.
....or a CEO*.
Yeah it does. But in order to do anything about it, you would have to fight against the tens of millions of dollars the medical community spends on lobbying congress every year , and put a cap on what a CEO can earn.
* According to Forbes , in 2013 the highest paid COE in the country, John Hammergren, works for a medical supply company;
CEO's, on average earn 350 times what the average rank and file worker earns, .... and you can blame that on the same people that let health care cost get out of control.
The United States ranks 67th in income disparity. The divide between the haves and the have nots has never been wider. The country is headed towards becoming an Oligarchy , but it may not be too late to stop it.
OldIroquois Indian saying;
"I n our every deliberation we must consider the impact of our decisions on the next seven generations. "
Thedecisions made in the next two years will depend on who gets control of Congress in November.