So you think you have insurance!

[Sg Brix]

Last time I was on this group 11/04 I was on my last leg, & I brought this topic up.
Since then I nearly expired a month later in the hospital with congested heart failure awaiting my valve replacement. My surgeons? bill was $6M hospital etc was $298M for which most now seem not to be covered. We carefully choose the hospital because it was "covered" in our plan. How did we know that every independent doctor that decided to visit the hospital could go home and send me a bill. Most I never saw or meet. A physical therapist I did see took me for a 7min walk $895! Well, she was cute, but still...

In retrospect I should have worn a foot bracelet, clearly stating that this patient will only pay doctors who belong to the following insurance plans.

This was not the way of life I had envisioned awakening to.

SG Brix

 

[MelissaM]

Glad you made it through your ordeal - sorry to hear your insurance is being a pisser.

If you have any amount of fight in you, fight your insurance company untill you are blue in the face. They count on folks NOT fighting. If you choose to fight, there are usually ways to do it - appeals, second level appeals, third level appeals, etc. The point of all those appeals is to wear you down. Keep going, and you might just be surprised. Especially if you chose a hospital in your plan and thought you would be covered.

 

[geebee]

First off, congrats on making it through what were some tough times.

If your insurance company required pre-approval for your surgery and actually gave you pre-approval, you should be able to get things covered. As Melissa said, it may take some appeals but do not give up. DO NOT LET THEM WIN!!!

Even if there was not a pre-approval situation, appeals may still be successful.

Take care and good luck.

 

[WendyD]

Hi there,
Hope that things settle down for you soon.
We are in a similar position after Ernie's OHS, as the bills are beginning to pour in.
If you are able to, scrutinize everything or get someone to check, get detailed breakdowns of everything charged for. Don't just accept a total from care providers.
Pester the Insurance company daily for answers, especially as you were led to believe you were covered.
When they realise that you are not going to go away, they will have to produce the facts.
It is awful, being unable to just concentrate on getting better, & having to deal with all this aggravation so soon.
After checking our accounts, we realised that we have been billed by the perfusionist, directly, and also via the hospital.
Hoping things get sorted out for you soon.
Very Best Wishes
Ernie & Wendy

 

[Jean]

Ok, please inform me what the M is after the $6. Millions? I wouldn't think so, but who knows nowadays! Yikes!

 

[hensylee]

Dear S - you don't say where you hail from. In Florida, we can go to our state insurance commissioner's office and make the insurance companies (the one your hospital accepted!) pay for this. Look into your state insurance laws - go right to the top and see what's there. The insurance companies MUST follow the laws set by your state. Please keep us posted on this because now and again we have other members with insurance difficulties. Other members are going to come in with more suggestions for you.

I am glad to know that you have recovered but sorry it's been so hard for you. God bless....

 

[savysmommy]

What's wrong with these people...? Insurance companies can be so horrible! I have not had heart surgery yet, but I have had to deal with hospital bills last year. During my pregnancy I had to have an emergency gall bladder surgery. My insurance didnt want to pay, because they said it wasnt an emergency. Then, they said that the doc wasnt on their "preferred' list... My surgery was on Dec 22 and my doc had became a perferred member on Jan 1st! They ended up paying afterall. It was a major headache though!

However, I was very lucky. The people at the hospital caught a ton of mistakes and questioned everything! They were the ones who alerted me to mistakes. I would have just payed the bills had they not said anything!

Good luck with everything!
Shannon

 

[Georgia]

If you had pre-certification for your surgery it's very unlikely that the insurer will get away with denying payment for ANY physician that saw you in the hospital. And I can pretty well guarantee that the hospital would not have allowed your surgery without precertification (they really really want to be paid). In general, anyone who sees you in the hospital is covered under the pre-cert, so do NOT take this lying down.

You have no control over who drifts in and checks you out while you're post-OHS and it's totally unreasonable for your insurer to expect it. Further, the insurer most certainly had someone monitoring your treatment at your hospital, so if he/she screwed up it's their problem.

You need to contact each doc who's sent you a bill and tell them to bill your insurer; and if you get any guff go directly to your state insurance department and raise a ruckus. Insurers HATE that sort of thing - because improper denial of claims raises flags and can end up in an audit.

Good luck and don't let 'em getcha.

 

[Harpoon]

298 million dollars for one hospital stay???


And I thought I was the million dollar man....


Actually, for nine weeks (five on life-support/vent in a pediatric ICU) at the Cleveland Clinic Children's Hospital my bill was somewhere over half a million dollars, before insurance.


AFTER insurance, it was closer to maybe a thousand or two. I actually remember one check for $1,200 going out and another for $786 and change...

I have heard that hospitals often inflate billing before submitting them to insurance companies and then the two entities hash out an agreeable settlement. I don't know if this is true or not.

For patients that get socked with big bills and don't have the financial means to EVER pay them off, some of the larger hospital institutions have foundations that are set up to assist financially disadvantaged patients... There are a lot of avenues that can be taken, but very little (if any) guidance available to us consumers of medical services...


In my situation, my cardiologist and primary physician were very instrumental in paving the way for me to get to Cleveland Clinic and for my insurance to foot most of the bill. Not everything was covered. I had some co-pay issues and my meds (anything taken after I got discharged anyways) are paid for out of pocket, but the bulk of the artificial heart valve tab was picked up by my carrier, Independent Health.

Oh, I should mention that Cleveland Clinic was an "out of network" facility as well as all the doctors that I saw there. It was also one of very FEW places in the world that would have been qualified to save my hairy white arse... =)


Sorry, was that too graphic?


It may take a lot of phone calling and pushiness, but you may be able to get some breaks if you challenge the right people on stuff in your bill.

 

[Lisa in Katy]

That can't possibly be millions. Perhaps you meant K instead of M. That would make more sense. Any large medical bill will be sent to utilization review for some period of time before they pay. My heart surgery was precertified and it still took over 4 months and several phone calls from me to get them to pay the bill. I was the Director of Managed Care at a sister hospital, had a copy of the contract, knew exactly what they were supposed to pay, but still.... It's just part of the process and a way for them to kite money for awhile. It is very possible that doctors inside the hospital aren't participating in your plan and you will have to pay the difference between whatever the insurance pays and their full billed charges. Sometimes you can talk to their billing people and they will give you a discount. Also, complain to the hospital. The hospitals that I worked for required the hospital based physicians to be on the same plans as the hospital so these problems wouldn't occur. Of course, the market here for those physicians is very competitive and hospitals have some power.

 

[hensylee]

298 million dollars for one hospital stay???




I have heard that hospitals often inflate billing before submitting them to insurance companies and then the two entities hash out an agreeable settlement. I don't know if this is true or not.
(QUOTE]

My sister was once on board of directors at a hospital in West Palm. She discovered that the hospitals had programs they used for billing. The program would list every possible charge connected with any given illness, procedure, etc., and bill for it all. Don't think they can do that now, but we don't know, do we? That's why we need itemized bills that we can check out and dispute.

 

[gadgetman]

Reminds me of the time my daughter spent some time in ICU at a civilian hospital many years back. I was active duty at the time and my "Military Insurance" was to cover all but $25.00. When we got the "bill" my wife started looking at it. My wife was with our daughter 24/7 while she was there. She only had one IV, there were 7 IV kits charged (don't remember prices--but you know they weren't cheap). There were 7 boxes of tissues charged, only GOT one. I can't remember what it was but something my wife was sure my daughter didn't get was charged, and it wasn't cheap. The wife went to the hospital to point out the mistakes and after about 15 minutes of corrections the woman in the office said "Why are you worrying about this, the INSURANCE is paying for it?" To which my wife replied "We all have to pay for it in the end.".

After the military paid the agreed upon price, we still got bills from the hospital for almost $15,000 not covered by the military. It finally got to worrying me that we MIGHT be responsible for this outstanding debt so I visited the hospital to ask why I was still getting a bill. She ASSURED me I was not responsible for paying it but they (the hospital) had to show "good faith" effort to collect for at least a year before they could WRITE IT OFF as a loss.

Don't you just love it???????

May God Bless,

Danny

 

[hensylee]

Danny - and nobody can seem to figure out why insurance costs are unaffordable! well, DUH!

 

[jeffp]

298 million dollars for one hospital stay???

When he said 298M I'm sure he meant thousands. Outside of the US M (mille) is for thousands. (maybe someone could tell us the history of where we started to deviate from the rest of the English speaking world.) For 298 million, they could do one case a year at the hospital and still keep the budget balanced!