Thanks for clarifying, I'll admit I'm fairly ignorant in hospital billing practices.
Medical bills from 3 year back
- Thread starter stockrex
- Start date
- Status
Originally Posted by Alfred_B
Insurance companies have a tendency to not pay their obligations because in their contracts they specify that they will only pay for medically necessary procedures.
CBS News reported a story recently about a guy that had a herniated disc that required emergency surgery per his doctor or risk becoming permanently paralyzed.
Insurance said it was not deemed medically necessary and denied his claim. Total medical bills were right around $500k, he hired someone to negotiate his bills and got it knocked down to around $220k. Being on the hook for $200k plus wipes out the average American financially.
Insurance companies have a tendency to not pay their obligations because in their contracts they specify that they will only pay for medically necessary procedures.
CBS News reported a story recently about a guy that had a herniated disc that required emergency surgery per his doctor or risk becoming permanently paralyzed.
Insurance said it was not deemed medically necessary and denied his claim. Total medical bills were right around $500k, he hired someone to negotiate his bills and got it knocked down to around $220k. Being on the hook for $200k plus wipes out the average American financially.
Originally Posted by splinter
Originally Posted by Leo99
...Total charges were $50,651. Aetna negotiated that down to $15,102...
Two industries rife with fraud and corruption. And other scammers, too.
We were asking for $50 but we'll take $15. Sheesh.
I was kidding with my wife that I was going to slip my surgeon $20 at the follow up visit so he'd clear me to resume marital relations. She told me I should slip him $100. That $20 wouldn't be enough to influence him. After she saw what insurance paid him, she agreed $20 would be sufficient.
Thank God there are great healers and hospitals accepting insurance.
Originally Posted by Leo99
...Total charges were $50,651. Aetna negotiated that down to $15,102...
Two industries rife with fraud and corruption. And other scammers, too.
We were asking for $50 but we'll take $15. Sheesh.
I was kidding with my wife that I was going to slip my surgeon $20 at the follow up visit so he'd clear me to resume marital relations. She told me I should slip him $100. That $20 wouldn't be enough to influence him. After she saw what insurance paid him, she agreed $20 would be sufficient.
Thank God there are great healers and hospitals accepting insurance.
Since I had to pay totally 100% out-of-pocket I spent almost 8 hrs of the phone being dicked around between various departments just to get the price on an ultra-sound guided steroid injection in my shoulder per doctors referral.
This was on a Monday and finally got an answer the following Wednesday. Three days just to get a simple price quote.
One would think since so many people with high deductibles etc and paying out-of-pocket they could give you a simple price quote on very common everyday procedures. What are they hiding? It seems so sneaky. Imagine any other business trying to pull this nonsense! They get away with it because you have no other choices.
This was on a Monday and finally got an answer the following Wednesday. Three days just to get a simple price quote.
One would think since so many people with high deductibles etc and paying out-of-pocket they could give you a simple price quote on very common everyday procedures. What are they hiding? It seems so sneaky. Imagine any other business trying to pull this nonsense! They get away with it because you have no other choices.
@Blaze. There is nothing simple in the medical world. While to you it's a simple procedure, it's a vastly complex process behind the scenes to bring all the parts together to end up with the delivery of the procedure.
Perhaps the only simple procedure in healthcare is a regular doctor's office visit. Even labs that seem simple are usually a combination of multiple procedures.
Perhaps the only simple procedure in healthcare is a regular doctor's office visit. Even labs that seem simple are usually a combination of multiple procedures.
A Google Voice telephone line, the creditor really has no idea who owns it nor where they live. As others mentioned, unless it is by first class mail and in writing, just ignore it.
Sometimes it is the insurance company's fault too. I got a bill recently for a charge that I know is 100 percent covered by medical, since the entire family already met our out-of-pocket maximum for 2019. When I called the insurer they said the doctor billing it is not "in plan" so they don't have to pay. But it was a radiologist who works for the hospital, to read X-ray charts taken in the hospital. So it is 100% covered. The insurer agreed and will pay the doctor regardless he is in plan or not, because it was a hospital procedure.
Read the fine print, and never assume your health insurer is on your side.
Sometimes it is the insurance company's fault too. I got a bill recently for a charge that I know is 100 percent covered by medical, since the entire family already met our out-of-pocket maximum for 2019. When I called the insurer they said the doctor billing it is not "in plan" so they don't have to pay. But it was a radiologist who works for the hospital, to read X-ray charts taken in the hospital. So it is 100% covered. The insurer agreed and will pay the doctor regardless he is in plan or not, because it was a hospital procedure.
Read the fine print, and never assume your health insurer is on your side.
Originally Posted by Alfred_B
@Blaze. There is nothing simple in the medical world. While to you it's a simple procedure, it's a vastly complex process behind the scenes to bring all the parts together to end up with the delivery of the procedure.
Perhaps the only simple procedure in healthcare is a regular doctor's office visit. Even labs that seem simple are usually a combination of multiple procedures.
The behind the scenes complexity is not an excuse for lack of billing transparency.
You can bet that there is someone at every provider, especially larger ones, whose job it is to ensure they bill each insurance provider on the most profitable codes. That is why providers don't take all insurances. That is why there is an industry providing coding consultation and services.
The information is available, it's just that the providers don't want to share it. Because they don't want people shopping around.
@Blaze. There is nothing simple in the medical world. While to you it's a simple procedure, it's a vastly complex process behind the scenes to bring all the parts together to end up with the delivery of the procedure.
Perhaps the only simple procedure in healthcare is a regular doctor's office visit. Even labs that seem simple are usually a combination of multiple procedures.
The behind the scenes complexity is not an excuse for lack of billing transparency.
You can bet that there is someone at every provider, especially larger ones, whose job it is to ensure they bill each insurance provider on the most profitable codes. That is why providers don't take all insurances. That is why there is an industry providing coding consultation and services.
The information is available, it's just that the providers don't want to share it. Because they don't want people shopping around.
- Status
Similar threads
