Consequences for not paying a medical bill

[Benito]

Originally Posted By: Alfred_B
Quote:
- The next year, without asking or informing, the doctor performed the EXACT same test DURING the visit.

- Insurance declined this charge saying it is medically unnecessary to perform the test yearly and that national guidelines specify the exact ages and frequency with which to perform the test.


Dispute the bill with the provider. Bolded is the most important part in this argument.

By the way, the preventative care is still shrouded in mystery. There is no standard method of billing for that in the industry. Either the provider will have to re-bill it or write it off. It is up to the provider to know whether it is medically necessary or not. You are the patient and you had done your due diligence.

Talk to a financial services manager at the provider. The front line people may not have the authority to make any decisions.


Exactly.

And the reason for me starting this thread was that:

- We already told them the above.
- They told us they would get back to us.
- They haven't and just re-sent the bill.

So since they are not responsive and I am not going to pay, I wanted to know what happens next.

 

[eljefino]

Originally Posted By: Benito

So for example, if they place a stethoscope on your chest, is that a separate chargeable "test" or is it part of a series of checks in the preventative visit?


I know someone who got billed $20 after their annual physical for "smoking cessation therapy" b/c the doctor told her "you should stop smoking."

Doctors go to seminars on how to pad their bills. Innocuous, cheap sounding stuff adds up.

I got a letter from my insurance company during "bird flu year" saying they covered the flu shot that year. They probably plan to not cover it next year.

 

[Alfred_B]

@eljefino, it's not for padding. What you are describing is unclear documentation and bad coding. Or it could be a misunderstanding by the "someone" as to what was done.

@Benito, the new bill could be auto generated. Call the billing office again and ask them to resolve the dispute.

 

[Benito]

Originally Posted By: eljefino
I know someone who got billed $20 after their annual physical for "smoking cessation therapy" b/c the doctor told her "you should stop smoking."

Doctors go to seminars on how to pad their bills. Innocuous, cheap sounding stuff adds up.


Exactly.

The irony in this thread is that some are saying their insurance is higher because I'm not paying the bill, when the truth is healthcare is expensive because doctors are interested in making as much money as possible.

I use healthcare so little that I prefer to have insurance only for catastrophic purposes ie save on premiums and pay out of pocket. Indeed, I used to have a high deductible health plan which saved me money. Under that plan I shopped around for health services. But despite that, these doctors and facilities do their best to be non transparent and sneak in charges.

Those who don't understand that 3rd party payer together with no requirement for up front estimates means we don't have a free market in healthcare, they have been hoodwinked.

 

[Benito]

Originally Posted By: Alfred_B
@Benito, the new bill could be auto generated. Call the billing office again and ask them to resolve the dispute.


The new bill has handwriting on it "Outstanding Balance".

 

[Alfred_B]

Originally Posted By: Benito
Originally Posted By: Alfred_B
@Benito, the new bill could be auto generated. Call the billing office again and ask them to resolve the dispute.


The new bill has handwriting on it "Outstanding Balance".


A biller has done this and has instructions to collect as much as possible.

The providers are in real big trouble -- more hospitals close every day. The insurances are paying less and less, and the federal government sequestration has caused financial distress, too. The only place left to improve cash is the patient responsibility. But people are becoming less and less able to meet their high deductibles/copays/coinsurance.

Buck the trend, work with the billing department.

 

[Benito]

Alfred_B, I am working with the billing dept. The question is, will they work with me or send this relatively small amount to a collection agency?

And believe me, the doctors are doing fine in my area. Most people don't question their bills.

 

[Benito]

So my suggestion to the facility that I would contact the state medical board seems to have worked.

They even said they follow the national guidelines but that different insurance companies decide to do something different.

That was a lie since the insurance company told me they followed the exact same guidelines in reaching their decision.

But I let them save face.

I didn't even have to say "This is my offer. ZERO". LOL

 

[NHHEMI]

Originally Posted By: Benito
So my suggestion to the facility that I would contact the state medical board seems to have worked.

They even said they follow the national guidelines but that different insurance companies decide to do something different.

That was a lie since the insurance company told me they followed the exact same guidelines in reaching their decision.

But I let them save face.

I didn't even have to say "This is my offer. ZERO". LOL


Congratulations. You managed to weasel your way out of paying for services received and rendered. Be proud. It is the new American way.

I have lost a lot of respect for you over this( not that you do or should care - just a comment ).

 

[Benito]

I disagree. The American way is to perform tests that are not in fact recommended by the medical associations while falsely claiming that they do follow those recommendations, to perform the actual tests in an underhand manner that conceals the fact that it is a separate billable item, and then get paid due to lack of questioning by the customer.

What I did was take responsibility for my healthcare and stand up to the overcharging that has contributed to US healthcare costs being double that of all comparable countries.

Btw, I lost respect for ALL the framers and apologists for the US healthcare system a long time ago.

 

[NHHEMI]

Originally Posted By: Benito
I disagree. The American way is to perform tests that are not in fact recommended by the medical associations while falsely claiming that they do follow those recommendations, to perform the actual tests in an underhand manner that conceals the fact that it is a separate billable item, and then get paid due to lack of questioning by the customer.

What I did was take responsibility for my healthcare and stand up to the overcharging that has contributed to US healthcare costs being double that of all comparable countries.

Btw, I lost respect for ALL the framers and apologists for the US healthcare system a long time ago.


How was it underhanded? Seems to me if you were as diligent as you claim you would have verified insurance would have covered it before agreeing to any tests/procedures. You could have looked in your policy or asked specifically at the doctors but you didn't. You "assumed" insurance would cover it. You also "assumed" it was the doctors responsibility to tell you if it wasn't. Both assumptions on your part were wrong. Always know what your policy covers and doesn't cover and it is NOT the doctors job to tell you if something isn't covered unless you ask 1st.

Also, if you signed a form saying you would pay what the insurance didn't you are the one being less than honest. If you signed such a form, and I suspect you did as it is SOP these days for any medical practice, you agreed to pay what insurance didn't and should do so. Not doing so is underhanded. You also have the right to a 2nd opinion if you feel needless test/procedures are being done. You didn't avail yourself of that option and agreed to the tests so again it is on you.

I am not apologizing for the US Healthcare system in the least. Having MS I deal with it all the time and it is a mess( a million times worse with Obamacare ). This is about you not wanting to pay for services you had done. Right or wrong you agreed to have them done and thus you should be stand up and pay that bill.

Not trying to be a tool here. I just couldn't disagree with your stance more. I find it reprehensible. Your are hiding a less than honorable act in a cloak of fighting for what is right. What is right is paying the bill.

I am not going to keep beating you up on this though. I have said my peace and enough is enough. Ultimately you have to live with the choices you make. I only commented as you made this info public.

 

[BRZED]

I'm going to see my doctor this November for my annual check-up. I'll ask him for an estimate before letting him do anything.

 

[NHHEMI]

Originally Posted By: BRZED
I'm going to see my doctor this November for my annual check-up. I'll ask him for an estimate before letting him do anything.

 

[BRZED]

Originally Posted By: NHHEMI
I have said my peace and enough is enough. Ultimately you have to live with the choices you make. I only commented as you made this info public.


I am channelling Pop_Rivit now, so please excuse my impertinence. You said your piece. Piece meaning "speech." If you don't speak your piece, you shall hold your peace. Of course, you could also hold your piece (gun etc). I hope this helps.

 

[Benito]

Originally Posted By: NHHEMI
How was it underhanded? Seems to me if you were as diligent as you claim you would have verified insurance would have covered it before agreeing to any tests/procedures. You could have looked in your policy or asked specifically at the doctors but you didn't. You "assumed" insurance would cover it. You also "assumed" it was the doctors responsibility to tell you if it wasn't. Both assumptions on your part were wrong. Always know what your policy covers and doesn't cover and it is NOT the doctors job to tell you if something isn't covered unless you ask 1st.

This is about you not wanting to pay for services you had done. Right or wrong you agreed to have them done and thus you should be stand up and pay that bill.


It seems you are listening selectively and then filling in bits with your own assumptions.

Firstly, this was the annual check up for our child. I was not there, my wife was.

They turn up for an annual PREVENTATIVE visit. That is what was booked with the doctor's office. We checked both the cost and that it was covered by insurance.

The doctor's assistant / nurse does the pre checks. Height, weight etc. Within those checks, she performs a particular check without asking whether we want that particular check performed. She carries it out as if it is part of the routine PREVENTATIVE visit just like all the other checks she is doing.

That particular check had already been carried out last year by the same office / same doctor. So it is in their records.

After some time passes, the facility sends us a bill for that check because our insurance company rejected it.

The insurance company rejected it because according to the American Pediatric Association, it is not necessary to carry out the test every year. In the medical field, it is not considered PREVENTATIVE when carried out more than required. Indeed, the guidelines outline the exact ages when the test should be carried out for PREVENTATIVE reasons.

When I speak to the doctor's office and get the bill written off, they actually informed me that they follow the American Pediatric Association guidelines and then tried to claim that insurance companies sometimes don't. Their desire to shift the blame to the insurance company was an attempt to stop me from making a complaint to the state medical board.

Their claim that they were following guidelines is clearly a lie and they know they don't have a leg to stand on. Which is why they readily wrote off the charge.

I don't know if you are getting it into your head but the contracting parties ie ourselves and the doctor, ONLY agreed to a PREVENTATIVE visit. If by their own admission, they performed a check, without getting approval from us, that is not deemed PREVENTATIVE, even by their own standards, then they are on the hook for it, not me.

 

[Doc8404]

Originally Posted By: Doog

- Insurance declined this charge saying it is medically unnecessary to perform the test yearly and that national guidelines specify the exact ages and frequency with which to perform the test.

Ask the doctor to tell them it was necessary.


Exactly. And let's not forget that the insurance company and the doctors office may be utilizing different recommendations on test frequency. Happens all the time.

 

[Alfred_B]

Insurance companies will weasel their way out of paying for services performed. There are multiple ways of doing that, and one is for medical necessity. They will use software to make that determination and someone with a high school degree will do the denial.

You cannot do anything about it, whether it's the doctor or the patient. They will not listen.

So there are two ways -- the patient pays it, or the doctor writes it off. In either case, it is a failure of the system.

 

[NHHEMI]

Originally Posted By: BRZED
Originally Posted By: NHHEMI
I have said my peace and enough is enough. Ultimately you have to live with the choices you make. I only commented as you made this info public.


I am channelling Pop_Rivit now, so please excuse my impertinence. You said your piece. Piece meaning "speech." If you don't speak your piece, you shall hold your peace. Of course, you could also hold your piece (gun etc). I hope this helps.

Speak your piece means you were able to add your comments to the discussion.

Speak your peace means you not only did that( ^^^ )but that you are content and your mind is now at ease. Commonly used for last word on the subject from that person.

Both are correct but it depends on how used. I used it correctly because I have added my thoughts and am now finished and thus at peace with the thread/Benito.

While I made this comment to you I only did so because it is not related to the thread topic. I have spoken my peace on that subject.

 

[racer12306]

Preface: I have not read all four pages.

In Maryland, if a medical provider submits a claim to insurance and is denied for some reason, it is not legal for the provider to submit the bill to you. If the providers sends the bill to you to submit through your insurance, the bill is your responsibility regardless of insurance involvement.

This was explained to me by CareFirst last year when my wife had surgery and a surgical assistant was used and CareFirst denied the claim. I got a bill and called CareFirst. The assistant's employer was based in Florida so they likely were not aware of this. I filled out some forms to assist the provider in getting paid, but that is where my responsibility stopped, legally.

Now, on the other hand, you can't just ignore bills.