Topic: Hospital Bill Nightmare

Forum: Employment, Insurance, and Other Financial Issues — Employment, insurance, and financial concerns are common. Meet others here to discuss and for support.

Posted on: Aug 25, 2016 12:27PM

Posted on: Aug 25, 2016 12:27PM

glc213 wrote:

Hello to everyone. I have researched online and on this forum and I am at an absolute total loss. I don't even know how to make this story in any way brief, but, here goes!

10/1/2015 I underwent a prophylactic mastectomy. I paid my in network deductible of $1500 to my PS (first one to ask). I have surgery, spend two nights in the hospital and go home for recovery. I was lucky to have no complications and was able to schedule my exchange surgery on 12/28/15. At the end of November/beginning of December I began to peruse my online claims w/Florida Blue PPO. It showed that I owed over $50k to the hospital although I had never received an invoice. I called Florida Blue and they were bleeping clueless. Couldn't tell me any reason for the $50k "amount I owe" and that I should call the hospital. This conversation was at least 45 minutes. I called the hospital and was connected with accounting. The gentlemen said he was "head of accounting" and read off my claim as I saw it online, but, said that the hospital has a contract with my insurance co. and accepted the amount that Florida Blue paid and not to be concerned as I owed nothing. What a relief!

Nope. My exchange surgery was a breeze and at some point in March of 2016 I received a bill from the hospital for $316.00 (from 12/28 surgery) of which I paid. No biggie--what is it for? Once again FB can not tell me anything. So, again I call the hospital and reach a different person in accounting. She tells me it is for something denied completely by my insurance company and narrows it down to something she sees on my invoice for that amount and sends me a copy of that invoice. It turns out to be the anti-nausea patch given to me that is only covered by Florida Blue at the pharmacy level. Want to know how I found that out? I researched the code online then in turn called FB and asked them about the coverage and after one hour the representative was able to give me that explanation. I actually just felt lucky that my in-network deductible and that inflated anti-nausea patch was all I was out for this ordeal.

So, in the beginning of June I open my mailbox to find a bill for $14K+ from a different named hospital. They were bought out or whatever. No idea. This bill is from my 10/1/2015 surgery. I call the number on the bill, but, they are just the billing company and can tell me nothing. The next day I call in vain trying to reach the hospital accounting department, but, no matter how I try I am transferred to this billing company. I call the morons at Florida Blue as a last ditch effort and get the same answer. I am responsible for the $50k as it says on my online claim and all they know is it was either experimental stuff or uncovered. No specifics. Ask the hospital. I did receive my statement from that visit with the hospital which was over $300k and 5 pages.

I'm at an absolute loss. I have not ever received another bill from the hospitals billing company after my initial inquiry when they were to research the claim, but, my online claims continue to say I owe tens of thousands. Has anyone gone through this and have any words of advice? I need someone to point me in a direction? The only thing I can come up with is to contact a patient advocate and pay for them to handle it as I can not get any answers.

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Aug 26, 2016 10:02AM glc213 wrote:

Thank you besa and badger, I will certainly look in to that. I am very appreciative of the responses and help.

I have great respect admiration for all of the women (and men) on this forum that help and support others. I am completely aware of how fortunate I am to have never had to endure what many of you have had to endure. I understand that many might feel that going through something like this without a direct family history and not even being BRCA tested let alone having atypia results is possibly crazy. I wonder if others were in my shoes what they would have opted for sometimes. Each biopsy took more of a toll.

Oh--and just a correction of something I typed earlier: I actually did not know that the anesthesiologist (and not to mention my spelling it wrong earlier-thanks ipad) would be in network, but, I did request that he or she be. My BS's office did make me aware a few weeks before the surgery that he would require an assistant. I assumed at the time and believe now that these are the infamous surgical assistants that insurance companies notoriously deny claims with. They notified me in writing and said to contact them if this would be a hardship. I called to ask "how much are we talking here?". The difference between hundreds and thousands and tens of thousands is what defines a hardship. My insurance ended up covering this person. Go figure.

At any rate, I looked at my claims and there are multiple that are incorrect. I need to get started clearing them up.

Thank you all again!

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Aug 26, 2016 04:18PM chisandy wrote:

Hospitals routinely overbill, double bill and incorrectly bill, hoping patients won't notice. This is because they are inadequately reimbursed for personnel and services--they can’t bill for residents, nurses, aides, transporters, etc. (all of whom are salaried), so they make it up by overbilling for tangibles--such as tissues, slippers, aspirin--that insurers do reimburse. Hence the $15 box of Kleenex, the $25 Tylenol and so forth. I know it sounds like a pain, and it might be hard to recall what was actually done & administered way back when, but we need to go over every charge on an itemized bill (and if the hospital won't give you one, demand it) to make sure it was legitimate. For instance, when I was in orthopedic-surgery rehab I was on an opioid painkiller. The nurses had a computerized locked meds cart that had a clock that turned over at midnight--and if you were supposed to get your dose before midnight and the nurse was late, the computer refused to release that dose and you had to wait for the first dose of the new day. It was a case of “use it or lose it." Even if you got your 11:30 dose at 12:05, it was counted as the first dose of the next day and counted as one of the four doses you were allotted the next day. But though the cart couldn't dispense the dose before it was due (so if nurses fell behind they could still administer the pills half an hour late), the dose was still entered in advance into the computer.....and billed. This happened three times during a 14-day stay--and I was billed for six pills I never got. If I hadn't been keeping a diary on my iPad I could never have proven the error.

Another time, when I was still practicing law, I was representing a decedent’s estate, and one of the creditors’ claims was the bill from the hospital where the decedent died. (“Expenses of final illness” are counted as a priority claim). For a two-night stay, the bill was about a third of the entire estate. I thought something was fishy, so I met with the executor who thought so too. For instance, the patient was a double amputee when admitted...but billed for a pair of slippers. We also found numerous duplications and treatments that were never administered. At the first hearing, I told the judge we were contesting the amount of the claim, and he ordered the hospital’s counsel and me to sit down, go over the bill and come up with a settlement. Because I already had a list of suspect items, we were able to cut the claim in half.

If you can pinpoint suspect items and explain why they are bogus, they will almost always be deducted from the total.

Diagnosed at 64 on routine annual mammo, no lump. OncotypeDX 16. I cried because I had no shoes...but then again, I won’t get blisters.... Dx 9/9/2015, IDC, Right, 1cm, Stage IA, Grade 2, 0/4 nodes, ER+/PR+, HER2- Surgery 9/22/2015 Lumpectomy; Lumpectomy (Right) Radiation Therapy 11/1/2015 3DCRT: Breast Hormonal Therapy 12/30/2015 Femara (letrozole)
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Aug 26, 2016 07:28PM badger wrote:

glc213, I've gotten a lot of great help & advice here at BCO over the years and am glad to pass it on. Everyone's situation is different but we're all in the same boat.

Wisconsin's public insurance advocate is OCI - Office of the Commissioner of Insurance. It's a good bet that most states have a similar agency, like the ICA in Florida.

Find your calm. Move forward from this place. Dx 12/22/2009, IDC, 2cm, Stage IIB, Grade 1, 1/4 nodes, ER+/PR+, HER2-
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Aug 26, 2016 07:57PM edwards750 wrote:

I can relate to an hospital bill that was a surprise to say the least. My DH had a colonoscopy in February. His doctor was in network but the facility where he did the procedure was not. We were told by BC/BS we were responsible for the $3000 charge. This had never happened before. Needless to say we were upset and I made multiple calls to BC/BS and appealed the decision. We lost but I didn't give up. A lady who worked for several doctors for years in the insurance department said call and complain to the doctors office. She said maybe we should have known but she said they should have as well. I did that and we haven't heard a word since then. A friend was declined coverage 3x before she was successful. They were being charged 5k for the Oncotype test. Her husband finally convinced the insurance company it was medically necessary. This lady's advice was squeaky wheel gets the grease. Worked for us. I agree with Sandy about checking your bills. FedEx where I worked used to give rewards for finding mistakes on medical bills. Saved the company a lot of money. Good luck!

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Aug 29, 2016 08:46AM glc213 wrote:

Thanks to all for the continued advice. I have my medical invoice from the BMX and it is a bit hard to make sense of,but, I suppose I should use google as my translator and get to work! It stinks that it won't show what charges were covered and/or declined so that I can just focus on those.

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Aug 31, 2016 08:22AM SanFranKitty wrote:

I thought cancer reconstruction was supposed to be covered by insurance companies. That is what it said in my plastic surgeons office. What state are you in. This sounds crazy. I really dislike insurance companies for this very reason!

Dx 3/6/2016, DCIS, Left, 3cm, Stage 0, Grade 2, 0/1 nodes, ER+/PR+ Surgery 4/24/2016 Mastectomy Surgery 8/22/2016 Reconstruction (left): Fat grafting, Saline implant; Reconstruction (right): Fat grafting, Saline implant
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Oct 8, 2016 02:42PM IHGJAnn49 wrote:

Hi Sandy and everyone... I'm new to this forum, but i just got my first bill from my surgery... $700+ and I'm trying to find out what else I might have to pay for... changing from a medicare advantage plan to a medicare supplement plan and trying to find someone to cover rx.s too... and nothing will start til Jan... I see my new MO monday and don't know if she will want me to start chemo or rads... I may just wait til january... I just don't have enough to pay for anything additional...

I can do all things through Christ who strengthens me. IDC, PNI, Oncotype 24 Dx 8/3/2016, IDC, Left, 1cm, Stage IA, Grade 2, 0/4 nodes, ER+/PR+, HER2- Surgery 9/2/2016 Lumpectomy: Left; Lymph node removal: Left, Sentinel Hormonal Therapy 10/12/2016 Arimidex (anastrozole) Radiation Therapy 11/1/2016 Whole breast: Breast
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Oct 20, 2016 07:44PM juneping wrote:

i called my health insurance and went through item by item of all the bills i didn't understand.

sometimes there's discrepancies of few dollars.... Dx 11/15/2013, DCIS Dx 11/15/2013, IDC, 6cm+, Stage IIIA, Grade 2, 2/35 nodes, ER+/PR+, HER2-

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