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Topic: Balance billing from healthcare providers

Forum: Employment, Insurance, and Other Financial Issues —

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Posted on: Jul 15, 2019 08:26AM

DogMomRunner wrote:

I have to admit that at least I am getting an education in medical financing going through BC. Anyone else getting balance billed by their healthcare providers? My insurance (admittedly not the best) reimburses pretty much close to the rate that Medicare does. My healthcare providers are not happy about this and are trying to pass the overage on to me. I like my MO, my BS and the other medical staff that provide my healthcare but I am also trying not to go broke during my treatments.

Anyone else getting balance billed? If so, do you know what a person is legally obligated to pay? I have the nurse navigator (insurance provided) negotiating but also don't want to put my credit status at risk by not paying

You ain't run far enough to say My legs have failed You ain't gone far enough You ain't worked hard enough You ain't run far enough to say It ain't gonna get any better. Nathaniel Rateliff Dx 4/24/2019, DCIS/IDC, Left, 1cm, Stage IA, Grade 3, 0/8 nodes, ER-/PR-, HER2+ (FISH) Surgery 5/17/2019 Lumpectomy: Left; Lymph node removal: Left, Sentinel Targeted Therapy 6/6/2019 Herceptin (trastuzumab) Chemotherapy 6/6/2019 Taxol (paclitaxel) Radiation Therapy 9/22/2019 Whole-breast: Breast
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Jul 15, 2019 08:34AM SimoneRC wrote:

Hi DogMomRunner!

So sorry you are dealing with this! If your provider is In Network, you are only obligated to pay what your Insurance Company says is your (the Patient) responsibility. When you use an Out Of Network Provider, Lab or Facility then you can be balance billed for the full amount that your Insurance does not cover. Hopefully the Nurse Navigator can help negotiate an amount that is lower than the full, unadjusted amount for you! This insurance business can be a real pain!

ATM Gene Mutation, Deletion. IDC w/Lobular Features and Focal Mucinous Features. Pre Pectoral Reconstruction. Hysterectomy Surgery 4/6/2018 Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Hormonal Therapy 5/6/2018 Arimidex (anastrozole) Surgery 7/3/2018 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Surgery 4/30/2019 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Surgery 4/30/2019 Prophylactic ovary removal Surgery 8/6/2019 Reconstruction (left): Fat grafting; Reconstruction (right): Fat grafting
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Jul 15, 2019 10:20AM edwards750 wrote:

Juggling insurance and medical bills is definitely stressful. We have BC/BS with a big deductible($5k). We reached that deductible in 3 months. Thankfully because my 33 radiation treatments that followed would have broken the bank.

Doctors offices and hospitals will be relentless in collecting their due. Don’t let them intimidate or manipulate you. We paid what BC said we owed from the EOB. They told us not to pay anything until we got the EOB. I had one doctors office tell me I owed $500 when in fact I owed $70 so no matter what wait for that EOB. The thing is the doctors offices and hospitals can access BC information so there’s no excuse for them being wrong about what you owe.

We also paid monthly for one monster lab bill. It took awhile but we eventually paid it in full.

OON physicians and hospitals will cost you a lot more but sometimes you have no control over whether a doctor is in network. The one you pick may not be the one who actually does the surgery, etc plus you have to make sure the hospital and lab are in network.

My husband and I did challenge an OON charge because the hospital that did his testing was the only one in town who did the tests and it was OON. It took some doing but we won our appeal. It was a $5000 charge. A friend won their appeal after 3 tries. It pays to be persistent.

Try not to stress over the charges. Communicate with the doctors and tell them what you can do. Most will work with you. Btw medical bills are usually the least concerning factor of a credit report because most people can’t shell out hundreds/thousands for a medical bill.

Good luck!

Diane

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Jul 15, 2019 10:28AM gb2115 wrote:

Does your health insurance policy state that the provider can't balance bill? I know mine does....hopefully that nurse navigator can figure it out for you. The insurance company should be able to tell you whether or not the providers are legally allowed to balance bill.

Dx IDC in October 2016, stage 2A, 1.2 cm ER/PR+ Her2-, Grade 2, 1/3 nodes. Mammaprint low risk luminal A, Lumpectomy + radiation + tamoxifen. Age 38 at diagnosis.
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Jul 17, 2019 05:54AM DogMomRunner wrote:

Thanks for all the advice and support.

At the start of this my husband and I were a bit naive. When the hospital called for two of my outpatient procedures, they offered us a discount to pay the bill. Which we did for two of the procedures. And that was dumb because we should have let insurance do their thing and then seen what the EOBs said. But my husband (love him) is a pay as you go, pay off the bills each month, carry no balance kind of guy and we thought we were doing what we were supposed to do.

Anyway yesterday I got a bill from the hospital for one procedure. $67000.00. Two thoughts have gone through my head since then. One, if I had given birth to this tumor, it would have been less expensive. And two, I should have gone with the voodoo priestess when I had the chance. It would have probably only cost me a chicken.

The nurse navigator is certainly going to earn her keep with me. :) :

You ain't run far enough to say My legs have failed You ain't gone far enough You ain't worked hard enough You ain't run far enough to say It ain't gonna get any better. Nathaniel Rateliff Dx 4/24/2019, DCIS/IDC, Left, 1cm, Stage IA, Grade 3, 0/8 nodes, ER-/PR-, HER2+ (FISH) Surgery 5/17/2019 Lumpectomy: Left; Lymph node removal: Left, Sentinel Targeted Therapy 6/6/2019 Herceptin (trastuzumab) Chemotherapy 6/6/2019 Taxol (paclitaxel) Radiation Therapy 9/22/2019 Whole-breast: Breast
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Jul 17, 2019 11:09AM SimoneRC wrote:

One time I received a bill after surgery for $40,000. I called the hospital to make sure they had filed with my insurance, which they had. Then I called my insurance company and they were still processing the claim. Shortly thereafter the claim was finally processed and paid by my insurance company. I think sometimes the hospital/provider just send the bill to the patient if the insurance company is taking a long time to process the claim. I never pay anything until the claim has been processed and I have seen what the Explanation of Benefits states I need to pay. Good luck and let us know how it goes

ATM Gene Mutation, Deletion. IDC w/Lobular Features and Focal Mucinous Features. Pre Pectoral Reconstruction. Hysterectomy Surgery 4/6/2018 Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Hormonal Therapy 5/6/2018 Arimidex (anastrozole) Surgery 7/3/2018 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Surgery 4/30/2019 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Surgery 4/30/2019 Prophylactic ovary removal Surgery 8/6/2019 Reconstruction (left): Fat grafting; Reconstruction (right): Fat grafting
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Jul 17, 2019 11:00PM edwards750 wrote:

Doctors offices and hospitals are Notorious for sending out bills before the insurance companies do their due diligence. I also check the BC/BS website for information about our coverages and bills.

Waiting for them to reimburse you if you overpay usually means weeks, even months.

Diane
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Jul 17, 2019 11:23PM gailmary wrote:

one time i had a provider that didnt send a bill till almost a year later. They lucked out. Their agreement with insurance said claims must be filed in a timely manner. They billed me late and submitted to insurance late and didnt get a dime. I think it was about $1500.

Gotta love it.

GAILMARY

Dx 11/25/2008, IDC, Left, 2cm, Stage IIA, Grade 1, 2/12 nodes, ER+/PR+, HER2- (IHC) Dx 4/13/2017, Stage IV, metastasized to bone Hormonal Therapy Faslodex (fulvestrant), Femara (letrozole) Radiation Therapy
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Jul 18, 2019 06:59AM DogMomRunner wrote:

gb - yes my insurance has a policy about balance billing. If it happens we can refer it to the navigator or a patient advocate group. My MO is trying to get me into the co-pay relief program but I'm not sure that we'll qualify. I know that they are doing as much for them (so they can get paid) as for me. I am not getting fooled into paying more than the EOB amount for chemo. Or the upcoming radiation therapy

You ain't run far enough to say My legs have failed You ain't gone far enough You ain't worked hard enough You ain't run far enough to say It ain't gonna get any better. Nathaniel Rateliff Dx 4/24/2019, DCIS/IDC, Left, 1cm, Stage IA, Grade 3, 0/8 nodes, ER-/PR-, HER2+ (FISH) Surgery 5/17/2019 Lumpectomy: Left; Lymph node removal: Left, Sentinel Targeted Therapy 6/6/2019 Herceptin (trastuzumab) Chemotherapy 6/6/2019 Taxol (paclitaxel) Radiation Therapy 9/22/2019 Whole-breast: Breast
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Jul 18, 2019 09:37PM edwards750 wrote:

That is funny Gail Mary. I get tired of doctors offices blaming the insurance copies for screw ups and vice versa. I had a doctors office insist they had filed and BC was at fault. Not only was she wrong about that it was a charge that wasn’t even ours. It took 3 phone calls to get it straight. Seriously.

What is balance billing by the way?

Diane

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Jul 19, 2019 05:47AM DogMomRunner wrote:

Diane - balance billing explained by someone who is not a financial/insurance savvy person. Balance billing is when a healthcare provider (who basically agreed to take your insurance when they provided the service - that is why they have you show your insurance card when checking you in) decides that they don't like what your insurance company is willing to pay them for services rendered and try to pass the cost off to the patient.

My insurance company basically reimburses at the Medicare rate. Which I understand is not a great reimbursement. But if the healthcare provider takes you on as a patient, then they are saying (imho) that they are willing to get reimbursed at whatever rate your insurance pays. Most providers (at least where I go) get that insurance card and start running as soon as you come into the door.

For my chemo treatments, my MO office financial person, started running the numbers from my first visit. She knows that their reimbursement rate is not great. So she is trying to get ME some help (through a copay relief program) which really means she is trying to get ME money so I can pay THEM. Otherwise, she knows that they are not going to get paid for their services at the rate they would like.

Don't get me wrong. I am appreciative of the services they have provided. I like my BS and MO. However, I cannot pay a $67,000.00 bill for a lumpectomy. That's just crazy

You ain't run far enough to say My legs have failed You ain't gone far enough You ain't worked hard enough You ain't run far enough to say It ain't gonna get any better. Nathaniel Rateliff Dx 4/24/2019, DCIS/IDC, Left, 1cm, Stage IA, Grade 3, 0/8 nodes, ER-/PR-, HER2+ (FISH) Surgery 5/17/2019 Lumpectomy: Left; Lymph node removal: Left, Sentinel Targeted Therapy 6/6/2019 Herceptin (trastuzumab) Chemotherapy 6/6/2019 Taxol (paclitaxel) Radiation Therapy 9/22/2019 Whole-breast: Breast
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Jul 19, 2019 06:06AM gb2115 wrote:

When I had my mammogram last year I had to go to xyz sucky hospital because my surgeon had moved and her (wonderful) in office mammogram wasn't up and running yet. I knew my diagnostic mammogram was free, I have 100% imaging except for big stuff like MRI.

So the breast center registration nitwit tried to collect $200 from me. Repeatedly. "I see you have a balance of $200." Nope. She kept insisting, but stating she couldn't see my insurance info but knew I had a copay (I didn't). It's like she wasn't going to let me through, with it right in front of her that I am a cancer patient with a follow up. Like for real lady. So I asked who I needed to talk to, she clammed up and gave me the number for the financial liasion, but then registered me for the mammogram.

Insurance paid it all of course. I have a friend who works in the registration Dept and she said they are instructed to try and get $200 no matter what. Unbelievable.





Dx IDC in October 2016, stage 2A, 1.2 cm ER/PR+ Her2-, Grade 2, 1/3 nodes. Mammaprint low risk luminal A, Lumpectomy + radiation + tamoxifen. Age 38 at diagnosis.
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Jul 19, 2019 07:52PM edwards750 wrote:

Thanks DogMom - $67,000? Good grief! I never knew what mine cost because I just checked what I owed. That’s flipping outrageous!

The women’s hospital where I had my mammogram and biopsy called me the night before my surgery to tell me what I would owe. I’m like seriously? I repeated to get what BC said about the EOB and she claimed she had checked their website. I said I would pay my portion when I got MY copy of the EOB. Stopped her cold.

As if we don’t have enough to worry about we have to deal with financial pressures as well. It’s so insulting his they try to make you feel like a deadbeat when you don’t pay them right then and there. I’m an outspoken person so I pretty much told them what I thought in no uncertain terms.

Gb - that’s unbeltoo. Good for you standing your ground.

Diane


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Jul 19, 2019 08:38PM Mavericksmom wrote:

I have been fortunate to have a great Medicare Advantage plan though my husband's retirement.

This past week however, I found out they won't pay any of my lymphedema wrapping materials or garments so I won't be getting any therapy. I'm okay with it only because my lymphedema only got slightly worse with the surgery this time.

I had the strangest issue earlier in the week. I had to go to the hospital and have a cystoscopy done which my doctor used to do in the office. In fact I had it last fall in his office and was in and out in about 30 minutes. He saw something in the bladder and wanted me to have a repeat test in 6 months. Due to my second round with cancer which I was unaware of in the fall, I had to reschedule for this week.

My doctor Used to be affiliated with two local hospitals, now he moved his office into one and is only working there. That hospital won't allow the procedure to be done in the office. When I arrived for my outpatient procedure I went to register and the woman insisted I had UHC through AARP! I don't, never did! I went back and forth with her, gave her my insurance card, all the while she is still insisting that I have two plans! You can't have two Medicare plans! She should know that. I was so upset that I almost walked out! She even said “I don't know why you don't have a card from AARP, I will just put down that you forgot your card!"

I told her again, then called my representative right there in front of her. She said my Insurance's were verified by so-in-so and she has been with the hospital for over 25 years and never makes a mistake!

Unbelievable! And we wonder why our healthcare is such a mess!

I called the hospital Billing and they got things straightened out. At least I hope so

And the procedure that I was in and out in 30 mins in his office took over 3 hours in the hospital. The growths are still there, he still doesn’t know what they are but he doesn’t think they grew. He took pictures (which he couldn’t do in his office) so I may need a biopsy. Ugh.!

I will take all of my insurance issues over what all of you have gone through! My heart goes out to you! No one should have to worry over insurance bills while going through cancer or any major medical condition!

I haven’t received many bills so far, but I have my EOB’s so I don’t think there will be any surprises.

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Jul 19, 2019 08:47PM DogMomRunner wrote:

Well I got the revised bill. This time for $26,000.00. Bite me. I will only pay my EOB amount. Now that I know better.

edwards - I wish I had known better when they called before the procedures to offer me the discounted rate.

Mavericksmom- sorry about your lymphadema wraps and garments not being covered. That sucks. When I think about all the money we have paid in premiums over the years, we shouldn't have to practically sell a kidney to medical care

You ain't run far enough to say My legs have failed You ain't gone far enough You ain't worked hard enough You ain't run far enough to say It ain't gonna get any better. Nathaniel Rateliff Dx 4/24/2019, DCIS/IDC, Left, 1cm, Stage IA, Grade 3, 0/8 nodes, ER-/PR-, HER2+ (FISH) Surgery 5/17/2019 Lumpectomy: Left; Lymph node removal: Left, Sentinel Targeted Therapy 6/6/2019 Herceptin (trastuzumab) Chemotherapy 6/6/2019 Taxol (paclitaxel) Radiation Therapy 9/22/2019 Whole-breast: Breast

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