<p>It’s not the doctors…it’s the insurance companies, and the billing companies. </p>
<p>I don’t expect my doctors to deal with the billing but I DO expect their office staffs to politely answer my questions…and they do.</p>
<p>The issues I have had with bills have been from doctors I have NOT seen in person…e.g. the radiologist who reads my films HOURS after I’ve left the facility…things like that.</p>
<p>Don’t blame your doctors for the poor practices of the insurance companies and front offices at a hospital/ER.</p>
<p>The issues I have had with bills have been from doctors I have NOT seen in person…e.g. the radiologist who reads my films HOURS after I’ve left the facility…things like that.</p>
<p>I really hate that. Or getting a bill from a Dr that insurance doesn’t cover because I didn’t get a pre-authorization, but my Dr. asked her a ? while they were in the elevator.
:p</p>
<p>But if you need a pre-authorization and it isn’t gotten, insurance will pay nothing and you will have the pleasure of paying the bill. What kind of drs are you referring to that you received a bill from but could not identify?</p>
<p>To clarify, preauthorization is only necessary in order to get your insurance to cover their portion of the charge for the service. If the service is provided, even if it is at the request of one of your other treating physicians, you are responsible for payment. Preauthorization is not involved in that aspect of your treatment. It stinks, and this is why the comments about insurance companies above were spot on.</p>
<p>Last winter I went through something quite similar. In my case it was not an emergency. I needed to go to a hospital for xrays. The hospital is in network and I had the RX from an in network doctor. Get this…NOT ALL RADIOLOGISTS ON STAFF are in network and they wanted me to sign something (tiny, tiny print) that stated that I would pay the radiologist’s bill if our insurance did not. Since this was not an emergency, I discussed my concern with the hospital (in admissions). They told me to simply cross out the tiny print that I did not agree with and write in that I am requesting a radiologist that is in network with my insurance to read my xrays. It all worked out fine…no bill!</p>
<p>We had a lady come in this summer in need of PT. It was going to be a major mess dealing with different insurances and such. She tried to go through our financial form and cross out things she disagreed with. She was shown the door…</p>
<p>^^Ahh, but this is a teaching hospital, and it is in network with my insurance company. If the hospital is network, I don’t see how they could show me the door because I don’t want to be billed by outside doctors that they have contracts with. If they don’t want me as a patient, they should not be listed as in network with my insurance that I pay THOUSANDS OF DOLLARS to every year!!!</p>
<p>I don’t really remember what kind of MD it was- I rarely go to the Dr anymore- I would prefer to pay out of pocket to see my naturopath than to get all kinds of tests & scans that aren’t going to change the treatment.</p>
<p>If I get a preauthorization for a procedure & the surgeon is in my insurance network-it didn’t occur to me that consulting Drs wouldn’t be.</p>
<p>Some healthcare groups have a group contract with insurance companies, but many doctors have individual relationships/contracts with insurance plans. It is so frustrating nowadays.</p>
<p>Patients soemtimes expect that the doctor/doctors office can GUARANTEE that the patient’s insurance company will pay. When benefits are verified, the insurance benefits person always says " verification of benefits is not a guarantee of payment. Payment decisions are made at the time a claimis processed". Sometimes (thankfully not often) insurance companies will have some absurd and untenable policy buried deep within their company documentation, often not available to the drs to see on the web. Then some claims person will deny the claim based on , typically, a misunderstnading of their own benefit. It is despicable.</p>
<p>Colorado’s SB 10-183 outlawed the balance billing practices like this: Prior case law interpreting Colorado’s health insurance statutes had allowed “balance billing” for increased charges of out-of-network providers working in in-network facilities without the prior knowledge or consent of insured patients. The general assembly legislatively overruled that interpretation, subject to future review and repeal. The act continues indefinitely the requirement that health insurers hold consumers harmless for charges over and above the in-network rates for services rendered in an in- network facility.
APPROVED by Governor May 27, 2010 EFFECTIVE May 27, 2010"</p>
<p>More patients should advocate for this kind of language. (I believe that some states provide that if the hospital and surgeon are in-network, that the patient is only responsible for what in-network charges would be whether or not the other clinicians are in-network.)</p>
<p>Our community hospital requires that the ER, lab, imaging, and pathology docs all have to be providers for all insurance plans for which the hospital is a provider.</p>
<p>Anthem did this to me too. Our local hospital is in network. The radiologists and lab work are NOT. This is ridiculous!! A patient doesn’t ever even know who the radiologists is and all the hospital employed physician offices send one right down the hall to the hospital lab for bloodwork.</p>
<p>When I contacted the hospital CEO, the basic answer was …“the radiology group is a separate entity and they are completely in control of which insurance companies they chose to contract.”</p>
<p>What a bunch of hooey!</p>
<p>Why Anthem and Wellpoint were ever allowed to merge is beyond my comprehension. Anthem controls almost everything in my state.</p>
<p>That may be, but I am completely in control of writing into the hospital agreement that I want to have an in network radiologist before I sign the agreement. I do not believe that the in network hospital is allowed to turn away a patient that has my insurance and still remain in network, but I do not know what would happen if I were turned away and reported the situation. That has not happened to me, and I was able to write in what I wanted. Afterall, I am the patient and the customer/consumer.</p>
<p>I find it irritating when radiologists read images too late for their interpretation to make a difference. When I was doing IVF years ago, the routine during ovarian stimulation was to go in for an ultrasound and blood tests in the morning. The fertility specialist would look at the ultrasound him- or herself to make a decision about that day’s treatment. There would always be a charge for a radiologist’s reading, but this reading never took place until late in the afternoon, long after all decisions had been made.</p>