We had trouble with our doctor’s office not billing the right codes. I spent way too much time going around and round with them and finally told them that we weren’t paying and they needed to resubmit with the right codes. It was ridiculously frustrating. It’s no wonder people just give up.
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If the bill is incorrectly coded as a private room, then the insurer may be owed a refund as well.
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That’s a good point, but when I called my insurer, she really wasn’t interested. I really believe the points made above that they just throw crap onto the wall to see what sticks, and people on both sides of the equation just don’t want to deal with it. It’s only the people who are willing to push, push, push, who see any resollution. The rest of the people who are abused are just dealing with too many other problems. Either they just cannot deal with it and default, or they have the funds to absorb the hassle and just pay to to make it go away. It’s just disgusting.
Or they don’t have the funds to pay it… more typically. Folks who are in arrears or have to declare bankruptcy due to unpaid medical debt are likely to have the same percentage/amount of incorrectly billed services as the rest of us. They just don’t realize it because the astronomical numbers keep piling up and they can’t bear to see the breakdown.
There is a new law that I did not know about, a federal law about “ No Surprises” in medical Billing.
Even if it may not exactly relate, asking for review by insurer and hospital may get dispute reviewed by someone who is supposed to know about these laws.
Submit a complaint
If your insurance company or provider isn’t following surprise billing rules, submit a complaint.
Submit a complaint over the phone:
1-800-985-3059
From November 2024
From https://www.cms.gov/medical-bill-rights/know-your-rights
“Your rights when you don’t have or don’t use health insurance”
Usually, providers must give you a good faith estimate of how much your care will cost. You may be able to dispute your bill if it’s at least $400 more than the estimate.
Yes, I believe that. In my situation, I’m just annoyed at being charged for something I didn’t receive. At the end of the day, I will pay it even if I still think it’s unfair, and I’m extremely privilieged to be in the position to do that.
BTW-anyone shocked at a BP of 213/99? I’m a Registered Nurse. When I saw that, I almost had a panic attack. That’s stroke territory, and both of my parents have been disabled by strokes. Strokes are rampant in my maternal family tree. I practically started hyperventilating. Pretty quickly, a nurse very calmly started an IV, and I recognized that fake cavalier attitude. I’ve been there-“Get that IV at first stick or this lady is going to stroke out before we can get meds on board! DO IT, and don’t come back saying you couldn’t!” Lol, I recognized his demeanor immediately. Soon thereafter, a nurse rushed in, pushed something into my IV, and I uncharacteristically didn’t ask what it was-I didn’t care. I just wanted my BP to come down.Whatever it was kicked in quickly and I felt myself relax. I’m very lucky I didn’t have a very bad outcome. So if I end up overpaying in the end, at least I’m okay when all is said and done. When I was feeling horrible and having to grab onto things to get around my house, I started having dark thoughts and wondering if something very bad was about to happen. Thankfully, it didn’t and I’m lucky to be able to handle a financial bump in the road, unlike may people these days.
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I am in the process of fighting a small portion of H’s hospital bill. Total bill was like $31K and about $10K was paid and the rest was “adjusted.” Medicare & therefore our insurer denied the pharmacy charges of $322.35 because while he was IN a room in the hospital but technically was just “under observation.” He had a bed, bathroom, window, room mate, hospital gown. He was given 2 antibiotic pills, some other pill and a steroid inhaler from the hospital pharmacy while lying in his bed.
Medicare refused to pay because they said these were outpatient medications. Because Medicare refused to pay, our BCBS refused to pay. I have spent from Monday through Thursday talking to Medicare, BCBS, hospital and finally Caremark about these charges, just because I know they should have been covered. As a patient, you are NOT allowed to bring in any medications and are supposed to take the medications that the nurse hands you.
I finally have been escalated to speaking with the supervisor of billing for the hospital where H was being observed. I told them they have two choices—complete the form that I started but need them to sign that the bill they sent him for the medications is correct and insert an NPI number and a phone number, then give it to us so H can sign and we can submit it with supporting documents OR the better thing is for them to just re-code the medications as outpatient and process it under H’s federal BCBS and have it be paid as it should be. I told them it will likely be MUCH quicker for them to be paid if they just re-code the bill and re-submit it instead of risking Caremark deciding we completed the incorrect form or completed it wrong.
They are mulling over their options and promised to get back to me on what they decide so I can follow up.
Mind you, this has taken a ton of phone calls to get to this point and I’m sure 99% of patients would have long ago thrown up their hands and just paid the blasted bill, but I just want this to be done correctly.
P.S. H had earlier that day had out-patient surgery. After we had a late lunch at home, he started bleeding profusely so we called the surgeon who told us to get to the ER STAT and he’d meet us there. We did (dramatically the security guy took one look at H and whisked him to wheelchair & then into a bed in ER) and then the surgeon got the bleeding to stop—we never signed any paperwork. The surgeon then suggested that H stay overnight for observation, to be sure we had no more bleeding, so that was why we were there in the hospital at all. (Our PT suggested it was miscoded and should be resubmitted correctly coded. She’s a fighter like me but her H just paid even though he had double coverage for his 4 surgeries and should have had no copays.)
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Wouldn’t a calm nurse do a better job putting the IV needle in on the first try? Was that nurse successful on the first try?
They might charge you more for “observation” in the ER. I would find out that charge also since you never had a room. Talk to the hospital osbudman or similar. Don’t talk no for an answer. But as stated (I didn’t read the whole thread), get your insurance involved. They actually have people to help you. Persistence is the key.
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You’re 100%correct. Being a doctor we dispute things all the time. It’s not by accident the hospital bills usually don’t make sense. I had a lower gi procedure and they double billed the room fee. Your not going to dispute that? Just asking lol. I could go on…
@Nrdsb4 I have a friend whose late husband had to deal with agent orange effects and the VA. Sounds horrible, both the VA and the effects so you have my sympathy.
I did a say it here yesterday on dealing with blood work and our ACA marketplace insurance. After 40 years of company provided healthcare coverage and now this, I’m very frustrated. So happy my husband goes on Medicare in 2 months. I’m on the fence of disputing a PSA test because it’s so much work. We’ve never had blood work not covered.
That’s the insurance wants, right?
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He got it on the first stick, though he had to move it around a bit, which technically you’re not supposed to do, but I was perfectly ok with it.
Wouldn’t that be hilarious? To go through all the hassle of disputing a bill, only to be told that ER observation is more expensive? That would be my luck!
I wonder how I could find out the answer to that question?
You’re much more persistent than I probably would be. I don’t know if I would have even noticed that particular error.
Ask!
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I did this exact thing when my elderly parent (who lives far away) had a hard copy of their credit report stolen. SO many calls… was already a PITA but would have been dang near impossible to resolve without ME impersonating my parent.
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I guess I call and ask the billing department?
See, this is why I hate disputing bills! 
Lol. I will call but I get half of the savings!!
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I went round and round for months over a charge related to a screening mammogram. The hospital billing department was useless, and my insurance company wasn’t much better. I just kept calling the insurance company until I finally got a rep who agreed to take it to her boss, and it finally got resolved. I’m pretty relentless with incorrect bills, because I have an aversion to incompetence. I make it my business to make sure that I don’t have to pay for something I shouldn’t have to pay for.
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