<p>I am overwhelmed and am looking for some advice about how to proceed.</p>
<p>Some of you may remember that I went to the ER about a month ago for a suspected kidney infection. I was pretty bitter about the whole thing since they didn’t even figure out what was wrong with me, but, you know, I’m over it. Since I wasn’t dying and had my choice of what ER I wanted to go to, I had called this one prior to showing up and asked if they participated with my insurance. They said yes. </p>
<p>I just now got the bill(s), and as it turns out the hospital and the physicians have separate billing, and only the hospital participates with my insurance. So none of my physicians bill was covered at all and the cost makes me sick. I wouldn’t have gone there had I known my insurance wouldn’t cover it, I had MANY other choices. </p>
<p>Is there anything I should be doing about this, or do I just pay it and not go to this hospital anymore? I called the billing company already to ask what was going on because it said “insurance company couldnt identify patient” on my bill and I didn’t understand, and this is how it was explained to me. I haven’t talked to anyone at my insurance. I didn’t know this could happen. I thought since I called and asked and they said yes that everything was okay. I can’t believe they didn’t have to tell me this when I asked.</p>
<p>And that’s a tricky situation that continues to be more and more common. What many people don’t realize that is a lot of the physicians you see in a hospital don’t actually work for the hospital.</p>
<p>You’d think they’d have to tell me that! I am so shocked and upset. I’ve only been managing my own insurance issues for the last year, this was the first big health issue like this that’s come up. I had no idea I even had to consider this. I asked, they said yes, I thought I was in the clear. </p>
<p>Maybe I am being unreasonable, I just got the bill a few minutes ago and am reacting, but I am just blown away. If the bill were just this much fine, whatever, I can pay it-- I just can’t believe the circumstances. I had no way of knowing. We have dozens of ERs here, I could have gone somewhere else. :(</p>
<p>As hops mentioned, this happens frequently. Unfortunately, who thinks to ask. And how many doctors know what plans they have agreements with, you probably have to check with their office. Don’t you have an “out of network” option you can submit the bills against?</p>
<p>You should be able to do a written appeal, the in network versus out of network is complicated, but this should be able to be addressed.</p>
<p>I had a case recently where the hospital was approved and the surgeon was approved but the physician’s assistance was not part of the group. That bill kept being sent for about a year until we got the appeal through the system. The initial appeal was requested over the phone and NOTHING happened, no answer, no nothing. Finally had the client write a letter and the insurance company approved it and paid the bill in full- I think the assistant got paid more than the surgeon as he did not have to accept the contracted rate.</p>
<p>You need to google it a bit looking for info in your state and with your insurance company, but essentially you should be able to point out that you went to an approved hospital for a covered charge and that you had no choice in your physician. If your policy has an agent, call them and ask if there are any certain buzz words which work best.</p>
<p>The bill automatically went through some sort of out of network thing, and they “discounted” $90 off the bill but I owe the rest of it and it is substantial. I have money in savings for such emergencies so it isn’t as though the rent will be going unpaid, but I am just very upset!</p>
<p>What’s the take home lesson here? Did I need to ask a more specific question? The billing company made it sound like there was no way to know, she said there’s tons of different doctors and there’s no way to know what billing company each one works with. Do you just not go to the ER unless you’re bleeding out!?</p>
<p>somemom-- I’ll look into that. It seems horrible that some of the doctors working that day might have participated with my insurance while some didn’t, and it was just russian roulette whether or not I’d owe the doctor my first born by the end of the day. I don’t know anything about the medical industry so I don’t want any angry doctors lecturing me for being unreasonable, I admit I am ignorant and could very well be unreasonable, but I am really in a state of shock over this.</p>
<p>We have been a bit spoiled with 100% coverage and no deductible, but will need to go back to more traditional insurance soon. I always choose a coverage which would allow me to go out of network, even if it means higher deductible in order to have lower premium. I would then use pre-tax money to pay for the deductibles. Overall it was cheaper and it also allowed me to go out of network.</p>
<p>OP is where she is now. I wouldn’t be so quick to pay them even if you have to pay. I would work with your insirance first to see if they would cover it. Ask them how you were suppose to figure out who is in the network when you were in the emergency room? If you have to pay, I would call up those doctors or hospital to see if you could get a big discount. Just tell them that you don’t have the money. If they could give insurance company a discount, they could certainly give you a discount. Then see if you could pay over time.</p>
<p>Ema, call your insurance company (Be nice and don’t blame them) and ask if there is anything they can do to help you out. explain what happened. It doesn’t hurt to ask.</p>
<p>If they can’t help, call the doctors in question and ask if they will give you a discount since you are paying cash. It’s amazing how much some of them are willing to negotiate when they find out they will actually get paid.</p>
<p>We use the Urgent Care services of our local health clinic… I know that.they are all in network. Of course that won’t work if the illness is late at night.</p>
<p>I suspect you would have been vulnerable to this issue at all the ERs. It rots.</p>
<p>I did this awhile back for work. I was calling these offices and some of them flat-out told me that EACH DOCTOR had different contracts with insurances so they couldn’t really tell me accurately what they took or did not take without individually talking to each physician’s nurse or secretary!</p>
<p>^That was more or less what the billing company told me. I was really stuck because I couldn’t get urgent care or anyone else to see me, so I guess this was inevitable.</p>
<p>I kept thinking that I couldn’t understand how this could be if it’s never happened to me any other time I’ve gone to the ER, it seems like there’d be a pretty reasonable chance of this happening to anyone at any time, but I guess all the other times I’ve gone I had a more commonly accepted insurance than my employer provides me. Though, as much as everybody complains about how nobody takes our insurance, this is the first time I’ve encountered somebody that doesn’t. </p>
<p>I can’t understand how this could be an acceptable way to do things. Why bother dealing with insurance at all if you’re not going to give people any opportunity to pick doctors that are covered. That’s insane.</p>
<p>This very subject was discussed in one of the healthcare or insurance threads within the last year. It was something that I would ask about after having read about it here.</p>
<p>Our kids have only been in the ER one time each and in one case, we had a $50 or $75 copay (this was in the mid-90s) and in the other, I think that everything was covered (that was about six or seven years ago). In the latter case UHC took care of literally all of the paperwork.</p>
<p>I think that the health insurers have clamped down on out-of-network providers in the last few years and that includes doctors in the ER - you would think that the hospital would deal with this issue but it appears that the doctors are independent agents which is strange. I think that a lot of patients get blindsided by this.</p>
<p>In both cases, we contacted our provider ahead of time and they cleared the ER usage. I did not think to ask about the doctor in the ER and maybe that wasn’t a problem back then but I will do so going forward.</p>
<p>When all is said and done, my insurance is covering about half of what I was charged in total for the visit. I am going to end up paying a little over a grand. A little bit nauseating when I consider that I pay $200/mo for this… I’d like to say at least I know I’m covered if I get run over by a truck or get cancer or something, but I suspect I would be in serious trouble then, too. </p>
<p>I just had NO IDEA that doctors are independent agents, and that’s what it sounds like they are. I am really not pleased with the hospital staffer I spoke to who didn’t point this out to me, but whatever. It seems as though there would have been no getting around this no matter what hospital I went to. People who aren’t covered by the better known insurance companies sure do get the shaft with this.</p>
<p>You are in the Detroit area, right? What insurance company is this? </p>
<p>I have heard of this, and it is absolutely wrong, as far as I am concerned. If you have coverage at a particular hospital, I believe that any doctor who treats you in that hospital … when you are not requesting him or her in particular … should be covered in the same way that any other doctor at that hospital would be for you. Was the hospital itself in-network? If so, it seems logical that any doctor assigned to you when you visit that ER should be covered at in-network rates. Not that I have found insurance companies to be all that logical. On the other hand, though, I HAVE found them to make mistakes.</p>
<p>Yes. I have Cigna, and the hospital was in-network. I called to confirm before I went.</p>
<p>When I received the bill from the hospital, everything appeared normal and I paid it. But when I got the physician’s bill today, it said “insurance company could not identify patient,” or something like that, and then it said something about the charges being billed through HAP-- which I didn’t understand, because I don’t have HAP. I have the Cigna PPO. I called the billing company, thinking it was some kind of mistake, and they told me that this was done because while the hospital participates with Cigna, they do not, but they do participate with HAP so it was billed through that as out-of-network-- apparently Cigna and HAP work together in some way I was previously unaware of. They had my name in their system along with HAP with the same ID and group numbers as is listed on my Cigna card. HAP didn’t cover anything but apparently they “negotiated” a $90 something discount, which amounts to nothing.</p>
<p>I find this whole scenario incredibly confusing.</p>
<p>You get insurance for only $200/month? Frankly that’s pretty reasonable. Maybe try thinking of it more as a catastrophic coverage since in this situation it still left you with a big bill. </p>
<p>From what I’ve heard, the actual physician probably gets only about 20% of that charge… and the rest to the ER servicer. Crazy.</p>
<p>Cigna contracts with HAP for its HMO overlay. If you want to PM me with the hospital and the physician network (if you know that), I will ask my Cigna contact to explain it tomorrow.</p>
<p>I was thinking along those lines, but it seems like my coverage is actually better for little things than it is for the big things. I have done really well for my regular examinations, and I got an eye exam and three pairs of glasses this year dirt cheap. After this experience I am afraid to find out what would happen if I were really, really sick.</p>
<p>Before my parents had to start buying private insurance, their insurance was less than half what I am paying and my boyfriend’s is, too, and they had better coverage. Perhaps I live in a fantasy world, but I don’t personally know anybody else on an employer provided plan that is paying this much for a single person. But that’s kind of a moot point, really, I am just frustrated in general about health insurance this evening!</p>
<p>if the ER visit qualified as an emergency according to the doc and your insurance companhy they may accept the non network physicians. This happened to me and when I contacted the insurance compaany about the nonpayment they resubmitted it and paid it. After all if it’s an emergency you may not be able to find or get to an in network facility (even though you did) or ask if the physicians are in network. Hope that works for you.</p>
<p>^ Agree that emergencies usually have their own extra provisos, which are supposed to cover you in this sort of odd situation.</p>
<p>Sounds like you haven’t spoken with Cigna yet? Only the billing co? I’d think the billing co is least able to straighten this out. They only have the info they actually received and, in many cases, only work reactively, paper in/paper out. Cigna can help you understand the specifics of your coverage. My mom had a similar issue and the same “insurance company could not identify patient.” It was because the physician charges and hospital charges had not been coordinated in a timely manner. The patient id used (in her case, generated by the doc) was thus not recognized by the insurer. The resolution came from the hospital, which reprocessed the doc billing, properly coded. I hope your issue is similar. You may need to call the hospital. But, do see what Cigna says and whether they offer to advocate on your behalf.</p>
I thought since I called and asked and they said yes that everything was okay. I can’t believe they didn’t have to tell me this when I asked.</p>