<p>I am involved in hospital billing for services. </p>
<p>I know when we contract with hospitals we have always been asked which insurances we had that were in network. There is no way a doctors group would be out of network with cigna. The “biggies” that every dr I know of are sure to be in network with are blue cross, cigna, aetna, united healthcare, medicare. If you had some other more minor insurance I’d say you might have a harder time. </p>
<p>Somewhere along the way the ball was dropped. Don’t freak out, don’t go yelling at the poor people who process the claims.</p>
<p>First, get out your insurance book that you should have been given at enrollment. It is your responsibility to know your own benefits and see what exactly written about emergency visits. Then call cigna. They can see what was submitted and how it was submitted and it could very well be some kind of billing mistake. Get that persons name. Call the billing office for the physicians office and speak to them and ask to speak to the head of billing if necessary. There is a place of service billing code that needs to be marked as emergency room - if that code was put in wrong that could have changed how things were billed. Ask them what place of service they used. I believe it should be 23 (though I may be wrong)</p>
<p>If they are truly out of network with cigna it’s time to ask for a discount. </p>
<p>Also - at the hospital you most like signed some kind of really long, impossibly small piece of paper that they call a release to allow 3rd parties to bill. Go find that paper and see what it says. Each hospital is different.</p>
<p>When I have called my insurance company regarding disputes of this kind, I’ve learned that each call is assigned a number. Before you hang up, get that number so the next time you call, you can get the new person you’re speaking to to refer back to your prior calls. Also take very detailed notes when you call, including the date, what you said (write a list before you call) and what you are told. Take your time and talk to the insurance company for long periods and often. I personally loathe my insurance company (Anthem Blue Cross) and like to think that even if I don’t ultimately get justice, I can cost them lots of money in customer service hours.</p>
<p>Call your insurance and get their explanation of what you are responsible for before you pay anyone anything. When my ds had an emergency appendectomy, we were in ER for 12 hrs, surgery at midnight, stayed overnight - almost 1 day - and it took me 1 full year to get all the various bills paid by insurance. There were separate bills from each provider - xray/ct was one group working within the hospital but “independent”, then the anaesthesiologist was another, the surgeon another bill, the ER another bill and the overnight actual hospital another bill. All told, people wanted $25K from me. I ended up paying my ER copay $500. But it took a YEAR to get everyone coded properly so that I wasn’t the one getting the bill - and each provider’s bill got more and more demanding “if we don’t hear from you, this will be sent to collections!” Once you get the clear picture of what you are being told by your insurance that you are responsible for (get a name, date for that insurance rep), call the billing contact # for each bill you are getting and give them that info so they can notate their files. In the end, noone is supposed to “choose” the ER dr that is providing service, or leave the ER to get an xray somewhere “in-network” - but you are the go-between between your insurance and the providers to make sure those bills get resolved - or they may never get resolved!</p>
<p>It seems to me that you contracted with the hospital by attending their ER. You gave them your health insurance card and everything. If they assigned you a doc that is outside your plan then in my logic the hospital is in error here. This whole insurance system is so broken. You did not ask for nor contract in any way with that doc. The hospital did. That they bill you separately is awful. We had a similar experience but in reverse, where the doc was covered but the hospital was not. And as you say, for this you are paying insurance? Insurance is becoming fraud IMHO. Would it be possible, since they are billing you separately, for you to contact the doc directly and work out a lower payment with them? You already have some discount, but this whole scene is ridiculous. That doc can probably go out to lunch on the months and months of savings you “owe” him/her. Shameful.</p>
<p>Ema, your situation was one where you used the ER as an acute care facility. We had a similar situation but it was an actual medical emergency. The hospital was covered…but the docs didn’t participate. I appealed the payment…the person visiting the ER was actually admitted to the hospital. In an emergency situation, you are not given the choice of a doctor. Our company paid.</p>
<p>BUT having said that…yours was not a medical emergency and your insurance company might wonder why you didn’t go to a walk in clinic. Still…it’s worth giving the company a call and explaining that you were in the ER, and when the doctor came in, you were not in the position to ask if he/she was a participant in your insurance plan.</p>
<p>Agreed with others…this is VERY common. Even IF the doctor works for the hospital, they still might NOT participate in your plan. I would call the insurance company and see what they will do.</p>
<p>When I receive a bill that I don’t owe from a “health care provider”, I send them an invoice back, with a note that I will be billing them $75 for each inquiry, plus 1.5% a month interest. On the invoice it says, “Receipt of this invoice is acknowledgment that the amount owed is valid.” Once, someone called me to ask about it. I informed them that they had just rung up another $75.</p>
<p>You wouldn’t believe how quickly I stop getting bills.</p>
<p>If push came to shove, strategies like minis wouldn’t hold up legally, but if the bill is not valid or is in identifiable then he has the right to ask for documentation that the bill is valid and for copies of the EOBs. Many offices would ignore the reverse invoice of the claim is valid. </p>
<p>Agree with all the advice about contacting your insurer. Do not argue on their side. By that I mean tell them it was an emergency and that you were instructed by your PCP to go to the ER. It’s there job to prove that it wasn’t an emergency. Not the other way around.</p>
<p>Oh, who said anything about legal? If they harass you for bills you don’t owe, it isn’t legal either. Doesn’t stop them “sending it collections”. I once told one “I was sending it to collections” too - collections was moi of course. Never got another bill or phonecall. </p>
<p>To make it legal, all you’d have to do is send them a rate sheet for your time in responding to their invalid billings. So when they contacted you, they knowingly entered into a contract. Not that it matters. It never gets to that point. They sputter, and it goes away.</p>
<p>You need to remember that collecting money for invalid billings (or billing the dead) is an important part of their bottom line. They collect often enough that behavior doesn’t change. And if they don’t get it from you, they simply move on to get it from the next sucker (or dead sucker). The idea is to bill anything that moves (or used to). It’s the American way.</p>
<p>Mini - I actually have to disagree with you. Part of my business is billing and it is extremely and heavily regulated. But it can also be extremely precise, and billing software can be a headache you can’t begin to imagine. I have to have a room set up in my billing office for medicare patients, and we don’t even see patients in our billing office. Insurance companies don’t tell billing companies their rules. </p>
<p>We’ve recently had two site visits - one from the state’s atty general office, the other from our accrediting agency, and we got an audit by mail by Medicare. And we are organized, precise, follow all the rules like you wouldn’t believe. In fact we just found out the reason we’re audited so thoroughly by the state is because we run such a tight perfect ship they use as an example to new trainees. Knowingly and falsely billing will get your company shut down in a heartbeat and possible jail time. And sometimes we make mistakes. A new person doesn’t completely get it and it slips by, or an insurance company changes a rule and you don’t find out til a claim is denied, or a regular employee just has an off moment.</p>
<p>What happens is regulations require a lot be done electronically that technology hasn’t completely mastered. And humans are in control as well. So sometimes you fight two opposing forces. And if by chance someone makes a mistake, it’s fixable, but the people in the billing office usually don’t have the authority to do anything beyond fix the problem.</p>
<p>It’s not a scam, and you can’t bill a company back for making a mistake.</p>
<p>I figured out that whether it’s in network or out of network, either way I still have a $750 deductible that I hadn’t met and I’d be paying this bill out of pocket either way. So, I guess it’s a moot point.</p>
<p>Not really, because it may not count toward your deductible or out of pocket max. You still need to call & get it straightened out, because if you do end up sick and need care this year - it could really make a difference.</p>
<p>“It’s not a scam, and you can’t bill a company back for making a mistake.”</p>
<p>You CAN bill a company for your time. Whether they pay it is another matter. But if the company requires you to put in time for it, you can bill for it. What do you think lawyers do?</p>
<p>As for false bills, as I said, my mother, Medicare, AND the insurance company each got billed for an ER visit to revive a man who had been dead for three hours. And they charged for an ambulance to transport him there, 200 yards from the nursing facility where he died. How did they do it? It’s simple. They made sure that no doctor would be at the nursing facility to pronounce death. But my mother had received a call telling her of his death three hours before the attempted revival. </p>
<p>As far as I am aware, Medicare paid the bill (they didn’t even want to talk to my mother when she told them what happened.) And the hospital is sitting fat and sassy.</p>
<p>False bills… those are funny. At one point, I had four accounts in collections (according to my credit report) due to medical bills. 2 of them were paid, 2 of them were supposedly from office/ER visits when I was… wait for it… not even in the country! When I challenged them, the two that were paid were sent to me showing everything paid, but with whiteout over the amount at the bottom and something like $20 handwritten in that I owed. They have since been successfully challenged and dropped from my credit report, but seriously?! </p>
<p>Ema, I’m sorry that there’s so much confusion about the billing process. I hope that whatever happens, it gets worked out. I’m so sick of insurance companies, hospital billings, etc. Let us know if anything changes. Please do try calling. I’ve disputed many bills that way and almost every single time they’ve found it to be an error on their part.</p>
<p>The weirdest bill we got was one that was for my D’s birth when she was–yep, 2 years old! I asked them to please provide me with details about what the charges were for and why we were being billed, since when S was born 2 years prior to D, we were only charged with the spouse’s tevek suit. Since we never used said suit for S’s birth, we brought it back for D’s & used it then. Under our calculations, we should have owed exactly $0.</p>
<p>They asked us in an exasperated tone how they were supposed to provide itemization of something that happened >2 years ago. I laughingly asked them how I was supposed to pay something if I had no idea what they were charging us for. They saw the point & told us to ignore it. I had them put it writing that we had NO outstanding balance on that & we no longer had to deal with the issue.</p>
<p>More recently, I received & paid a bill for > $800 for a lung test. I was puzzled and called them back about WHY I was charged so much when normally, I had only been charged under $40 for my share. They looked it up & agreed that I had been over-charged >$800 and then–wait for it–asked me if I was requesting a refund of the overpayment!!! I thanked them and they put it back on the charge card I originally paid the bill with. I guess they don’t expect patients to notice & ask about these things. EEK!</p>
<p>Good luck, Ema. Please be a squeaky wheel. As you can see from our above experiences, it generally DOES pay off, even tho it is a bit of a bother. DOCUMENT the names & dates of folks you talk with, as well as their phone numbers (direct lines if they will give them to you).</p>
<p>Did you call Cigna? I hope you are trying to say they said the $750 is your nut either way, so, from your own money perspective, the cost to you is equal, no matter how you look at it. Not that you are avoiding the fix. </p>
<p>Again, Kelsmom is being your point gal: what if what you pay on the side is not counted toward dedictible or oop max? Because it did not run through the insurer? These matters are aggravating but you just go take care of them. I think most of us here will agree that the complexity of life only increases over time. It’s good to get the hang of tackling challenges.</p>
<p>With our health plan, OON charges do NOT contribute towards meeting the deductible. </p>
<p>I would file an appeal (and a follow-up appeal) to your health plan and bring in the state insurance commissioner’s office if necessary. Our state commissioner’s office got three day action on a problem with UHC that I’d been trying to deal with for several months. BUT – appeals probably have to be in writing, and sent to exactly the correct address provided in your plan book for appeals – in order to be valid. </p>
<p>Separately, I’d appeal to the doctor as well.</p>