<p>No, I didn’t miss your point. I don’t believe that the purposeful attempt to defraud the patient is as rampant as you imply. Yes of course it happens, and probably mostly by big hospital institutions, but I don’t believe that the billing problems are often with the purposeful attempt to illegally increase revenues as you suggest. Insurance companies are not the innocent victims in this. They do a spectacular job of denying legitimate claims, stalling, incorrectly processing claims, rejecting claims for stupid reasons requiring them to be refiled, etc. Many hospital or medical office billing programs automatically generate bills to the patient every 30 days and they commonly reflect that outstanding balance that is due, usually by the insurance company. However, the balace is shown as due and the patient may erroneously pay it. This is very confusing and I have had to call our doctors and dentists frequently about this. It is misleading, I agree, but it may not be a purposeful attempt to illegally generate revenue. Health insurance companies are making huge profits-- they are increasing premiums to be paid by both the employer and employee while simultaneously decreasing coverage and reimbursement to the providers. It is an extremely broken system. I know of insurance claims reps who said they were offered bonuses for denying claims, stalling on payments and thereby keeping the money that should have been legitimately paid on claims, in the insurance companies bank account as long as possible, earning interest. That is simply disgusting. I had to fight a series of denials on legitimate claims for 10 months. It took an extreme amount of my time and energy, and was given every BS excuse and circular logic in the book. I knew I was right and pursued it all the way to the head of the HR Dept of my h’s employer. It got resolved, but $3000 was finally reimbursed (and I had to pay the provider out of pocket for these charges). Think of the thousands of patients who didnt have the knowledge or the energy to get the claims paid correctly. Thats a LOT of money kept in the insurance companies pockets. </p>
<p>As for doctors requiring office visits for prescription refills, this is not to purposely get the copay out of you. That is insulting to the doctor trying to provide adequate are to their patient. Very often patients call in for refills of prescriptions who haven’t been in to see their doctor in a very long time, or who have frequently cancelled their appointment at the last minute. The doctor has a responsibility to appropriately care for their patient, and there are liability issues at hand if an error is made. The patient may have had new health issues surface, or may be on new meds prescribed by another doctor that could be contraindicated with the refill you are wanting refilled over the phone. If a doctor hasn’t seen a patient in quite some time (say, 6 months) it is approriate to be seen in the office before meds are dispensed.</p>
<p>Are you going to sue every doctor whose billing company makes a mistake, when billing has become so complicated? This is due to Medicare and insurance companies making it so. Doctors did not design this system. </p>
<p>I guess that you will then have even more doctors retiring early, or leaving medicine, if you decide to have a class action suit against virtually every doctor in this country. It is very easy to make mistakes in billing, or do what medicare or an insurance company may consider a mistake.</p>
<p>“The person /group issuing the bills has nothing to lose, they can easily say “oops it was mistake” if they are caught, but in many many cases, they receive payment from those who either won’t question the bill or don’t know their way around EOBs which can be confusing.”</p>
<p>I disagree completely with this statement. The physician’s practice that does improperly balance bill (whether by intention or mistake) does have a lot to lose. If it is a Medicare patient, the physician can be held liable for fraud, up to and including jail time and a hefty fine. If it is a private commercial insurance, the physician/group risk losing their contract with said group and all the patients associated with that. </p>
<p>I agree with jym626 that I would be surprised if there were a lot of physicians purposely attempting to defraud patients by balance billing. I DO believe there are honest errors made by billing clerks and even I’m ashamed to admit practice administrators such as myself. I recently sent a patient a bill for $253. United Healthcare (the worst of the worst insurance companies - there standard reply to many claims is to state “they never received it” and then deny the claim as not being filed in a timely manner) denied the claim for one year, saying they were not the primary coverage. My biller spent countless hours pursuing this; UHC said they would reprocess the claim 4X and never did so. We finally did get paid one year later. Ten days after receiving payment they recouped $253 saying they had processed it incorrectly. They gave not reason as to why it was processed incorrectly. I therefore billed the patient the remaining amount. The patient who was very savvy and backed up our office called UHC and demanded to know what was going on, conferenced me in the call (in excess of 60 minutes time, transferred x 5, etc). The final person at UHC said this was a multiple procedure discount that had once again been processed incorrectly. The patient didn’t owe us anything but UHC did. That was 30 days ago. I still haven’t received the money and I’ve written it off because honestly it’s not worth my time at this point. </p>
<p>If you made it through that story I commend you but this is what doctors offices go through every day for many payments. If they inadvertently make a mistake, please bring it to their attention and I’m sure they will rectify it with proper documentation. I regularly use a collection agency letter after patients have received SIX statements. I usually get a good response. I don’t even feel bad about it. Six statements is more than enough - it should be after two -that’s what credit card companies do. </p>
<p>There is something inherently wrong with a system that issues credit to a patient for their healthcare and then has to fight to receive money for services rendered. Would you go to Target and tell them to bill you for your groceries? The only people getting rich here are the insurance company executives; doctors make less every year. Pretty soon healthcare specialists will be unavailable for many people with managed care. </p>
<p>Don’t even get me started on the prescription issue eadad; why should I refill your prescription if I haven’t seen you in a year. I work for a urologist; let’s say you have a standard prescription for Cialis. We require that you are seen once a year to review your past medical history, other medications (to make sure there is no contraindication) and review of systems (do you get lightheaded when taking the medicine - could this be a precursor to a life-threatening situation caused by the medicine?) So you would like me to do all this by phone (15 minutes time) and go through the pre-authorization required by your insurance company that requires 30 minutes of time on my part (we’re up to 45 minutes here folks) and never see you again? It seems to me you are still receiving a service and you should have to pay for it. Yes it should be appropriately coded and our office audits our physicians to make sure it’s done properly. </p>
<p>Whew, off my soapbox. </p>
<p>Carole who had a very rough week at work dealing with IVRs, insurance people with no authority to do anything and crabby patients.</p>
<p>Has anyone had this happen? I saw a dermatologist in late June. I filled out completely new paperwork there because it had been too long since I had last been there. Last week, a call comes to the house from a “billing company” & my teenage son gave them my cell phone #. I got a call on my cell phone from an 800 # which I did not answer. They left a voice mail saying that there was a billing problem and they needed my SS# and DOB to process. I call back the number left and it was a bad number, although if it was an 800 #, they only gave the last 7-digits, so I assumed it was local. </p>
<p>After I thought about it, I realized that I had most definitely given the dr’s office that information and that I wasn’t about to provide it to someone calling me from a “billing company” from an 800#. I called the dr’s office and the person I spoke to seemed confused, although she did say they use a billing company. And she said they were hard to get a hold of. I told them that I was not going to provide that information to someone whom I didn’t know who called me out of the blue. I said (and will say this to the billing company if they call back) that they need to get this information from the dr’s office and I will not provide it to an unknown person over the phone.</p>
<p>Does this sound like a scam or just local incompetence?</p>
<p>There are so many ways that information can get miscommunicated in the very complicated health insurance billing system, that you should just check with the doctor’s office.</p>
<p>As long as there are insurance companies in the health care system with a goal of “managing to care less”, we will continue to get what we pay (extra) for.</p>
<p>I don’t think that any of the present presidential candidates favor getting rid of health insurance companies, they just want to give them access to more government funds. The candidates receive too much money from the health insurance companies to do that. </p>
<p>Off point but related to health care: I am assuming that Obama is now the greatest recipient of the trial lawyers donations, now that Edwards is gone?</p>
<p>Our healthcare system is a mess. I have had the same experience that Jordansmom describes with UHC. In fact, a few times I have personally stood in line at the post office to get send a copy of the patient’s record that UHC requested (another stall tactic and/or way to try to deny the claim) via certified mail so that they cannot pull the “we didn’t receive it so you missed the deadline and we aren’t going to pay you” line. I’ve had insurance companies tell us one thing and the patient another-- trying to make themselves look good and the doctor look bad. They flat out told us that something was not a covered service, but told the patient to go ahead and have the procedure done and let the doctors office file the claim, as if it was a covered service. We tried to get a three-way call set up to clarify this, which the insurance company refused to do. </p>
<p>I am sure jordansmom has a million more of these kinds of stories-- and of being put on hold forever, transferred a gazillion times and then disconnected. Another common problems is that oftentimes the claims dept is in one country, and benefits verification in another, and the computer systems don’t communicate with each other.</p>
<p>I love what I do, but I dislike the increasing hassle it is to be able to do it. Many people in my field simply do not accept or file insurance anymore because if the increasing hassles and decreasing reimbursement from insurance companies. Its a shame. But its also a shame that the doctors and hospitals are often seen as the bad guys when very often they are not. This is not to say that there arent bad apples out there, but much of this mess is really the fault of the insurance companies. </p>
<p>tango-
You are right to NEVER give your SSN out to anyone who calls you. Call the drs office and find out what the issue is, assuming there really is a problem at all. This could be a scam. Be careful.</p>
<p>I fully agree with doctors not accepting insurance anymore. It’s the only way in some specialties and geographic areas to survive financally. The insurance companies are very difficult to deal with, reimburse poorly and slowly, and add to the cost of health care tremendously.</p>
<p>It is far better to have the individuals deal with reimbursement, and to pay doctors directly and then get reimbursed. The individual should take the deep discounts, not the doctors.</p>
<p>swatparent-
I don’t want the direct this thread into a discussion of presidential candidates or politics, buy you are right that the government is very much in bed with the insurance companies. The government was going to hit the Drs with another 10% cut in reinbursement (and when medicare drops rates ,all the others follow) but the bill was overturned. Bush threatened to veto it because the money would be taken away from what the govt was going to give to the private insurance companies. Thank heavens there was a big enough group to override Bush’s veto.
[House</a> Votes to Block Cut In Doctors’ Medicare Fees - New York Times](<a href=“House Votes to Block Cut In Doctors' Medicare Fees - NYTimes.com”>http://query.nytimes.com/gst/fullpage.html?res=9F02E0DD1239F936A15755C0A96E9C8B63)</p>
<p>“I don’t think that any of the present presidential candidates favor getting rid of health insurance companies, they just want to give them access to more government funds. The candidates receive too much money from the health insurance companies to do that.”</p>
<p>You won’t find any disagreement from me! ;)</p>
<p>Unfortunately, sadly many patients simply can’t affort to pay up front for services. It would be great if, as jordansmom’s post suggests, that we pay for our healthcare the way we pay for our groceries. But it is often just too expensive to do so. That said, many people will buy an expensive flat panel TV and put it on their credit card, but don’t consider doing the same for their healthcare. There are some programs out there that are essentially a credit card for healthcare that is interest-free, but I haven’t seen them become too popular yet. Anyone had any experience with these?</p>
<p>My employer is self-insured with a BCBS (Blue Cross) administrator. There are days when H spends hours just trying to sort out medical insurance and billing issues. It’s impossible- and the doctors aren’t to blame. They have a billing staff that can’t figure out any of it (who can?). Not sure what the answer is.</p>
<p>Just two more quick things. I got a little worked up on my last post and got off track :)</p>
<p>To the original poster, it is possible that your insurance company is in-network with the hospital and NOT with the ER physician group. I have a friend whose son goes to Univerity of Illinois. He split his chin playing intramural volleyball. It was after clinic hours and had to be stitched; if he had waited until the morning they would have been unable to close it because of the risk of infection. He went to the Carle Clinic ER at U of I because it was in-network. My friend got a bill from the ER physicians’ group a month later balance billing them because the physicians group (the professional component) was out of network with their (very common) insurance plan. I think its reprehensible that this happens. The group should be mandated to accept the same insurance as the hospital. This is a tactic that many physicians or groups use. By electing to be out-of-network, they can charge a great deal more and balance bill. I would argue that if it was a true emergency, the patient had no other options, the ER physicians group should write off anything over the out-of-network reimbursement (which oftentimes is much higher than the negotiated in-network rate). </p>
<p>Also to the poster who had a call from a billing company asking for SSN & DOB; I would tell them to call the doctor’s office. Only provide to a trusted source. Also be advised that you are not the primary insured (policy holder), some insurance companies require the DOB & SSN of that person. You may have provided your SSN & DOB but they may need your spouse’s if the insurance if through their employer.</p>
<p>jordansmom-
When it is a true emergency you should go to the closest hospital (in or out of network) and can then appeal to the insurance company to have them process the bill as in network, regardless of whether the hospital or drs are in network. Of course the insurance companies dont tell their customers this, but the will do it. When my s shattered his femur skiing a few yrs ago, they took him first to a local community hospital which didnt have the resources to handle his surgery. He was transferred to another hospital for the surgery which was out of network, and we were balance billed. I found out from one of our insu co claims reps (who is now practially my new best friend, LOL) that we should appeal the out of network benefit rate, and bingo-they paid it all at in -network. She told me that regardless of which facility it was (the first or the second) if you need to be treated for an emergency, you go to the nearest facility and they will (or should if you ask) pay at the in-network rate. Now why didnt they do that in the first place, and why didnt the previous 5 or 6 or 8 claims reps that I’d spoken to (I called originally because they thought that the 2 ambulance rides, to each of the hospitals, was a duplicate bill, and it wasn’t) tell me that they should have processed both hispital stays as in-network? Gee, let me guess-- they want you to pay more and they want to pay less.</p>
<p>Now that said, I do agree that emergency room docs contracted with big hospitals should accept the same insurance that the hospital does. That only makes sense. But if not, the hospital should tell the patient, at discharge, to request that their carrier process the bill at the in-network rate. Our insu is a PPO. I can’t guarantee that the POS and HMO’s work the same way, but after Kaiser got its butt sued bigtime for millions for having a little girl taken many miles past the closest emergency room for treatment at an in-network hospital (she died en route) the insurance companies are flexible about this. But, you have to request it.</p>
<p>jordansmom, this group is in-network. The EOB shows zero patient responsibility, and I confirmed this by phone with BC on Friday. I agree that it is reprehensible when hospital staff physicians are not in the same networks as the hospital. I believe that I have run into this before.</p>
<p>My dermatologist, who is an acquaintance because his kids work for us told me that he makes less money per insurance claim than he did 20+ yrs ago.
Don’t ge me wrong…he has an ace in the hole, as far as serving a community with few to choose from in this specialty.</p>
<p>He has advised my daughter, who is pursuing a career in medicine…not sure what to make of it, but I do know as a consumer who pays for healh insurance, I do question the legistamacy of some claims.
I have little or no time to invesigate charges when I work full +++ time
I also do no fret it like my parent’s generation would ( as some previous posters have stated )
The threat of it affecting ones’s credit is minimal.
It has never impacted anyone I know, despite the threats</p>
<p>When an entire system of health care is, a-hem, “morally challenged”, it should not be seen as surprising that there are individuals and entities within that system who share those “challenges” as well. :rolleyes:</p>