Thank you everyone for such great advice. I do have access to my records and I don’t recall seeing notes from my cardiologist for my hospital stay, but there were a lot of documents so I’ll check my portal more closely over the weekend.
I’ll be making some calls on Monday and feel much better prepared than before I started this post!
Hopefully this won’t take months to resolve — I’ll post an update when I learn more!!
If it was a courtesy call, he shouldn’t have charged you. I would call his office to complain. Insurance denied it since it wasn’t directly related to the reason you are in the hospital. I think it’s unscrupulous to charge for a visit like this.
It can take a bit of time to resolve but it is worth speaking to the cardiologist’s office & billing dept and the benefits person who covers the insurance at the workplace. No one needs extra charges and grief after a hospitalization.
Decades ago, I had to fight with my insurer when my S had anesthesia from an out of network anesthesiologist at a participating & preferred facility and with a participating & preferred surgeon.
I successfully argued that it made no sense that a parent (or young child) was supposed to quiz anyone as to whether they were participating & preferred or not when they worked on S. It took about 18-24 months, but I kept the anesthesiologist’s office aware of the dispute and the insurer ended up paying and and office accepted their payment. The money was under $2000, but to us it was a lot of money at the time. It was really the principle.
Yes, no one really gets a choice about the anesthesiologist. I think it should be illegal for hospitals to allow the procedures when one doctor of another won’t accept the patient’s insurance. If that is the case, don’t pre authorize, or don’t schedule two doctors who have different accepted insurers. This is 100% unfair to patients.
I thought they changed that so that hospitals or anesthesiology groups could no longer do that? Maybe part of the no surprise bill act?
I personally think that it’s a ploy by anesthesiology groups to maximize profit.
Many anesthesiology groups are private, not employed by the hospitals and by design try to hold the hospital, insurance and patients hostage for their own greed.
They know we don’t have choices. They know what insurance is going to pay. And still they decide to be out of network.
Not at all excusing this practice, if it’s still going on, but this is a thought too. Their malpractice insurance is quite high. If some insurance companies reimburses at a terribly low level, they may choose to be OON for that insurer. Anesthesiologists Pay Some of the Highest Malpractice Premiums
Our medical care is quite broke. I see my doctors bill my insurance company thousand of dollars, and get only few hundreds paid. Your cardiologist may have assumed his charges were in network and your insurance would have paid a lower agreed amount. I think you probably could get it resolved amicably with your doctor’s billing office.
BTW, I don’t think he should have charged you if you didn’t ask for a consultation.
Recently spent an hour on the phone with my insurance company, my colonoscopy was covered but the anesthesia wasn’t. Finally figured out it was coded wrong (I’m on the 5 year plan and it was coded for regular 10). Unfortunately that bill would’ve made us reach our $5000 deductible, now that it’s covered we still have to pay more oop, so didn’t help.
My wife has found this had happened to us and my nephew, young guy, as well. Happens more than you think. Not easy to fix but is fixable.
It takes calmness, patience and discussions with both the insurer first and then doctors office to figure this out. Patience and calmness are key because it’s not quick or easy to get corrections.
One article online says up to 60% of bills contain coding errors - which is amazing. I personally don’t see it but it’s online. The ANA also notes there are many coding errors.
I am always amazed at the # of different bills from different people that come in and then labs. I wish you could get just one bill and a centralized place then pays out so you have everything in one place vs bills showing up randomly for months.
Doesn’t mean you were miscoded but it’s worth checking each bill, especially the dr who popped in if he wasn’t supposed to or required to.
Doctors really have no idea about their billing departments unless they are doing the billing themselves. The doctor very well could have no idea this was billed as it was. However, the doctor would have needed to submit to insurance to be paid.
I know my insurance questions any visit that is only 10 minutes long. That is noted on my EOBs.
Asking the doctor likely isn’t going to be as helpful as asking their billing department! And many outsource their billing.
The outsourcing of the billing lately is crazy! I’ve started credit card disputes over legit bills because I don’t recognize the charges. My anesthesiologist bill I fixed was delivered to me as a text. I get bills with amounts, but not what they’re for. We still have 3 kids on our plan so sorting it out isn’t fun.
We have issues because our insurance carrier is a small regional group that partners with other small groups. So finding if something is in or out of network can be a nightmare. The day before my colonoscopy I don’t know how many calls I was on trying to figure it out. In one 30 minute span I had two people from the insurance company saying different things and also two people from the doctors office. It did wind up being covered - which I had expected since H and many many people from the workplace go there and it’s always covered. But it was a mess.
And im currently going to have to fight H’s cancer hospital. They got a new billing group and one of his bills they aren’t recognizing that it’s in network and I only owe the negotiated amount. The insurance EOB says it’s in network. The insurance rep who handles my employer says it’s in network and sent the billing department the paperwork and said to wait 30 days to see if it is resolved. 60 days later - nope. I’m going to have to call again. The rep said she would mail the billing department the agreement they have with them if she needs to.
But then all the other bills from the same visit at the same hospital were processed correctly. It’s just that one. And how many people (especially elderly) would just go ahead and pay the full amount without realizing it’s wrong?
We did have a great experience with our last agent, took an hour but she was friendly. When calls need to be made, I need my husband here, he is so patient and kind, me not so much. Even when I think I’m being nice I get schooled by my daughter, who asks me why I’m so mean. I’m easily frustrated.
Yep I pay nothing without an EOB. And yep the texts you owe us money are annoying.
Someone up thread said they paid a bill to avoid collections.
I pay all my bills that are legit. Or that could proved to be legit.
Wanna send me to collections. Go ahead.
In my case I paid the amount I owed. I skipped the part I didn’t. Hospitals and med facilities are usually ok with you just paying something - at least fair while. I know with our hospital some people pay $10/month until everything is straightened out. Getting sent to collections would scare me too
Yes there are often coding errors, especially in large practices. My billing person would always call a potential new patient’s insurance company with the codes we use (that are correct for the services provided) to verify benefits, and they would give her the estimated coverage and copay. Sometimes the patient would call their insurer and give the wrong information (their intention was good, it was just not correct, or they would use a term when they asked about coverage that we KNOW is not covered) and several occasions the insurance company would tell the patient to just go ahead and have that service done and they could see how it processes. Well, my billing person is very knowledgeable and very experienced and knows how it has processed in the past, but would courtesy call the insurance company back based on what the patient said they were told, and would be told something completely different than what the patient said they were told. She had to arrange a 3 way phonecall with the insurance co and the patient to get everyone on the same page. Very time consuming.
Sometimes a patient would ask that a service be billed with a code that isn’t really correct for the service being provided, but has better coverage. Thats not only unfair to ask the provider, but it can be illegal. And the insurance company will often ask for the records/report before paying a claim, and then deny based on the records. They also can review a claim and have (in my state) 18 mos (maybe it’s 24 mos?) to review and ask for a payment recoupment, or take it out of payments on future patients. So if they retroactively deny a claim they paid 18 mos before, the drs office has to then try to get the payment from the patient, eons after the service was provided, and most patients won’t pay it. They think its an issues between the drs office and the insurance company, when its not. So it can be more complicated than some realize.
Sorry you were ill and experiencing this. Apologies if I missed it but did you ever reach out to the doctor and request his services?
You referenced him dropping by based possibly on recognizing your name. You describe it as asking about a medication. That doesn’t require an in person meeting and shouldn’t have created a billable event.
If you didn’t request or solicit his services you are being charged this can be fixed relatively easily I suspect.
Sometimes the hospitalist (or whoever is the primary attending for an inpatient) will ask for a consult from the patient’s other doctor re: some related medical issue that the other doctor is treating. Sometimes too a patient has to be cleared by cardiology before a treatment can be initiated, and sometimes a medication has to be changed or stopped temporarily before another one can be initiated. It would be helpful to know if any of those issues occurred, and if the cardiologist was consulted by a treating doc, if the cardiologist then also stopped in to see the patient as part of that.
I have an EOB for a cardiology ablation that could not be completed (my heart developed other arthymias during the procedure and the doctors decided to not proceed any further). The total is 67K. Insurance paid 42K, we are “responsible” for about $5K but have not yet been billed. I actually called the hospital to see why (the procedure was in April) or if I somehow mislaid a bill that large.
The EOB is exactly that, just an estimate. The insurance company doesn’t like somethign about the diagnosis/coding/cardiology costs, and the hospital is resubmitting all of the paperwork. All of it. Hospital billing says this is common, esp with cardiology, and until I actually have a bill in my hand, the two entities will fight it out. My cardiologist was appalled, but has offered to do whatever the insurance company wants with paperwork.