<p>I asked a health insurance question here before and got a lot of great advice, so thought maybe parents could spare some wisdom this time around as well. My parents are immigrants and are usually at a loss. I would greatly appreciate it. </p>
<p>I was referred to a medical center for a heart scan of sorts by my medical provider. Before making an appointment at said medical center, I checked and doublechecked that they take my primary insurance. After making the appointment, I filled out paperwork and listed my primary and secondary insurances where appropriate. Additionally, I told the secretary which is my primary insurance and which is my secondary insurance. They made copies of the insurance cards. </p>
<p>I later get hit with a bill from the medical center. The bill is not for the procedure, but for the doctor’s review of the results and the “verdict” that everything is within norm. I find out that this doctor is out of network. Yes, they did have in network doctors within the medical center, says the customer service rep, but this particular one is out of network and I am made responsible for the cost. Does this appear to be a mistake on their part to anyone else but myself? Why would they choose an out of network provider to review my results? </p>
<p>As an aside, the primary insurance did cover the fee for the procedure itself. </p>
<p>As I try to file paperwork and fnd out about out of network benefits from my primary insurance, I get referred to collections. Eventually, my primary insurance covers some of the cost. Right now I am sorting out if the secondary insurance can pick up the rest of the cost. </p>
<p>I am not sure if the secondary insurance will pick up all of the cost. Does it seem reasonable that I would continue to fight this battle if I still have to pay the remaining balance? </p>
<p>The balance at this point is a couple of hundred. Sure, not the end of the world, but still significant and I feel that I could have avoided paying had I had an in-network provider. </p>
<p>Our local hospital, the only one in town, does this and it fries my cookies. They do it w/ bloodwork, radiologists, etc.–providers whom you cannot control–people you never choose nor see. In my case, I am talking about Anthem–the largest ins. co. in my state. The hospital could leverage these providers to become in network, but they will not do so. I feel that if you go to an in-network hospital and they send stuff out–that it should be to other in-network providers. The hospital, as in your case, is well aware of what insurance you hold. The difference in deductibles and co-pays is often vastly different for in and out of network. It’s ridiculous the patient gets stuck with this.</p>
<p>GRRRR! This is a major source of irritation for me as well. I try to do due diligence when selecting Dr’s and medical providers. I have looked into the hospitals in our area that are participating but have labs, etc. who do not.</p>
<p>I would say, pay out of pocket to avoid collection, and fight the good fight with your insurance company as long as you have steam. Five years ago I would have said hold out, but the economy is so tight right now that if you are 30days late on a utility and are reported you can be denied a mortgage even with good credit. I wouldn’t risk it… but I would not let it go.</p>
<p>We deal with this type of thing when we take my son to see his surgeon. We get two bills, one for the honor of simply walking in the building, and a second from the Dr. One is in network, the other is not. It did not start out this way which is what irritates the crow out of me! When we decided on a surgeon and hospital we made sure EVERYTHING was in network, EVERYTHING. I checked and rechecked everything through insurance as we were out of state. Let’s just say that the expense was no less than the Ivy League education that CCer’s are accustomed to. The original surgery and hospital stay was without financial glitch (thank God). Fast forward a year and our surgeon decides to no longer accept our insurance. Hummm, for new patients, yea… what about those that are in the middle of a multi year process and require monitoring and another surgery? I honestly called the business office assuming that some sort of grandfathering would have to take place. They couldn’t just through us under the bus. Well, here we are with tread marks on our chests. We deal with it from visit to visit, hoping that by the time the final surgery is due he may accept it again. It seriously just isn’t right…</p>
<p>So, fight. It’s YOUR couple of hundred bucks to spend how you choose. You may not get anywhere, but it’s worth the effort to appeal.</p>
<p>I would choose to not pay. The medical center should be happy to get what they already got from your insurance. YOU didn’t give consent to use out of network doctor. They made a mistake, they should pay. I would play the poor student card. Ask them where you would get the money to pay them? Ask them what they would do if it was their kid? </p>
<p>Just a side note…My daughter’s wireless provider in Sydney claimed she had a usage bill of $600 one month. I told them that she had no money, and I think it was mistake on their part. I offered them $80 AUD, and they took it.</p>
<p>Tell the medical center to take you to court to collect.</p>
<p>^^^ I totally disagree. Unfortunately, you were not completely informed by the institution that you would be charged an institutional fee and a professional readers fee. It is NOT the fault of the doctor who read your scan that you were not told you would incur this charge. If you fail to pay this charge the doctors billing office will send your claim to their collection agency. I suggest you contact the doctors billing office and discuss a payment plan with them. Your anger should be with the institution not with the reader.</p>
<p>I actually do not agree that doctor has no responsibility on this issue. How many doctor would take someone as a patient without checking the patient’s insurance coverage first? The doctor should have known that he was not in the OP’s network. He should have questioned at that point if he should be the one to do read.</p>
<p>I had a similar situation with lab work. My in network doctor’s office sent lab work to an out of network provider without my knowledge or consent. I called my insurance company then called the lab. Basically I told the lab to take it up with my doctor’s office as it was their error. Eventually the doctor’s office took care of it BUT you need to document everything. Call the company that sent you the bill and tell them you want a note on your file. Then call your insurance company and tell them you want a note on your file and ask them how to proceed. If you don’t want to pay the bill but want to avoid collections you will have to fight it. It will take time and patience. Good luck.</p>
<p>I contested a medical bill. Did not pay during discussion. End result: my credit rating has taken a dive. Fortunately, I am not in the market for a credit card or a mortgage. But this will be with me for, what–7 years? So I would take care if I were starting out just now. There is what is “right” and what will work out for you. So I would advise that you pay and also fight for reimbursement.</p>
<p>However this plays out…fully check your insurance coverage to see which hospital centers in your area have labs, radiologists, etc., that do not participate/may not participate/or have not resigned their contract for the year. This can vary by location even with hospitals owned and operated by a large group.</p>
<p>Yes, this is a pain. It is work. When you make your appt for the MRI ask if the anyone involved in the process may not be a participating provider. If they do not know, ask for the procedure code and call hospital billing. If they have a radiologist that ‘may’ not be participating, can you request to ONLY be read by a participating provider. If not, call another facility. This is work, but not half as much work and frustration as a bill that is unexpected and trying to fix it after the fact. I have been there. Once you have identified the hospitals and medical centers that will work with you, you go there first and simply verify that all information is still the same. Usually from Jan 1 after contracts are signed it will not change.</p>
<p>I speak from being in your shoes and needing to navigate this type of thing. I am sorry that this is happening to you. It stinks that it requires this amount of work ahead of time to make sure we get the coverage we think we are supposed to.</p>
<p>Thank you parents for all the advice! I am in disbelief about how commonly this error occurs.
I think I will pay what they are asking since this collections business has been going on for a few months – scared I will have a bad credit rating. I will try then try to get reimbursed by the insurance company. I will try to be even more vigilent about checking.
I also hope to grow a thicker skin. The hospital did not admit to the mistake and told me to check with my insurance anyway. Then they referred me for collections and how do people not develop anxiety disorders after talking to these people? Oh my.</p>
<p>I don’t believe for a second that this kind of thing is an error. I think they know what they are doing and know that by not warning you ahead of time, they can make money from you. By “they”, I mean the doctors, especially those in private practice, the receptionist, the billing dept, all of them, and of course, the insurance company.</p>
<p>Like someone before me, I had the same thing happen with lab work that was sent by my doctor’s office without my knowledge to a lab that wasn’t in my insurance network. After much haggling, I got my insurance co. to pay part of it. I pointed out that if it had been an in-network lab, they would have paid for the procedure, so why not pick up the same amount in this case? I paid the balance.</p>
<p>OP - Congrats on the report coming back clean. </p>
<p>The prevalence of this practice strongly suggests it’s not accidental … nor is it an error. Still, rest assured the bill will be referred to a collection agency if you ignore the matter. I’m partial to Bay’s approach … but whatever works for you.</p>
<p>Worth2try- If you have made a solid decision to make payment, contact the provider and ask for payment arrangements. Depending on the type of ‘collections’ they have been employing you may be able to deal directly with them. Their ‘collections’ may have been inhouse, many health systems do. This may work in your favor. An outside collections agency may mean your credit has been affected.</p>
<p>When you speak with them to make arrangements tell them that you intend on paying in full and will deal directly with your insurance company. Tell them your credit is very important to you and ask what their reporting policy is. Your mind may be eased if you find out this hasn’t been reported. If they have not, you may be able to head them off. The human element can work in your favor.</p>
<p>This is not admitting defeat. This is switching gears and making sure you are taking care of your own personal interests. I am not trying to make you more anxious. I am trying to impower you to take charge of the situation. It is nerve wracking. The system is confusing, filled with red-tape, and unpredictable. I have had the same company for over 20yrs and it is a constant dance of covering my families interests.</p>
<p>Regarding the common lab problem. Ask before they run the tests what lab will be reading the results. This is total overkill, but as we can see, necessary. If you don’t recognize it as a provider, ask for an order to be written so you can get the labwork done elsewhere.</p>
I don’t understand. The receptionist is going to be paid her usual salary by her employer regardless of whether the OP pays the bill, the insurance company pays the bill, or all/part of the bill is forgiven. Ditto the billing department. And neither the billing department nor the receptionist decides which MD reads test results, so the fault here couldn’t be theirs.</p>
<p>I guess we should establish who “they” are in this case. Are you saying that the MD determined that he/she was out of the OP’s network and deliberately grabbed the OP’s test to interpret it in an effort to make more money? Seems to have backfired here, since a collection agency is involved.</p>
<p>I hate that this practice goes on. As a lawyer for a health care system I always put in our contracts that contracted physicians (radiologists, pathologists, etc) must participate in the same networks as our hospitals. It’s really outrageous when hospitals don’t do that – especially for those physicians who are behind the scenes (in which the patients do not have a choice as to who provides the service). However, it sounds like in your case, this is an employed physician, not a contracted one. If he was contracted, the bill would have come from the physician, not the hospital. This is truly unconscionable for a hospital to have out of network physicians who are hospital employees because the hospital is contracting with managed care payors for both the hospital and employed physicians (and has complete control over having them in the same networks).</p>
<p>My friendly advice to you is to call the billing department back and explain how improper this is (in a nice tone) and tell them you will be happy to pay the contracted rate (that is, the amount you would have paid if the physician had been in network). Keep asking for their supervisor until someone agrees. If you find out that this is an independent physician, you can still request the same thing. I am aware of many instances where physicians will modify the charge accordingly.</p>
<p>OP, I am confused as to why you didnt receive money from your insurance company for the radiologists reading. Even if he is not part of the network, the insurance company should have reimbursed you directly for part of his fee. When a provider is part of a network they agree to accept a pre-determined amount for each procedure code billed. The benefit to being in a network is that the payment is sent directly to the provider and not to the patient. Example: You have an X-ray at a medical clinic and the clinic hires a private radiologist to read your X-ray. The radiologist charges $100 for the reading. Your insurance company determines the U&C (usual and customary) charge for that procedure code is $75.00 and you have an 80/20 coverage benefit. The insurance company will pay the provider $60 and you should receive a bill (from the provider) for the remaining $15. You should also receive an EOB from the insurance company showing the original charge, the networks U&C and the amount paid to the provider. If your radiologist is not part of the network the insurance company should still pay $60. The payment along with an EOB should be sent directly to you. You will be required to pay the provider the $100 originally billed.</p>