Support for LateToSchool

Parent Cafe
1881

<p>Aibarr – I had a situation like yours a couple of years ago … I just refused to pay, writing a letter in protest… and after 2 years the bill went away. So don’t think you have to pay if you think there is something that should have been covered by your insurance.</p>

<p>In my case, I just inquired as to what the procedures were to dispute a bill. They told me to write a dispute letter to their billing dept., stating the reasons why I was unwilling to pay the amount charged. Months and months went by, and then about a year after the initial incident they wrote me a letter saying my protest was “denied” and I owed the amount billed. I ignored that letter, doing nothing. During all this time, I was NOT receiving bills – the letter-writing had taken the item outside the ordinary billing track. Another year went by. They wrote to me and said that they had decided to waive that bill so I didn’t owe them anything.</p>

<p>Bottom line: don’t be afraid to protest payment. Keep in mind that this is what the insurance companies are doing every step of the way – so the medical billing departments are used to not collecting on everything they bill, they are used to hearing “no” for an answer… and most of all, they are aware that sometimes it is easier for them to accept a smaller negotiated payment or close their books entirely than to try to collect on something.</p>

1882

<p>Calmom, I hear you loud and clear. I am very rarely alone when I go for these things - I am never alone even just for chemotherapy, but, this seemed rather simple - a CT scan for staging. Plus having someone there would not have helped; in radiation oncology you cannot have anyone else in the room - your support person has to stay in the waiting area. I also agree that the non-physician administrator very likely made a call along the lines of “small cell lung cancer, this patient is as good as dead anyway” and so made the change.</p>

<p>After more rounds of apologies from various players today (which I did not accept), there is now a conference call scheduled Monday. I am going to demand a full explanation, demand that the administrator be held accountable, demand that the lying, dishonest behavior be addressed, and demand to have her removed from ever having anything to do with my case and current or future treatment plans. And I’m not going to accept half answers or lame reassurances or even compromises.</p>

<p>Aibarr, do not be so hard on yourself. I agree that you reacted exactly how most people would. After all, how - and WHY - to anticipate such a thing? I would have been caught by surprise, as well. I do agree with Calmom re do not pay the bill, or, protest it. I am glad that medically everything is o.k.</p>

1883

<p>Aibarr,
If the report comes back that there is something to be concerned about, that Echo tech may have done you a favor.
Would you have declined the procedure if you were presented with the cost?</p>

<p>Now that it is done, keep positive thoughts and dispute the bill.</p>

1884

<p>Thanks to everyone for the kind posts and wishes. I worked all day today, serving my clients and doing what I love so much, and I am so happy that I get to do the same thing on Monday, with no interruptions for scans or tests or chemotherapy. I am looking forward to a nice weekend. I am also feeling happy that the shortness of breath seems to have eased quite a bit. Perhaps things are moving in the right direction…</p>

1885

<p>I feel so much anger coming out of your post about the conference call Monday. Maybe this anger keeps you going but I hope the hormones that it releases in your body are not doing you harm.</p>

1886

<p>busyparent: While I don’t pretend to be an expert on such matters, it’s difficult for me to see how anger, especially if justified (as here), could do one harm. Much more likely to be harmful, I think, would be an attempt to deny, or otherwise repress, one’s anger. </p>

<p>Besides, what’s wrong with anger, anyway? While I may agree with Burt Bacharach and Hal David and Dionne Warwick that “what the world needs now is love, sweet love,” a good argument could be made that not-so-sweet anger has driven more positive changes in the world, both large and small, than love.</p>

1887

<p>I’m certainly no endocrinologist but one reads so much about the deleterious effects of anger and the number of anger management classes in our area increases daily. The sense of control that comes out of justified anger is probably a positive thing and most certainly beats fear and denial but I worry that the ongoing need to have everyone from the CEO to the lab tech admit fault with a thorough explanation etc might be going from justifiable anger to something harmful and like everyone else on this thread I pray for a complete recovery for late to school.</p>

1888

<p>If an echocardiogram is not covered by your insurance, then you are responsible for paying for it. You may have a deductible that needs to be fulfilled prior to having tests reimbursed. It actually is the responsibility of the subscriber to find out if a test is covered, especially if you are basing a decision as to whether to have a test based on your insurance coverage. The hospital can find out prior as a courtesy to let you know and to collect at the time of the test, but ultimately it is a subscriber’s responsibility to pay what the insurance does not reimburse. The hospital cannot write off all of the tests that insurances do not pay. They do have a right to collect prior to treatment unless it is an emergency. Granted it was awkward that you were getting into a gown when this occurred, and they should have had you wait to undress until they had spoken to the insurance company. However, every insurance company reimbursement line states that even if they say you don’t owe or owe a copay for the test, that is not guaranteed. It is more cost effective to collect prior to a nonemergent test than to bill the patient after. You can appeal and try to get reimbursed directly from the insurance company. But a patient has the responsibilty for payment, hospitals cannot give all of these nonemergent tests away for free. They too have to pay their employees and bills, like every other business.</p>

1889

<p>nameneeded, correct, but it is inappropriate to do a procedure and then ask for $500 after the fact. It sounds as though someone did not get the needed pre-certification for a procedure. If an network doctor ordered a test and it was done at an in network site it should be covered if the insurance is a PPO (we do not what type of major med coverage the poster had).</p>

1890

<p>It was in-network lab, and my health insurance is a PPO. I pay through the nose for the upgraded insurance, as well…</p>

<p>And nameneeded, I agree. I’m fully aware that I’m responsible, and had no intention of not paying. Even while the insurance lady was on the phone I dried my tears and dug out my wallet, she came back and before she said a word, I handed her my credit card. At the end of the transaction, I reassured her that I wasn’t upset with her, and I thanked her for all her help in dealing with the situation. I never had any dispute about the bottom line, always had every intention of paying it in full at the time of the test, but I think I’m rightfully upset about how it was all handled. I’ll be going back and asking some pointed questions about procedure… From the insurance lady’s reactions, this is not the first time that a situation like that has happened.</p>

<p>Anyhow… I have a bit better appreciation for how much it sucks to be the patient. It’s already upsetting enough without the added dimension of these sorts of pitfalls… LTS, hopefully you’ve had your full share…</p>

1891

<p>two more lung cancer “survivors”</p>

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<p>[Lung</a> Cancer Online: About LCOF](<a href=“http://www.lungcanceronline.org/home/editor.html]Lung”>http://www.lungcanceronline.org/home/editor.html)</p>

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<p>[Support</a> Groups - Patient Stories - Joanie Willis - M. D. Anderson Cancer Center](<a href=“http://www.mdanderson.org/patients_public/support_programs/display.cfm?id=24C666AD-25D6-4807-B8447BD4A75D784E&method=displayfull]Support”>http://www.mdanderson.org/patients_public/support_programs/display.cfm?id=24C666AD-25D6-4807-B8447BD4A75D784E&method=displayfull)</p>

1892

<p>An echocardiogram is not a procedure that would require precertification, as it is too routine for that. When you go to a medical facility, you give insurance information and sign a statement that you will be responsible for any payment owed. If you have a deductible or something is not a covered service, then you will be asked to pay whatever is owed prior to the proceudre. If the medical facility is unable to verify your insurance, or the facility is unable to reach the insurance company (hour waits are not unheard of when calling) or if it unlikely to be covered, then you may have to pay up front. On the other hand, even IF the insurance company quotes a reimbursement prior and then the reimbursement turns out to another number or if it is NOT covered at all, then the pateint is responsible for paying for the test. Whenever a medical facility or patient contacts an insurance company, then there is always a disclaimer that calling and getting verification is no guarantee of benefits. Try calling your insurance company and pressing the line for providers and you will hear this. For subscribers they have a similar disclaimer. Bottom line is that the patient is responsible.</p>

<p>aibarr: if you were intending to pay, and it was collected prior to the procedure becuase you owed it, what are the pointed questions for them? You should have received an explanation of benefits from your insurance company by now that would verify what you owed, and if the hospital was mistaken about that amount. </p>

<p>It is obviously a problem when insurance does not cover everything, but that is how it is structured when you sign up for particular plans.</p>

1893

<p>nameneeded, I don’t know about aibarr’s plan, but most PPO’s are structured so the health care provider must bill the insurance first. Even if the amount is within the subscriber’s deductible, the rate the subscriber is billed may be reduced because of the contract with the PPO. </p>

<p>That is: lab bills PPO $500. PPO approves claim, but doesn’t pay because the amount falls within the patient deductible. However, PPO also reduces charge to $375, because PPO has decided that is the proper cost for the EKG. Patient then pays $375.</p>

<p>If a lab insists on payment up front rather than going through the insurance billing procedures, they can get away with charging $500 for services that insurance pays $375 for. If the bill never gets sent to the PPO… the patient never knows… and in fact the $500 never gets applied to the deductible.</p>

1894

<p>calmom, is absolutely correct. My H had a test done a year ago and the bill sent to our insurance company was 17,000. Our insurance company paid 10% of that bill as payment in full (1,700)! I guess that was the insurance company’s prenegotiated fee. The test was ordered by an in network physician, and the test was done in an in network hospital by the same in network doctor that ordered it. We might have had a copayment of $50, I do not recall, but that was it! We have a PPO.</p>

1895

<p>“The Lung Cancer Journalism Awards”</p>

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<p>[The</a> Lung Cancer Journalism Awards - Welcome!](<a href=“http://www.lungcancerjournalism.com/results_07.html]The”>http://www.lungcancerjournalism.com/results_07.html)</p>

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<p>[The</a> Lung Cancer Journalism Awards - Welcome!](<a href=“http://www.lungcancerjournalism.com/results.html]The”>http://www.lungcancerjournalism.com/results.html)</p>

1896

<p>Busyparent, if people are not held accountable, nothing changes. In this case, a non-physician administrator changed ordered nurses to change the treatment plan, and when caught, lied about it. She then summonded financial people into the treatment area and demanded a $3,000 check, and lied about that as well, positioning it as their idea, when in fact they were as clueless and as embarrassed as her nurses. </p>

<p>The slimy, meaningless apologies and worthless verbal reassurances I have received since just don’t cut it. It’s not a matter of anger with me - it’s a matter of making sure this person is held very, very accountable, that her superiors, specifically the hospital executives, are aware, that this is documented, and that this sort of dishonesty is confronted, hard.</p>

<p>Specific to health care, we NEED anger and other motivating emotions, and as a society we need to get very angry and stay that way for a long time. I’m very, very lucky - lots of resources, support, and thanks to a baseline of excellent health perhaps a small chance to actually win this unfair fight. But I’m the anomoly. I spend a LOT of time on the phone with people around the country, and the suffering and sad situations are just simply overwhelming. </p>

<p>There are people who cannot even make it to their chemotherapy appointments for lack of transportation. There are people who do not have anywhere near enough money to buy food, or pay for their medicines, and, perhaps saddest of all, there are people going through this very, very difficult fight all alone. They do not have anyone to go with them to chemotherapy or even bring them a meal or even check on them. They don’t have access to the internet so that they can research their disease and try to understand how they might be able to help themselves, or access clinical trials (less than 5% of lung cancer patients end up in clinical trials). Sure there’s the public library but most of these people are too sick to go. And if some administrator demands something unreasonable of them, as like what happened with me, they have zero chance.</p>

<p>Beyond just lung cancer, there is the whole issue of survivorship, and late effects. I spoke to the five year survivor in Texas last night, and, while he is grateful to be five years out from small cell and no recurrances, he has had numerous opportunitistic health issues as collateral from his cancer treatments, including the latest concern, a racing pulse that cardiologists are trying to get under control. (On top of this mess - the economy is now about to harm him - he is a rancher; he and his wife have run through their considerable savings these past five years. He cannot seem to achieve traditional employment because of the lung cancer; he might have to sell his ranch. He is lucky that he has a military pension to fall back on…) These matters are becoming critical to all cancer survivors, regardless of type of cancer. A lot of serious work needs to be done to ensure that cancer survivors are left with some quality of life. </p>

<p>This sort of comes full circle to my issue - the matter of medical decisioning of whole brain radiation vs. cyberknife in a 48 year old as a treatment methodology for three mets that are each .5 cm. For a non-physician administrator to just whimsically make this treatment plan change - and then lie about it all - is just beyond any measurable boundary of acceptable behavior. And, on Monday, I am going to ensure that she finally understands this.</p>

1897

<p>Epistrophy, many thanks for the links; I appreciate it, especially considering how busy you are.</p>

1898

<p>Oh, LTS, you go, girl!</p>

<p>(Rooting for you on Monday. What a great day to 'get your Irish up)</p>

1899

<p>“This sort of comes full circle to my issue - the matter of medical decisioning of whole brain radiation vs. cyberknife in a 48 year old as a treatment methodology for three mets that are each .5 cm. For a non-physician administrator to just whimsically make this treatment plan change - and then lie about it all - is just beyond any measurable boundary of acceptable behavior. And, on Monday, I am going to ensure that she finally understands this.”</p>

<p>The other important thing is that if this happened to LTS you can be sure it wasn’t the only time. It is probably the only time they have been caught. It is almost impossible to find the words to describe how outrageous this was.
To change a treatment plan without the patient’s knowledge is certainly malpractice.</p>

1900

<p>I wonder, too, if the ordering physician was consulted, +/or informed, +/or agreed. Surely, the administrator would expect repercussions when the reports indicate a different procedure than was ordered.</p>