Posted on 09/06/2008 8:56:26 AM PDT by DeaconBenjamin
In a controversial practice known as "balance billing," health-care providers are going after patients for money they don't owe
As health-care costs continue to soar, millions of confused consumers are paying medical bills they don't actually owe. Typically this occurs when an insurance plan covers less than what a doctor, hospital, or lab service wants to be paid. The health-care provider demands the balance from the patient. Uncertain and fearing the calls of a debt collector, the patient pays up.
Most consumers don't realize it, but this common practice, known as balance billing, often is illegal. When doctors or hospitals think an insurer has reimbursed too little, state and federal laws generally bar the medical providers from pressuring patients to pay the difference. Instead, doctors and hospitals should be wrangling directly with insurers. Economists and patient advocates estimate that consumers pay $1 billion or more a year for which they're not responsible.
Yolanda Fil, a 59-year-old McDonald's (MCD) cashier in Maple Shade, N.J., got tangled up with balance billing after gall bladder surgery in 2005. She and her husband, Leon, a retired state transportation worker, have coverage through Horizon Blue Cross Blue Shield of New Jersey. Horizon made payments on Fil's behalf to the hospital, surgeon, and anesthesiologist. Then, in 2006, Vanguard Anesthesia Associates billed Fil for an unpaid balance of $518. Soon, a collection agency hired by Vanguard started calling Fil once a week, she says. Although she thought her co-payment and insurance should have covered the surgery, Fil eventually paid the $518, plus a $20 transaction fee. "I didn't have any choice," she says. "They threatened me with bad credit."
(Excerpt) Read more at businessweek.com ...
Took my neighbor to the ER with what turned out to be a kidney stone, he waited for two hours for the staff to find special filters for him to take home and strain his urine to verify the passage of the stone; when they handed him a small packet of them he laughed out loud, they were the identical filters he used at work every day - you see, he is a bodyshop mechanic/painter.
I looked like a monster and yes I learned my lesson.....It did take a few days to go down....uhhhhhhhhhhhhh
I’m not looking for a handout in medical care.....if was a hefty balance for me and I’m still paying my $25.00 a month.....
$6500
My health insurance provider actually sent me a letter advising me not to pay any additional invoices.
I would love to be able to demand an itemized bill from that hospital, just like I can from that $100-an-hour plumber.
Illegals don't have to deal with any of this, by the way, and they use emergency rooms as the family doctor. The word gets around. If it works, why not?
I do know that I have paid income taxes for 46 years, and "welfare" of all kinds are included already. I don't really feel guilty about not paying another $6000 "contribution" on a $500 visit.
Not only could she have diagnosed and treated herself, she could have performed thyroid surgery on herself too. /s
Unfortunately, that's what medical practice is coming to. I just buy the drugs on the internet now and skip the doctors.
"The doctor who treats himself has a fool for a patient." -Mom
Or just never get sick.....
I see people go to E.R.'s all the time for non-emergent care. That's not what E.R.'s are made for......
You would be amazed.....at the stories I could tell you.
Well, that’s true. But I think you might have missed mine.
A lot of people don’t have enough medical knowledge to diagnose whether it’s something serious or not. Your eye lids are swelling up, do you risk your vision and hope an over the counter medicine will help it, or to go see a doctor as soon as possible, even if it means the ER?
And unfortunately, there is often not an alternative. Wait two to three days to see your doctor or go to the emergency room. Walk-in clinics have helped, but I don’t think my insurance covers them.
There is another group of people that can’t afford to see the doctor, so they go to the emergency room because they know they will not be denied care. That’s a structural problem with care delivery. I don’t know why hospitals haven’t set up 24 hour clinics for non-emergency care. But a lot of what hospitals do is structured by the way they get reimbursed. Government needs to give them more flexibility.
A little yes....but you've cleared it up with this post.
A lot of people don’t have enough medical knowledge to diagnose whether it’s something serious or not. Your eye lids are swelling up, do you risk your vision and hope an over the counter medicine will help it, or to go see a doctor as soon as possible, even if it means the ER?
Well...firstly I wasn't speaking about other people. Secondly I think I said it was my opinion. Not trying to be contrary here....just rehashing what I said about this particular poster's story. Thirdly, IMO....just from what I was told by the poster....she didn't need to see a doctor....A simple call to a PharmD could have prevented a E.R. visit. OR, a phone call to a friend to help them look up info...OR, some plain common sense.
And unfortunately, there is often not an alternative. Wait two to three days to see your doctor or go to the emergency room. Walk-in clinics have helped, but I don’t think my insurance covers them.
You would be amazed at the "free" info that is out there....that can help those that can read, and understand....if they would take the time.
There is another group of people that can’t afford to see the doctor, so they go to the emergency room because they know they will not be denied care.
Emergent care, yes. Other care....nope, you are incorrect. Many E.R.'s deny some care....
That’s a structural problem with care delivery. I don’t know why hospitals haven’t set up 24 hour clinics for non-emergency care.
Many hospitals have.
But a lot of what hospitals do is structured by the way they get reimbursed. Government needs to give them more flexibility.
On this we agree........
No, it is the cost of business, insurance, taxes, technology that drives the cost of business. Doctors annual salaries and insurance reimbursements have been declining since the advent of managed care.
Most hosptials these days are losing money and many doctors are retiring early because the problem.
Good look getting an onocologist or specialist care in your retirement. You will be waiting in a very long line.
The only game is that people expect 1st rate care, the insurance does not pay reasonable rates, and the patient does not want to pay the remainder. This is the reason even the Mayo Clinic will no longer accept Medicare patients insurance.
I can’t tell from the tone of your post. What do you find unbelieveable about your balance?
I think you missed the point, she is not a doctor- how did she know it was a minor thing before she went to the ER and was checked out? I would have went to the ER too if I couldn’t get in to my doctor’s office.
This is what galls me about medical professionals- they go to school quite a while to learn about illness and injuries- and then expect their patients to know exactly when to go to the Dr. or to the ER. To me it is one of the most challenging decisions when I or someone else in my family has an issue. Over the years I have had doctors scoff at my concerns (several times they turned out to be wrong) and I have also been chided by them for not going sooner.
I do agree that sometimes people go to the ER when they really shouldn’t- but many times they go with scary symptoms and are made fun of if it turns out to be nothing. All medical professionals need to remember that few of thier patients have any medical training- so they should not want them to diagnose themselves.
There are a couple of MD’s in my town that have gone to a “new model” with their practice(s)
They have gone “bareback”; meaning that they carry NO malpractice insurance. They have made their practices LLC’s in order to insulate their personal property from lawsuits, and have signs in their waiting rooms and have patients sign waivers acknowledging this fact.
Secondly, they have rejected ALL insurance: office visits are $30 cash on the barrel-head. All necessary tests are outsourced to insurance-taking hospitals or labs. Necessary procedures patients are put on a payment plan, or they pay cash at time of service.
The MD’s in question have been able to cut office staffs radically due to the reduced paperwork from NOT having to file insurance (a major PIA). The get paid at/near time of service, and don’t have to wait for 3-6 months to get paid by 3rd parties.
It must be popular; both MD’s that I know that have gone to this model stay packed.
Reminds me of going to the MD as a child. Small office, one nurse and Mom paid cash when we left.
My husband has a family history of diabetes but had never tested positive himself.
One Saturday, I noted he was drinking water at an astonishing rate and was in the bathroom 4-5 times an hour. He kept saying nothing he did would quench his thirst and he felt like he had to urinate continually.
Knowing the symptoms of diabetes sometimes caused this, I called out next-door neighbor and asked to borrow her glucometer. I tested him three times over a 30 minute period and each time his sugar levels were too high for the meter to read.
I placed an emergency call to our GP and was advised to take him immediately into the ER.
12 hours later we were taken into a room in the ER where his blood was drawn and a urine sample collected. At this time, my DH was sweating, turning white and cold/clammy to the touch. A quick reading on a glucometer showed his sugar level had dropped to 71.
They brought him in OJ and told me to find a 24 hour fast food place to get him some food since the kitchen was closed. I left the ER, found a donut place open and got him a sandwich on a bagel.
Four hours later a doctor came in, looked at the results of the labwork and told hubby to make an appointment with our GP Monday morning. No medicine, no glucometer, no insulin, nothing. We were given “discharge” instructions and sent home. It was then that we noticed the hospital had listed my husbands hypertension NOT hyperglycemia. DH’s blood pressure has always been normal whenever checked.
Then the bills came rolling in. Since the ER put down hypertension, a non-emergency by our insurance carrier, we were originally told our responsibility was to pay 80% of the bills, bills which came to a total of $14,800.
It took me over a year of fighting and in the end we paid only $50, our co-payment for an ER visit.
How anyone could begin to justify almost 15k for sending me out to get him food, telling us to get an appointment and providing him with no treatment is beyond me but they did.
Hubby is now a diagnosed diabetic and in complete control of his glucose levels through diet and exercise. I will admit, our tempers were not in the best control during the year we fought the hospital and our insurance carrier over this mess.
Yeah, me too.
However, my Mom had a job that had a “new” perk: 100% employer-paid health insurance.
What happened was this: Mom would go, or take us, to the Doctor. She would pay, or make arrangements to pay, the doctor on the way out. She’d take her receipt to work, get a form thereat, and file with the insurance company herself. A month or so later, she’d get a check from the insurance company to pay for their contracted share of the bill. Worked like a charm.
All this “managed care” crap has done is drive up the cost of healthcare services due to increased compliance costs; those costs are mostly due to goobermint interference, since private insurance companies have fallen in line with the compliance requirements of Medicare - and they barely pay more than Medicare anyway.
I ABSOLUTELY knew she wasn't a doctor for crying out loud. Ha!! Ah...how about common sense? The poster applied too much of cold cream?? Or something...I can't remember now. Anyway with liability the way it is...don't you think the box/tube had warnings on it? And possibly what could happen if applying too much?
This is what galls me about medical professionals- they go to school quite a while to learn about illness and injuries- and then expect their patients to know exactly when to go to the Dr. or to the ER. To me it is one of the most challenging decisions when I or someone else in my family has an issue. Over the years I have had doctors scoff at my concerns (several times they turned out to be wrong) and I have also been chided by them for not going sooner.
It generally galls the heck out of me...when patients don't follow directions, then want their Doctor to "fix" them. Then there's the pts. that take ZERO responsibility for understanding their illness..but complain about everything. Sure, there are some people that just can't manage their own affairs. But I'm not referring to those people.
I do agree that sometimes people go to the ER when they really shouldn’t- but many times they go with scary symptoms and are made fun of if it turns out to be nothing.
Really? You know this happens "many times". Or is this just your personal experience/history?
All medical professionals need to remember that few of thier patients have any medical training- so they should not want them to diagnose themselves.
Well...we obviously don't agree...I don't expect everyone to have complete knowledge....but I do expect reasonably intelligent people to make reasonable decisions about their health needs. There is so much info out there about so many disease processes....and bodily functions..that's it's irresponsible of most of our population to not have some basic knowledge about THEIR bodies.
Once again....it was my opinion...that the poster needlessly presented herself to the E.R. and then complained about it. And that was my point. And you disagree. Fine...so be it.
FWIW-
The first thing that struck me is how happy I am that you are not my doctor with your attitude. WOW you have the very arrogant attitude that I mentioned.
I realize she admitted she put on too much eye cream, but the resulting swelling of her eyes sounds like a scary symptom to me- one that needs to be checked out ASAP, the eyes are not something I would want to wait before getting medical attention.
Many illnesses and injuries are caused by the patient not following directions- so they shouldn’t seek medical attention if they may have caused the problem? If a man uses a power tool in a way he shouldn’t and causes great injury then he shouldn’t go to the ER, because it was his fault to begin with?
I think if patients didn’t go to doctors for anything they caused- doctors might starve- between bad judgement, avoidable accidents, and poor or risky lifestyle- much of what happens to people could be their fault in one way or another.
I do see a large group of people that fill ERs with common colds, flu, and other minor illnesses- and I don’t think they belong there, and they should know they don’t belong there- but to say someone with eye swelling shouldn’t get checked at the ER- no matter what caused it is amazing.
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