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 ...
Bump
Actually you know nothing about me....but I respect your feelings.
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.
It wasn't swelling of her eyes. It was the eyelids. Great difference. There you go again.
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?
I never exactly said that, did I?
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?
Okay......obviously we can't have a conversation. I can think of many things to say here...But let's just end this here.
Thanks
That does look just like the filters we use to strain urine! The hospital costs of all items have to include employee costs from purchase, delivery to Central Supply, filling each floors Pyxis System.
http://www.cardinal.com/us/en/providers/products/pyxis/
So does the paint supplies store.
Had some of the places try to collect, threaten a bill collector, and then I tell them to check with Federal BC/BS and give them the number and then call the local Federal BC/BS — their calls and letters stop.
They do it to my Mom all the time and I refuse to pay her bills like this but if I wasn’t handling it, I am sure she would pay.
We had one that threatened to ruin my Dad’s credit so he couldnt’ buy a car last year and he died in May ‘97. ou should have heard my comment to that remark. Believe they prey on senior citizens.
I just now noticed this thread.
It is not just insurance write-offs ("adjustments") that are relevant here, either. This past March, I received a bill from a provider for about $1,200 in unpaid charges. However, I had the pertinent EOBs, which I collect and enter into a medical spreadsheet: They indicated that the provider had been tardy in filing with BC/BS for reimbursement (the carrier allows 180 days); therefore, neither they nor we are responsible for the charges.
I sent a copy of the pertinent EOBs (there was a total of five services involved) to the provider, and that resolved the matter.
I do the same thing with bills and what they submit so I can go back and check on them when they come calling about some deliquency that is their fault not ours.
What bothers me are the people that don’t understand what is happening. There would have been $2500+ paid out this year if I didn’t track everything. The billing departments for medical have gotten so much worse over the last few years.
What bothers me are the people that don’t understand what is happening. There would have been $2500+ paid out this year if I didn’t track everything. The billing departments for medical have gotten so much worse over the last few years.
You are to be congratulated for checking your bills (and your mom's bills) carefully before paying them. Like you, I believe in paying my legitimate obligations promptly; but paying for other people's mistakes is quite another matter.
Some people make the mistake of believing that whatever a bill says must be correct. But the people who work in billing departments are not infallible. And there is an old saying that is certainly applicable here: No one else will look out after your interests the way you will.
And you are surely correct in your observation that billing departments, by and large, have become more aggressive in recent years. My guess is that those who work in these departments have been instructed to bill the customer for all unpaid charges--even if the billing department was delinquent in filing the claim, and therefore at fault--in the belief that many will not notice, and will compliantly pay the amount for which they are billed.
Let me ask you this. You bill my insurance company, lets say Blue Cross Blue Shield, $276.00 for services to me. Blue Cross determines that the allowable amount is $166.00 They then pay you $149.00 and I pay my coinsurance of $17. End of story.
Now let me ask you this. Lets say I don't have any insurance coverage at all. Are you going to bill me the same $276.00 or are you going to bill me the $166.00 which is what the insurance company would normally have paid you ?
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