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Posts Tagged ‘medical billing’


Yep.  That’s me. Are you being screwed, too? 

I cannot think of another way to summarize the health care system besides using this term. When you live in a small, rural community that is isolated from the rest of the world, I really do think that the health care systems feels you are supposed to feel indebted to them while being screwed. And if you don’t?  Well, they don’t give a rip.

You may recall my earlier post about 2010 and the struggles I’ve been dealing with regarding medical billing. Yes, they continue. I spent nearly 6 hours non-stop today scanning, copying and summarizing the one situation in my complaint to my state’s Public Regulation Commission (PRC). 

Do I feel better? No. Why not? I’m expecting to be screwed yet again for reasons that are presently unknown to me.

The health care system is not just screwed up, it’s totally broken.  I have *zero* hope that it will ever get fixed.  Socialist health care won’t fix it. Goodness knows having insurance doesn’t contribute in any way past lowing the dollar amount owed by those with good insurance by which the consumer gets screwed.  It’s like having a bullseye on you when you have insurance.

Seriously.  One test now in dispute was billed at over $220.  Insurance says “reasonable and customary” for that procedure is around $40.  Insurance paid at 90% even though the PPO provider sent the labs to a non-PPO lab.  Which means…… I am “responsible” for paying the difference.  See -that’s getting screwed. 

Insurance says the contracted amount should only be around $40 and will pay over $35. My portion, if the lab had been under contract with my insurance group, would have been around $3.95.  But I, the consumer playing by the rules, is going to be billed the remainder of that $220 plus amount, and will be screwed if I don’t pay.  And, I’ll be charged tax on the whole amount because, since the provider is not in network, neither is lab testing, which means they can charge me gross receipts tax for any non-covered procedure.

I can’t tell you how darn tired I am of getting screwed. The consumer, as far as I know, has no recourse, except to file a complaint and ask for an investigation. It feels like everyone is out to take advantage of people who do have insurance, especially those in poor, rural locations where options for care are not abundant. 

In my opinion, if I go to a PPO (in-network) provider for a ser vice that is contracted and covered by my insurance, it should be the responsibility of the provider to perform and likewise send labs to other PPO providers. I was never given a warning that this would not be the case, nor the option to specifically chose who labs get sent to. Rest assured, I would have travelled 200 miles in any direction to ensure that things would go to ONLY PPO providers had I known the alternative. Traveling would mean ultimately paying more out-of-pocket, but to not have the battle afterwards would justify the expense, in my opinion.

I’ve also recently been told that no one cares about pursuing this because of the low dollar amount.  Excuse me? For me, it’s not so much the dollar amount as much as it is the principle of the thing.  I’m not one who says, “Oh, gee, because this one only costs “x” amount, I will pay it.” It doesn’t matter.  The point is that they could charge you *ANY* amount.  Dollar amount does not make something right. The could charge $2,000 for the labs or the procedure – they could only charge you $2. Some might say that the lower dollar amount isn’t worth their time to fight.

Who is going to pay me for the 6 hours I spent today to speak up? If they charged everyone $2 and no one complained, it wouldn’t take long for it to add up. They can screw up my credit rating over $2 if I don’t pay it, yet I have no recourse for unethical and fraudulent billing?

Here’s another problem with the medical community where I live.  In order to get into a doctor, it takes as a new patient nearly 3 months to be seen. Most doctors here are already overwhelmed and aren’t accepting new patients.  Until I got sick 3 years ago, the only medical person I saw in the last 15 years was my midwife. That’s right, I don’t use doctors unless I have to.

Now imagine you don’t have a family doctor and you or your child gets really sick with a respiratory something. Is it reasonable for you to wait 3 months to be seen – or even 2 weeks if someone is willing to try to squeeze you in -when you are very ill and having difficulty breathing *now*?  No, it’s not.  So, what to are your choices?  In the last year, we have finally gotten a single non-emergency after hours clinic that is open on Saturdays and until 9 pm. Before that? Nada.

It was no wonder people went to the emergency room for non-life threatening problems! Initially, my company’s health insurance plan responded by changing the deductible for emergency room visits.  At first, it was $300 out-of-pocket, which did not go towards meeting the deductible, and then it was contracted plan amounts after the deductible was paid. Then, it went up to $500 out-of-pocket etc. This extra amount was waived in the event you were admitted to the hospital. 

I don’t know what it is now, but our family motto is that unless death is imminent, we’re not using the ER (which only works unless stitches are needed). And, even though you go to an in-network/PPO provider like both of our local hospitals, the ER doctors are provided by a company/service which was not contracted with my PPO, which meant that we got charged all the excessive charges because they weren’t bound to a contract.

Both hospitals used this same service because since we are in a rural town, they weren’t able to ever get enough people on staff to cover the ER. So now you get totally screwed again. And charged tax because the doctors are providing the in-network provider with out-of-network services.

Yes, I know the world isn’t fair. Yes, I know I have no real impact over anyone doing (or not doing) the right thing. But I am TIRED OF GETTING SCREWED.  If that means I have to waste my time to complain and go public, then I will. Until you and I, the consumer, keep at it until someone gets tired enough of hearing from us to address the issue, unethical and fraudulent medical practices will continue.

But darn, I am tired of the fight. I’m tired of the hassle, the headache, the stress and chasing things down trying not to get screwed. If you have answers, please share!

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Yes and I don’t know.   I had 9 major items on my to-do list today, most of which involved using the telephone.  I am not a phone phobe, but I admit that I *much* prefer email and other online communication. Calling is rarely something I look forward to doing.

Calling to struggle with medical insurance and billing is never something I look forward to doing. Today was no exception. I always anticipate a solid, uphill battle; rarely actually seeing the results that were supposed to come from the first round of calling.

The result today is a mixed bag. I did get the one bill issue resolved, I think.  She said she deleted the one account addressed to Hunny Me; hopefully it really IS resolved.  On the upside, two bills – both to labs with the same name but different locations – were sent for review when I called a few weeks ago, even though I hadn’t gotten the second bill.  BOTH of these bills were from last April.  Are you kidding me?  It takes 8 months to finally bill insurance?? 

 

While insurance did pay the in-network amount for “reasonable” charges on both bills, there was a substantial amount of the most recent bill that was not deemed “reasonable” by insurance.  *This* part of the billed amount is what the other providers (out-of-network providers practicing at in-network facilities from my post here: 2010) like to use to try to screw over consumers with, in my experience. 

Even though my insurance has graciously paid at the in-network price on the reasonable charge, because the provider is out-of-network, they justify charging you the whole amount because they are not bound to any kind of contract with your insurance.  See how this works?  They could charge you a million and $1 dollars for a Tylenol, and expect you pay the million dollars your insurance has deemed to be not “reasonable and customary.”

Now I get to sit and wait. When it comes to this kind of stuff, that usually means worrying, too.

Was the day a total loss?  I don’t think so.  I think it was a victory to get the one account cleared up, and hopefully that solution sticks.  I made numerous phone calls over several hours; calls that I had been dreading.  I feel better knowing those are off my mental plate.

I also got some work stuff accomplished, which is also nice to get off my mental plate.  I missed my opportunity for a nap today, and my head is pounding. I am hopeful it will not become a migraine.

I haven’t gotten anywhere with the dealing with the stuff issue, as we didn’t get the cubes (see my Stuff  post to know what these are).  We looked at the cubes, but the sale was over, so we’ll wait until they come around on sale again. That might actually give us time to sort through the stuff and get some of it sorted!  😆

I feel good about what I got done today.  It’s a tight time-line, and I need to stay on track. I am a list-maker on days when I have a lot to do.  It’s a good feeling to cross things off that list and know you won’t have to do those again today. Tomorrow, I’ll make a new list, unless I do that tonight so I don’t forget something.  😆 

For now, I am going to drink my pot of chamomile tea, and think about what to make for dinner.   🙂

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