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Author Topic: Tell me there's been a mistake!  (Read 1882 times)

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Offline blusky_1

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Tell me there's been a mistake!
« on: August 30, 2003, 06:10:38 AM »
I just got the Explanation of Benefits from my worthless insurance company regarding the charges for the outpatient surgical center. I think the surgical center billed wrong...VERY WRONG! They charged $8675 just for the use of their facility?!?! My 3 procedures only cost $6724, so how can 5 hours in this center be so much?! The surgical scheduler for my OS had told me it would be around $800 for the center.  And the day before I went in for surgery, I spoke with someone in their billing department and was told that even of I had a 20% copay, it shouldn't be more than $200 on my part.

I'm really freaking out here.It is bad enough that I still have to come up with the $6724 for the OS, then my trip to the ER.....UGH! Can we say bankruptcy???

Brooke
Arthroscopy 8/8/03 - partial meniscectomy (x2), chondroplasty, lateral release (failed). 1/04 - dx with "miserable alignment". 11/04 - dx patella baja.

Offline tazmanian_devil

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Re: Tell me there's been a mistake!
« Reply #1 on: August 30, 2003, 07:06:03 AM »
Brooke, I don't blame you for freaking out but I'm sure it's a mistake, you didn't ask for a pain pill did you??!! :o cause I understand those are $1,000ea. LOL So don't worry all weekend. Theresa
« Last Edit: August 30, 2003, 07:09:15 AM by tazmanian_devil »
L ACL Recon. L lat. meniscus tear 1991, R Dislocated 1996, R ACL partial tear, MCL tear 08/01, R Chondroplasty 2/14/02, R Lateral Release-Medial Reefing-Chondroplasty 12/3/02.

Offline Heather M.

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Re: Tell me there's been a mistake!
« Reply #2 on: August 30, 2003, 09:15:40 AM »
I think you should talk to the person you spoke to pre-op, but....my surgeries have all been around $2000-$4000 just for 1-2 hours in the surgical center.  It's obscene.  And the anesthesiologist, OS and supplies ($160 for an ICE PACK) were all extra.

However, if you were told it wouldn't be more than $200 keep following up.  There has to be some reason--were you kept a long time?  Complications?

Time to start calling people and yelling.  Don't fret about bankruptcy yet, most places will allow a very long-term payment plan with low to no interest.  Try to straighten it out before you freak.  We're here to bounce ideas off of, don't worry.

Heather
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline Janet

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Re: Tell me there's been a mistake!
« Reply #3 on: August 30, 2003, 06:51:03 PM »
The first thing I would do is ask for a detailed listing of all the charges that added up to that huge amount! They might have told you one figure just for the surgical suite, but by the time they added all the extras like bandages, pain meds, etc., it really adds up. I was sent a detailed reporting and found that they actually charged separately for everything from gauze to needles to pain meds. I was surprised, but the total was only about $3,000.

Janet
Torn quad tendon repair & VMO advancement 4/99, MUA with LOA 10/99, Patella baja and arthrofibrosis, LR & medial release & LOA 5/01, LOA & chondroplasty 6/03,TKR on 11/06, MUA 12/06. From perfect knees to a TKR in 7 years, all from a fall on a wet floor...and early undiagnosed scar tissue.

Offline blusky_1

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Re: Tell me there's been a mistake!
« Reply #4 on: August 30, 2003, 07:19:08 PM »
I plan on stopping by there on my way to work Tuesday and asking for a detailed listing. As for paying a bill that large....honestly, I already have about $25,000 in bad debt from my divorce 5 years ago, so they can just get in line, or not get a penny! They did give me pain meds, but I can't remember how much. I know they gave me a shot in the butt..took me a few days to figure out why it hurt so bad, then I saw the telltale bruise.  Three weeks later, I still have a lump there and it hurts to put pressure on it (sitting back in bed reading, etc). I just remember I was in terrible pain due to the LR. I was knocked out for approx. 5 hours. I refused to let myself completely wake up until they called my ride to come get me. They putzed around on that. Every time I'd wake up (every 10 minutes or so), I'd ask if they had called him yet and they told me no. Starting to sound like a scheme to keep me there longer to pad the bill some more! UGH!

I called my father last night and warned him thatif this bill is correct, he better be ready to help me file bankruptcy (he's a bk attorney)! He told me not to worry about the bill and finally agreed that it would be time to file if the bill is correct. I'm sending him all my itmeized bills as I get them, and he's going to be the jewish lawyer that he is....trying to bargain as if he's buying something at the flea market! He said his surgeon for his triple-bypass settled for 50 cents on the dollar. Hence the term "Jew them down"...my dad is one of the oes contributing to the term! He hasn't even started and I'm already embarrassed! I figure at least if I file bk, I can start over with a clean plate. At this rate, I'll never qualify for a home loan. Geez, my last car loan on my own ( 1998 ) was at 21.99%, and the last one with a co-signer with good credit (2001) was 16.99%. Luckily, I've paid that off, but with the high cost of living in Denver, my $26,000/year doesn't go far at all! Now I'm finding out my knee is worth a whole year's salary....ever feel like you can't win for losing? *sigh*

Brooke
« Last Edit: August 30, 2003, 07:30:12 PM by blusky_1 »
Arthroscopy 8/8/03 - partial meniscectomy (x2), chondroplasty, lateral release (failed). 1/04 - dx with "miserable alignment". 11/04 - dx patella baja.

Offline Jennie

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Re: Tell me there's been a mistake!
« Reply #5 on: August 30, 2003, 08:25:58 PM »
Hey Brooke

The same day surgical centers are up there...my TTT cost $9000 and my hand surgery was $4000 at the surgery center so therefore the rest I have chose to have at the hospital!

Good luck
Jennie
21 yrs. old..Right knee injury. Ligament Recon 6-21-01, 2 LR's 3/02 & 9/02
TTT 11/08/02, patella and ligament recon 5/03
Recently dx with OA, Having hardware removed and knee scoped on 6/24/04

Offline Donna

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Re: Tell me there's been a mistake!
« Reply #6 on: August 30, 2003, 08:40:13 PM »
Brooke,

I sure know what you are going through.  At my latest outpatient surgery center where my stay was only 5 hours also; they billed my insurance over $19,000 for the use of the surgery center.  The previous four knee surgeries before this one I had done outpatient at a hospital never cost more than $3300. This new place just billed my insurance; received their money and my insurance sent me a explanation of benefits. Something seems very fishy to me. I did call the insurance commission on this because I also have never received a statement of any kind with a description of these charges from the surgery center.
I sure plan to get to the bottom of this. I am going to demand a detailed statement from them.

Best of luck to you and I hope everything works out.

Donna
4/88 menis, chondroplasty,
10/01 menis, chondroplasty
2/02 microfrac,chondro,menis,
4/02 Fulkerson TTT, LR, microfrac,
2/03 open LR,fat pad removal, lysis,menis Still need more surgery.

Offline Heather M.

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Re: Tell me there's been a mistake!
« Reply #7 on: August 30, 2003, 10:17:08 PM »
Brooke,

One thing to consider is the billed amount vs. the contracted amount.  For example, the billed amount is what the patient with no insurance pays.  For my surgery it was $4800 for the surgery center.  And I was there for an hour.

But when I looked back months later at what the insurance company paid, I saw that their maximum contract amount with my insurance company was 10% of the billed amount.  So my insurance company paid $480 to settle that bill.  It's criminal--when I was self pay I had to pay it ALL, yet the insurance company squeezes them for .10 on the dollar.

So be sure to follow up and see what the contract amount your insurance company will pay is--hopefully, your copay will reflect THAT and not the billed amount.

Heather
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline Jillian24

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Re: Tell me there's been a mistake!
« Reply #8 on: August 30, 2003, 10:17:35 PM »
Brooke,
   Hang in there kiddo~ I have a feeling you will find that they back down, especially now that your papa is on your side. I live in Tahoe and the cost of living is outragous here too! I have been lucky that all of my surgeries have been covered my double insurance through my parents. But now I am on my own and about to have a TTT. (Donna your freaken me out!, we go the to same OS) I had very very very bad luck at our local hospital and I really really really don't want to go there, but the surgery center will cost sooooo much more. So I guess I have quiet a decision to make.
The good thing about med bills is that as along as you pay a little bit they are happy. Thats all you can do, then thats all you can do. Don't give up, and ask question, many questions! I wish you the best of luck and I will be thinking about you.   Jillian
ONE TTT LAST OCT
10 LR'S    ONE MEDIAL RELEASE
STAPH INFECTION.....MANY MONTHS IN HOSPITAL

Offline enuff81020

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Re: Tell me there's been a mistake!
« Reply #9 on: August 30, 2003, 10:33:21 PM »
Hi!

I'd have reacted to that bill too--wow.  My experience has been like Heather's--the surgical center and the hospital that I (have to) use are part of my insurance compan\y's PPO and the part they are billed and actually pay is a lot less than the price quoted.  It makes me really mad though because they als o feel as if they can call the shots on my tratment and care--# of days, kinds of meds, support, etc...It is most annoying and it is obscene.  They do not know me or my needs and I doubt if the bean counters know a lot about medical care--just about $ and keeping down the overhead.

Take a deep breath--you know if they are outrageous that you have a plan and the best possible help.  Good luck, I'm thinking of you, Sylvia
Both kneesOA.
Scope on rt knee,9/00;2/01
scope w/ LR and debridement rt knee 2/02
left knee same5/02
Patellar problems
LeftTKR12/16/02
Right TKR7/14/03
Complications MUA 8/14/03
R TKR revisio

Offline blusky_1

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Re: Tell me there's been a mistake!
« Reply #10 on: August 30, 2003, 10:51:00 PM »
Thanks all for your responses. I'm starting to think there was no mistake in the bill after all. What really gets my is that I was lied to from the get-go...from the surgical scheduler, the billing specialist at the center, and by my piece of &$!* insurance company! Here's what my EOB shows:
Total Charge: $8674.85
Ineligible: $6437.89
Reason Code: MB (Max. payment for benefit plan has been ehxausted)
Adjustment Amount: $2168.72
Covered by plan: $68.24
Deductible: $0
Co-Pay: $0
Balance: $68.24
Paid At: 70%
Payment Amount: 47.77

Than at the bottom, it states "Patient is responsible for all Deductible, Co-Pay and certain Ineligible amounts." I paid $100 when I checked in that morning. Considering all  the damage their anesthesiologist did inside my mouth and the problems days later due to him not listening to me, I think the $100 was more than fair on my part! LOL
Arthroscopy 8/8/03 - partial meniscectomy (x2), chondroplasty, lateral release (failed). 1/04 - dx with "miserable alignment". 11/04 - dx patella baja.

Offline sgriff4644

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Re: Tell me there's been a mistake!
« Reply #11 on: September 01, 2003, 04:19:07 PM »
I would go back and check with the surgical center to make sure they applied the appropriate write-offs.  When I got my EOB's for two hours of surgical center time, the basic charge was similar to yours.  They applied massive write-offs to bring the charge in line with the negotiated rates they pay the insurance companies.  The insurance company then took this reduced charge and applied the deductibles and co-pays to a much smaller number.


Offline dm

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Re: Tell me there's been a mistake!
« Reply #12 on: September 01, 2003, 05:49:54 PM »
Brooke,
One thing to do is to check with the insurance plan documents to see what the exact contract is. I've found that the person on the phone has sometimes been wrong. Who knows what they're looking at ???My company sends each employee a copy of the plan docs so you can look up exactly what the coverage is and what he exclusions are. That's one way to make sure they didn't tell you wrong, since most ins co c/s depts deal with multiple plans.  They should also have a record of who you talked to on the date you called the ins co to ask.  Keep fighting it, sometimes the persistent "little guy" can win! Good luck!
multiple arthroscopies 2/00,3/01,6/01,1/03, 12/07,10/10. chondromalacia, severe medial joint space narrowing following 3 partial menisectomies, chronic pain problems, kneecap problems, OCD lesion, failed mfx.

Offline Janet

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Re: Tell me there's been a mistake!
« Reply #13 on: September 01, 2003, 10:50:45 PM »
You can always ask for them to reduce the amount you owe. My son had surgery at the Cleveland Clinic when he was two. We had to sign a form that stated they would charge over the "usual and customary" for their services and we were liable for the difference. But when the bill came and I called to make payment  arrangements, they told me that if I paid it all at once, they'd give a 50% discount! I took them up on that right away. Anyway, it never hurts to ask if there is any way to reduce what you owe. By law they have to bill you for it, but they don't have to collect it all. Good luck.

Janet
Torn quad tendon repair & VMO advancement 4/99, MUA with LOA 10/99, Patella baja and arthrofibrosis, LR & medial release & LOA 5/01, LOA & chondroplasty 6/03,TKR on 11/06, MUA 12/06. From perfect knees to a TKR in 7 years, all from a fall on a wet floor...and early undiagnosed scar tissue.

Offline blusky_1

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Re: Tell me there's been a mistake!
« Reply #14 on: September 03, 2003, 04:54:05 AM »
What a relief! I went by and picked up a copy of the charges and balance due. Even though my insurance isn't going to pay, their contract still works as far as what the center can charge. Soooo...I only owe $1766! I would love to see it broken down even more, but I'll settle for the fact that they adjusted $6760 from the bill! They charged for 14 units of "drugs" (only $163), 31 units of "med-surg supplies" ($583), 9 units of "equipment ($425) and 15 units of the recovery room ($570)...where they got me was in the fact that they also charge for each procedure! 1 was $1512, one was $2932 and the final was $2489.... and that's separate from what the OS charges! I'll never understand how they can get away with stuff like that! What a mess! At least $1766 is workable...now I just have to wait and see what the final charge from the OS is...maybe they managed to cut his bill down too!  ;D

Brooke
Arthroscopy 8/8/03 - partial meniscectomy (x2), chondroplasty, lateral release (failed). 1/04 - dx with "miserable alignment". 11/04 - dx patella baja.















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