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Shocked by medical billing.

khlifhummar

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It's frustrating when you expect a covered service like an annual wellness checkup only to be hit with unexpected charges. I've had similar experiences with my Advantage plan, where seemingly routine services end up with additional costs. It's important to stay informed and advocate for ourselves when navigating these situations. This article on medical coding audit services sheds light on some of the complexities involved https://www.linkedin.com/pulse/top-5-medical-coding-audit-services-your-practice-josh-souders-hiwbc.
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Balr14

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It's frustrating when you expect a covered service like an annual wellness checkup only to be hit with unexpected charges. I've had similar experiences with my Advantage plan, where seemingly routine services end up with additional costs.
Current medical service providers find more ways to add additional fees than airlines or cable companies do. The true irony of this is that I used to be the head of IT technical support for the medical provider that's robbing me now. My daughter-in-law is a director for that company and my daughter is a director for their primary competitor. Talk about being conflicted!
 
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HoosierDaddy

HoosierDaddy

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I forgot about this thread.

Just updating to say my recent first hospital stay billing was similar to my emergency room visit that prompted this thread.

I tumbled down a hill in San Fran and broke my hip. Hospital billed insurance ~$200,000 but accepted ~$20,000 as payment in full.
 

sms2022

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I've been pretty much immune to illness. Always had insurance thru employer or now Medicare but never even saw a doctor between some time in the 90s and last year when my wife told me to pick a primary care doctor just in case. So, I did and got a bunch of tests and a #%$^ load of vaccinations. Which was nice because now I can tell how many toothpicks are laying on a floor just by a glance. But I digress.....

A while ago, I had a pain in the abdomen and chills in the middle of the night. The insurance nurse hotline said to call an EMT but since I live within a stone's throw of the Mayo Hospital, I asked if I should just go there instead and they said yes.

I went and they diagnosed a kidney stone and told me to see a urologist. But I've had no symptoms in the almost 2+ months since and never bothered. But again, I digress....

Last week I got a statement from my Medicare Advantage plan with United Healthcare.

Mayo billed UHC $7,722. They accepted $1,399 as payment in full . That's less than 20% of the amount billed. I am sure if I didn't have insurance, I would have been billed for the $7,720 (at least) instead of a $50 ER deductible.

Some of the items:

Walking in the door: Mayo billed UHC $2,880; were paid $100.
CT scan: Mayo billed $952; were paid $86.

This is outrageous. If I dented a fender on my car and paid to have it fixed myself, I sure as hell wouldn't get billed for FIVE+ times what they would bill an insurance company for the same job.

The system is F'ed!
Get this one, $80,000 surgery, accepted $1700 from Medicaid. Probably didn’t even cover the cost of the tools they used. Not me but a client who just showed me their EOB today. Timely thread.
 

DrZed

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The other problem is this:

Mayo may have charged the OP a cost of $7722, but stroll a few blocks or cities outside of the area and you would find 3+ or more Hospitals that would charge in excess of $7722... like 3x+ more that amount for same SAME EXACT procedures and tests.

The medical pricing structure has NO standard at all. It’s insane what these Hospitals, Pharmacies and Doctors can charge.

Ever see the multitude of drug commercials on TV? Do you ever question the fact of how can Drug Company XYZ charge $500 for prescription strength ABC, but if you call them you can get a discount code or discount to only pay $25.00 for it? The question should be - WHY isn’t the normal cost $25.00 straight up from the get go, instead of $500?

It’s all a big scam and if the patient does not review his or her bill and does not question charges on that bill or the cost of their needed drugs - guess what, they’re over paying and being flim-flammed by the Hospital, the Dr. AND their Health Care Ins. Co.

Imagine all of the people who DON’T question or call about their medical bills and just pay the dislike value seen on the statement?

Robbery in broad daylight without anyone even questioning or reporting it, that’s what is going on with medical billings.
FLIM FLAMMED! It's been a dogs age since I heard that. It is my goal this week to use it!

TY.
 

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Shifting_Gears

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So, we had our first child in early December. Still sorting through billing headaches and trying not to get screwed.

The most ridiculous things were as follows:

Baby is covered 30 days post-birth under my coverage. Hospital and pediatrician try to bill under the baby’s name, insurance rejects. We receive bills for $1,000’s. Call insurance, they state they never received billing from the hospital. Told to rebill under my name. Contact hospital, initiate rebilling under my name. Insurance rejects. Find out to has to be billed under my wife’s policy. Meanwhile we are getting letters demanding payment from the hospital with the threat of collections. The amount of time wasted on the phone between the hospital and insurance company was ridiculous.

Baby’s hospital bill included charges for the same after birth suite, which was also billed on my wife’s bill. The hospitals logic is they are both patients, so they each get charged for the same room that they were both in at the same time.

Services rendered at an in network hospital were performed by out of network specialists, the in network hospital. Had to fight to have those covered.

Hospital double billing the baby’s services, same services and two different amounts. Hospital doesn’t know why we are being charged twice, tells me to call them back in a week so they can figure it out.
 

Silver Bullitt

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Services rendered at an in network hospital were performed by out of network specialists, the in network hospital. Had to fight to have those covered.
This has to be one of the biggest headaches for patients. Like we are supposed to ask every single person we see if they are in our network. Oh, where are you sending my blood work? Are they in network? F’ing ridiculous. If the hospital is in network, then the doctors working there and the labs they use should all be required to be in network. The onus should not be on the patient! Period!
 

sk47

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Oh, where are you sending my blood work?
Hello; I moved to a new area 14 years ago. Found a new GP. Got to be every time I visited his office he ordered a blood draw. I would pay my copay at his office in full. A few weeks later I would get a bill from a hospital in a town 15 miles away where he sent by blood.
I finally called my insurance to see if I was required to pay two co-pays for the same visit. Took a while to get the second charge dismissed. Kept happening even after I went to the doctors office a few times and reminded them.
Eventually i switched doctors. The current place will also draw blood sometimes but no more double billing.
 

Shifting_Gears

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This has to be one of the biggest headaches for patients. Like we are supposed to ask every single person we see if they are in our network. Oh, where are you sending my blood work? Are they in network? F’ing ridiculous. If the hospital is in network, then the doctors working there and the labs they use should all be required to be in network. The onus should not be on the patient! Period!
Yeah, it’s truly ridiculous. You don’t even see some of the people… they’re “behind the scenes”.

Not to mention they sent in someone with a credit card machine to take payment before we were discharged. I asked for what, and they said to reduce the bill prior to insurance receiving it. Lol. I said sure, take the peanuts left on my HSA card. Funny how they would take ANY amount she can’t even tell you what the total is. They don’t even know at that point.
 

Silver Bullitt

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Yeah, it’s truly ridiculous. You don’t even see some of the people… they’re “behind the scenes”.

Not to mention they sent in someone with a credit card machine to take payment before we were discharged. I asked for what, and they said to reduce the bill prior to insurance receiving it. Lol. I said sure, take the peanuts left on my HSA card. Funny how they would take ANY amount she can’t even tell you what the total is. They don’t even know at that point.
I refuse to pay anything before I get an EOB from my insurance carrier. I’ve walked out of an MRI before because they would not perform the procedure without prepayment. They can sometimes get the amount you will owe from insurance, but I still refuse to pay in advance.
 

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Strokerswild

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FLIM FLAMMED! It's been a dogs age since I heard that. It is my goal this week to use it!
Heh. A friend and I often use 'flim-flammery' when referring to an unusually high level of bullshit.
 

Joe B.

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Retired now, I have always had the Cadillac of health insurance through my Carpenters Union. As of Jan. we retirees got put on a Medicare Advantage plan.
Still waiting for the air to clear, but someone in management got flim-flammed to the point that the trustees gave all retirees and their spouses each a check for $1000 because of the negatively perceived changes in coverage.
I have not needed any medical so have no personal experience yet with the new plan, but I have never been asked for a credit card before services and hope I never will.
 

RPDBlueMoon

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The healthcare is absolutely trash, and I say that as someone who works in the industry. I am very thankful that I can use the VA and I'm entitled to Tricare so I don't have to rely solely on Medicare or employers insurance.

Where I live it doesn't even matter if you have insurance or not because you are going to the same place and getting the same treatment. The hospitals here only care about milking as much cash as they can from patients and its really bad. We pay the most and have the worst medical outcomes of any developed country. Its like paying $30 for a big mac at McDonalds. Its only going to get worse in 2030. Really wish more was being done because the high costs aren't indicative of high service like you'd expect.
 

Balr14

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The healthcare is absolutely trash, and I say that as someone who works in the industry. I am very thankful that I can use the VA and I'm entitled to Tricare so I don't have to rely solely on Medicare or employers insurance.

Where I live it doesn't even matter if you have insurance or not because you are going to the same place and getting the same treatment. The hospitals here only care about milking as much cash as they can from patients and its really bad. We pay the most and have the worst medical outcomes of any developed country. Its like paying $30 for a big mac at McDonalds. Its only going to get worse in 2030. Really wish more was being done because the high costs aren't indicative of high service like you'd expect.
It would be like paying $30 for a Big Mac, if you added $2.00 for the box, $1.50 for the paper it's rapped in, $10 for the services of the person who rapped it and put it in the box, etc, etc.
 

detamble13

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Canada is not that far guys and the winters aren't as bad as they used to be. Come on up.
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