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  1. #1
    Grandma broke her coccyx! Uncle Rico's Avatar
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    Medical Bills
    As some of you know, my wife has had a lot of medical procedures in the past month. We have Blue Cross & Blue Shield insurance. For the types of services she has had, we have a $1000 deductible and a $2000 co-payment. Our insurance clearly states we have a $3000 max out of pocket expense.

    At this point, we have paid out the $3000. Now, I see the bills going to the insurance company and what they are paying the providers. The hospital, general surgeon, and plastic surgeon are all sending us bills for the amounts Blue Cross & Blue Shield did not pay for 100%.

    So my $3000 max out of pocket seems to be a bunch of crap. If I add up the bills we received from the various providers and add to the $3000 I have already paid, I am close to $6000.

    I guess this is one of the problems with health care. The provider provides service and bills insurance company for $10,000 for procedure A. The insurance company says that procedure A should cost $8000 and send a check to provider for $8000. Provider then turns around and sends a bill to patient for $2000.

  2. #2
    Beachy Bill's Avatar
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    Unfortunately, that is one of the vagaries of the intra-state, rather than inter-state, nature of insurance laws. Here in Maryland the copay is all we have to pay; providers must accept what the insurance companies pay.

    When I go to a doctor for a check-up or an illness I pay five bucks - that's it. Blood tests, in-office EKG, etc. are all included (even though I see the lab bill gets paid only about half of what is invoiced to the insurance company).
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  3. #3
    Grandma broke her coccyx! Uncle Rico's Avatar
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    When we go to the doctor for a checkup or illness, we pay $20. The deductible and co-insurance only kick in when there are major services performed like in this case.

    Seems like a crock. The hospital and providers are all in-network with BCBS.

  4. #4
    Moderator leeann's Avatar
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    I'm surprised the insurance co. paid your bills already. If it was all in-network, they should only be charging what the insurance will pay. You may have to do some fighting.
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  5. #5
    ABW Ambassador Greg Rice's Avatar
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    Sounds like time to ask some questions, of both BCBS and the provider. I would think that if the provider is in network, that means they agree to charge what the insurance will pay. I'm not sure about this though.
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  6. #6
    Influencer Marketing GravityFed's Avatar
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    Works out really well for the ins companies doesn't it?

    And just think at this point some people in your situation Seymour get their coverage dropped altogether.

  7. #7
    Moderator MichaelColey's Avatar
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    Like the others have said, I think it has to do with in-network vs. out of network. If they're in network, part of the agreement for being in the network is accepting the network-negotiated amounts. If they're not in your network, they're under no such obligation.
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  8. #8
    Grandma broke her coccyx! Uncle Rico's Avatar
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    They are all in-network 100%. I will have to make some calls.

  9. #9
    OPM and Moderator Chuck Hamrick's Avatar
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    My wife is a State Farm insurance rep so I asked her opinion:

    Before you bad mouth the insurance company, you should be contacting them to assure that all medical parties involved are in network, contracted providers. As such, they are bound by their contract with the insurance company to NOT bill you, the insured the difference. This is a physician issue, not the insurance company issue.

    We have found through experience that some providers profess themselves to be "In Network", but fail to tell you that they are not "contracted". There is a difference. We have been through surgery at an approved, contracted facility, with contracted surgeon, nurse, lab tech, just to find out that the anesthesiologist is not contracted - stuck with a big bill there.

    You need to contact your insurance company, go over your coverage in detail, go over every physician and bill in detail and find out why they paid what they did to each and to make sure the provider is in fact an in-network, contracted provider.

  10. #10
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    Quote Originally Posted by SeymourButts View Post
    They are all in-network 100%. I will have to make some calls.
    The state insurance commissioners office in the Albemarle Building is a good place to start. Nothing is 100%, but they usually are willing to give good advice and in some cases they will push the insurance company.

    Good luck and I hope that things work out for you.

    PS.....Chuck posted while I was composing. His advice is totally good...................
    Last edited by Witzer; April 6th, 2010 at 02:37 PM. Reason: PS
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  11. #11
    Grandma broke her coccyx! Uncle Rico's Avatar
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    The BCBS rep I spoke to has confirmed to me that the hospital, surgeon, plastic surgeon, and anesthesiologist are all in-network. This may be an issue of timing, where the providers are not fully aware of how much I have contributed to my deductible and co-insurance amounts at the time the bills were sent out. Or, maybe they are aware.

  12. #12
    OPM and Moderator Chuck Hamrick's Avatar
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    Its a lot of work and frustrating but you have to treat it like questionable charges on your credit card statement. Use the system to make them account for everything.

    Unrelated but similar, I got a ticket after I moved out of Colorado. The ticket was in Wyoming and I live in Utah. I lost the ticket and had changed my license to Utah. About a year later I voluntarily contacted Wyoming to get the ticket paid. Then I get a notice that my insurance was to be canceled because I had a suspended license in Colorado. I had to prove that the ticket was paid and then petition to get my license reinstated in Colorado. This took two months and cost and extra $95. Once that was done my insurance company dropped it and was able to renew. This was in in February and I haven't had a Colorado license 2008. Moral of the story is I had to play the game by their rules.

  13. #13
    Grandma broke her coccyx! Uncle Rico's Avatar
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    I plan to let the bills I have sit for a little while anyway. If after much investigation and inquiries I find that I do owe this additional amount, I will pay it. I won't be happy to pay twice my max out of pocket, but oh well.

  14. #14
    OPM and Moderator Chuck Hamrick's Avatar
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    I hope it works out, there is nothing more stressful than bills after surgery. I have been running $1000 behind each year versus the Flex Spend account I pay into. Have it maxed out to $5k per year but with six in our family we have had at least one surgery a year for the last 4 years. We got hit with a $900 anesthesiologist bill after we found out he wasn't in network. My wife blew out her knee skiing two weeks ago and started physical therapy. The PT is a family friend who said not to go too often because she will need more PT after surgery. Cheryl is checking the pre-autorization closely so we don't get any surprises. I am putting off ACL surgery for next year as mine isn't too severe.

  15. #15
    ABW Ambassador meadowmufn's Avatar
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    Quote Originally Posted by SeymourButts View Post
    I plan to let the bills I have sit for a little while anyway. If after much investigation and inquiries I find that I do owe this additional amount, I will pay it. I won't be happy to pay twice my max out of pocket, but oh well.
    My guess would be the timing too. I'm betting once all is said and done, since they are all in-network, you won't have to pay those extra bills. It just takes a little time and diligence on your part, not something you want to deal with during times like these...
    -Don't criticize anyone til you've walked a mile in their shoes. Then when you do criticize them, you'll be a mile away and have their shoes.
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  16. #16
    Moderator leeann's Avatar
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    Also, if you do find out (which will probably take months) that you owe, talk to the doctor. Many times what is billed to an insurance company is far more than what non-insured people pay. Most physical therapy places are very negotiable, but you have to ask.

    Oh -- and get a tape recorder and plug for your phone. It's nearly impossible to remember everything and the names of everyone you will talk to and no one at the same company or facility will say the same thing. Having everything on tape and engaging in 3-way calls (insurance co., facility/dr, myself) saved a ton of time and money.

    One more tip -- All of the out-of-pocket expenses are possible tax deductions. Start keeping a list --

    Doctor- Facility - Phone/Address - Dates of Treatments - Medications - Costs - Out of Pocket - Insur. Paid

    Even the mileage to and from medical treatments and parking fees are possible tax deductions, so also log that information.

    It will help at tax time and could be a life saver if later there is a reason to turn to medicare. Trying to dig all the information up later can be a nightmare.

    If keeping stuff like this is not a strong area for you, try to turn that around. It can all get out of hand so quickly and in the end you are the only one who will lose out financially.

    Good luck,
    Last edited by leeann; April 6th, 2010 at 05:48 PM.
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  17. #17
    ABW Ambassador meadowmufn's Avatar
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    Quote Originally Posted by leeann View Post
    Also, if you do find out (which will probably take months) that you owe, talk to the doctor. Many times what is billed to an insurance company is far more than what non-insured people pay. Most physical therapy places are very negotiable, but you have to ask.

    Oh -- and get a tape recorder and plug for your phone. It's nearly impossible to remember everything and the names of everyone you will talk to and no one at the same company or facility will say the same thing. Having everything on tape and engaging in 3-way calls (insurance co., facility/dr, myself) saved a ton of time and money.

    One more tip -- All of the out-of-pocket expenses are possible tax deductions. Start keeping a list --

    Doctor- Facility - Phone/Address - Dates of Treatments - Medications - Costs - Out of Pocket - Insur. Paid

    Even the mileage to and from medical treatments and parking fees are possible tax deductions, so also log that information.

    It will help at tax time and could be a life saver if later there is a reason to turn to medicare. Trying to dig all the information up later can be a nightmare.

    If keeping stuff like this is not a strong area for you, try to turn that around. It can all get out of hand so quickly and in the end you are the only one who will lose out financially.

    Good luck,
    Great advice, Leann! I totally forgot about the tax deduction angle.
    -Don't criticize anyone til you've walked a mile in their shoes. Then when you do criticize them, you'll be a mile away and have their shoes.
    - Silence is golden. Duct Tape is silver.

  18. #18
    Full Member Lindy Rig's Avatar
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    Beware of state laws regarding taping phone conversations. They differ state to state. Ask the person if it is ok to tape the conversation because you can't write fast enough. If they hem and haw.... might be an indication? I'd say PRESS for the 'okay' to tape the call... and of course, once it starts, simply say... "For the record, this is a taped phone conversation on such-and-such a date, with ____________, who has given permission for me to record the conversation". (this is because I've "been there, done that")

  19. #19
    Affiliate Manager bs0101's Avatar
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    As such, they are bound by their contract with the insurance company to NOT bill you, the insured the difference. This is a physician issue, not the insurance company issue.
    chuck is spot-on here. the physician's 10K rate for said services were negotiated down by BCBS to 8K, thus the 2K difference they are now alleging you owe. BCBS should provide you with an itemized list of services / proceedures they paid out on your behalf, ideally this would have the corresponding medical billing code for each line item. These should match up with the codes on the bills you are being presented by the physician's / service providers. The correlation of the two (e.g. code AF207h4RF7 dated 02/02/2010) is what locks down a strong case on your behalf.

    more importantly, best wishes to your wife's health.

  20. #20
    Affiliate Manager guinness618's Avatar
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    Looking at all the prenatal care bills, it is ridiculous the discount that the insurance company gets. A $350.00 charge to me, only costs the insurance company $128.00. Why not just give everyone the same discount. If you let the bill go long enough, they are willing to negotiate a lower amount anyway!
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  21. #21
    ABW Ambassador ladidah's Avatar
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    Also make sure that the hospital did not send you an "estimated itemized statement" of just the costs. Sometimes they do this to let you know what is happening in terms of your bill but it is NOT a bill. It will say "This is not a bill" or something to that effect. The reason I mention this is that it seems so soon after your wife's procedure for them to have the bills all figured out...(just a thought not saying that this is the case).

  22. #22
    Half a Bubble Off Plumb RemodelingGuy's Avatar
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    Bummer Seymour.....

    If it makes you feel any better, I got a bill ( well, a notice from a collection agency ) that said I owed $156,000 for my hospital stay during my coma last year, BUT, if I send them a check in the next 30 days, that they would accept $118,000 ......

    And that's JUST for the hospital.. No Surgeons, anesthesiologists, surgery, ICU doc's ... Just the hospital...

    Anyone got any loose change around?

    Truly hope you get things worked out.

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