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  1. #1
    Grandma broke her coccyx! Uncle Rico's Avatar
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    May 8th, 2007
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    Stupid Scenario of the Day!
    John Doe has health insurance with BlueCross & Blue Shield, which inludes a $10 copay and a $40 ER co-pay. One Sunday morning John Doe is not feeling well at all with symptoms of head spinning and nausia. John's wife drives John over to the local "In-Network" emergency room to get looked at. After 3 hours of mostly waiting, John pays his $40 and goes back home.

    BC&BS pays the hospital bill that was submitted, but does not pay the ER doctors bill that was also submitted. Why? Even though the hospital is In-Network, the actual ER doctor that saw John was not in the BC&BS network. Therefore, BC&BS labeled the ER bill as out of network and paid them a negotiated rate, which was about 25% of the bill.

    Now, a year later John gets a call from a debt collection agency saying that they are trying to collect a doctors bill back from 2006. This is Sept 2007 and this is the first John hear from them. BC&BS said they will not pay the remainder and the debt collection agency tells John he is fully responsible for the other 75%.

    Since this initial call last week from this debt collection agency, John now gets about 2 automated calls per day, which he ignores out of spite.

    This, among others, is the kind of thing that really frustrates the hell out of John based on principle. If John goes to an In-Network hospital for an emergeny he shouldn't have to play his odds on whether or not the attending physician is also In-Network.

    The ER physician made no diagnosis nor perscribed any medication and charged over $300 for the 10 minutes he saw John.

  2. #2
    Affiliate Manager Alan Hamilton's Avatar
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    March 13th, 2006
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    Reminds me of a similar scenario experienced by a "Fred Doe" I know 5 years ago. Fred was fly fishing about two miles into a mountain canyon with his eldest son, who was 25 at the time.

    Fred slid on some ice and one of his feet that was between two rocks trapped his foot. As he fell to the ground, his leg broke. His son hiked out the canyon and called 911 while Fred lay on the side of the river in excrutiating pain.

    About three hours later, a rescue EMT team made there way to Fred, loaded him on a floatable gurney and got him out of the canyon to a hospital down the mountain. The next morning, while Fred was under the influence of Morphine and a muscle relaxer, an orthopedic surgeon came to see Fred and told him that he was going to have to surgically repair the leg and use a metal plate with screws to keep the bones in alignment. Fred signed the consent form and was taken into surgery.

    Some weeks later, Fred received a bill from the surgeons office for $1,200.00 that the insurance company would not cover because after Fred was put under, the surgeon called in another surgeon from his own practice to assist.

    Fred was not happy, and so he explained to the surgeons business manager that they should remove the assisting surgeon charge because the procedure did not require an assisting surgeon, and that Fred was not advised of this before they put him to sleep. The surgeons biz manager (from what I hear) refused to do so, stating that they would turn it over for collections and report it to a credit bureau of Fred did not pay it.

    Fortunately, Fred had been around a while and knew how to proceed. So he wrote a notarized letter to the Surgeons office stating that they had seven business days in which to remove the charge or suit would be filed. He also instructed them that if they filed a report with a credit bureau that he would litigate for added damages and bring the matter before the medical board in his state.

    Ten days went by and Fred received no reply, so he called the surgeons office again. They restated their position. Upon hanging up, Fred made out a check for $1,200.00, mailed it to the surgeons office, and then drove down the mountain and for $19.00 filed a suit in superior court seeking a reversal and added damages against the doctors practice.

    Approximately two weeks later, Fred received a call from the Doctors business manager saying that they had made a "mistake" and would immediately refund the $1,200.00 overcharge, and pay for Fred's time and expense to file the action. This way, Fred protected his excellent credit rating without having to take months of time and frustration to have a credit bureau reverse a potentially damaging derrogatory on his credit report, and was still able to see justice prevail.
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  3. #3
    Affiliate Manager
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    My friend Bob Doe could've used Fred Doe's help about 10 months ago. Bob Doe was referred to several "specialists" by Mr. Doe's family doctor. Said specialists did nothing and Bob Doe got stuck with a $3K bill when insurance refused to pay.

  4. #4
    Moderator MichaelColey's Avatar
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    So what kind of lawsuit did Fred Doe file? I'd be interested to hear more details.

    I've had similar situations several times. Once an urgent care place claimed to be in our network (which meant we should have only had a $40 copayment) when they really weren't and the insurance didn't pay anything. Another offered a cash discount for a procedure that wasn't covered by insurance, then tried to charge us the full amount. Another tried to charge us almost triple what the insurance company considered usual, customary, and reasonable. My strategy (which has had mixed success) with each of those has been not to pay a cent until they agreed to accept a reasonable amount as payment in full.
    Michael Coley
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  5. #5
    Affiliate Manager Alan Hamilton's Avatar
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    Yeah, the Doe's of the world are up against it all the time aren't they. MC, if you are seeking advice for use by one of the Doe's you know, I welcome you to P.M. me and I'll see if I can get in touch with Fred.
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