Out of Town ER visit/expenses

PetMom · #1 (**permalink**) 10-21-2009, 06:07 AM

Yes, we have insurance, we have a set out of pocket limit.

But an ER trip during a trip last year is still yielding medical bills.

We just recieved in the mail a $340.00 Dr. bill on top of already paying a group of heart sepcialists (in a tiny town with only one heart specialist).

When you have two hospitals, ambulance, heart specialist (I met with only one - there was only one in this little country town) and a heart specialist center that we did not even go to who has billed us (but could have run the tests?) we just keep getting billed and billed and aggressively.

One hospital, when we were not paying on their designated payment plan, but making payments, threatened us with a collection agency - quite obviously we got on their payment plan quickly. I politely asked for a bill of all the services done and they said they would send us one - never got it.

They also told us "they took a loss on us". I called our Human Resources Dept. and they told me 'that is not true, they are just telling you that'.
I surely did not want to pester them for a bill when they were treating us as a charity case. The finance dept. at this hospital assured me they threaten everyone with debt collectors until a person gets on the 'official payment plan'.

Questions if anyone knows answers:

Do we have a right to an itemized of each procedure bill - or do we just get the what we owe them bill?

Can new bills continue to come in from different places/people nearly a year later (note that ins. out of pocket caps are yearly)

Is there one centralized place (eg our insurance co) that has all of these different billings together with procedures done?

Is double billing common and who does that? The ins. co?

I have more of a law background and know under FFOIA (freedom of information act) we have rights to detailed itemized bill - we do not want to use this as the way to get a bill.

southerndoc · #2 (**permalink**) 10-21-2009, 07:24 AM

You have a right to view an itemized bill. This is an absolute must for you to view this if you do not have insurance.

Billing someone a year out is a little delayed. Most groups should bill within 30 days. I would call and ask why it was delayed and what services were rendered.

Double billing? You're probably referring to balance billing (requiring you to pay the difference between what the insurance pays and what is billed). This is illegal in some states, but most states allow it. You should argue with your insurer that you had no choice to use an out-of-network hospital and argue that your condition was a true emergency (particularly if you were admitted).

Freedom of Information Act does not apply to healthcare. That applies only to government operations. However, you have a right as a consumer to get an itemized bill.

I think the best thing for you to do is to get a healthcare advocate. You should have a professional advocate to reduce your bill, get itemizations, etc. Contact the state attorney general office where the services took place. It's going to be hard to do this a year out from services rendered though.

disneysteve · #3 (**permalink**) 10-21-2009, 08:50 AM

Quote:

Originally Posted by southerndoc

You have a right to view an itemized bill. This is an absolute must for you to view this if you do not have insurance.

It is an absolute must for everyone even if you do have health insurance. Nobody should ever pay a hospital bill without first reviewing an itemized list of charges. 90% of hospital bills contain errors.

I've shared before that after my wife's gallbladder surgery a couple of years ago, I found an error of over $1,000 on her bill. That is money that I would have paid out of pocket over and above what our insurance covered.

Call the hospital's billing office and have them send you the bill. They are required to do so.

As for the timeline here, after my daughter was born, it was 18 months before the last bill was settled so I don't see this as unusual. What often happens is the provider has 90 days to submit the claim to insurance. The insur. co. then may take a few months to process the claim and respond back to the provider that info was missing or incorrect. The provider resubmits the claim after some time and the insurer reprocesses it. Only after all of that happens will the patient get billed for any charges not covered by insurance. It is very common for 6-12 months to pass during that process.

PetMom · #4 (**permalink**) 10-22-2009, 10:09 AM

Thank you both for answering this and letting us know the resources available and what our rights are. And that it is plausible that it could
take this long to get a bill.

We are going to ask for an itemized bill from this latest bill and will just pay it out.

Good lesson: get itemized bill more promptly.

GREENBACK · #5 (**permalink**) 10-22-2009, 10:44 AM

Quote:

Originally Posted by disneysteve

It is an absolute must for everyone even if you do have health insurance. Nobody should ever pay a hospital bill without first reviewing an itemized list of charges. 90% of hospital bills contain errors.

I'm not sure about what most folks here think but a medical bill is one of the hardest to interpret. All the procedures are abbreviated medical jargon. I look at it and scratch my head. Plain language should be a part of any new healthcare plan.

I wouldn't be a bit surprised that I and many others have been overcharged for things in the past due to lack of understanding of the bill.

disneysteve · #6 (**permalink**) 10-22-2009, 10:50 AM

Quote:

Originally Posted by GREENBACK

I'm not sure about what most folks here think but a medical bill is one of the hardest to interpret. All the procedures are abbreviated medical jargon. I look at it and scratch my head. Plain language should be a part of any new healthcare plan.

I wouldn't be a bit surprised that I and many others have been overcharged for things in the past due to lack of understanding of the bill.

You make a very valid point, but I would still urge everyone to review the bill before paying it. You don't need an advanced degree to find errors. There are often stories of things like some man being charged for maternity services or stuff like that. Sometimes the errors are truly ridiculous. Even simple things like being billed for more days than you were actually in the hospital.

If you get the bill and you don't understand something, call the billing department and get them to explain it to you. You should never pay a bill that you don't understand.

Homebody · #7 (**permalink**) 10-22-2009, 11:37 AM

Medical bills are abbreviated medical jargon because that is all the space that is available on the computer programs sometimes that processes said bills.

Having said that, I was charged for a reduction once for a fracture when the fracture was not reduced, but just splinted, so yes an itemized bill is always a good idea.

I think you should call the hospital you were treated at and ask them who you should be getting bills from. Most hospitals have a sign that says who you will be getting bills from, but with you having an ER visit, you probably did not see the signs.

Good luck.

GREENBACK · #8 (**permalink**) 10-22-2009, 12:47 PM

I'd be ok with abbreviated common language for my bill. Let the doctors and ins. co's talk in medical terms.

cschin4 · #9 (**permalink**) 10-22-2009, 12:58 PM

People also need to be aware that there are various bills for the hospital, providers, procedures, etc. Doctors and other services are often billed seperately and not part of your hospital bill. Many doctors and other services are contracted providers and do their own billing which is NOT part of hospital billing. You will get a hospital bill but you should also expect to pay your providers as well for their services such as anesthesia, ER doctor, radiology, etc. That is not "double billing" but fees for services rendered. I think people sometimes confuse this.

PetMom · #10 (**permalink**) 10-26-2009, 07:01 PM

I may not have worded it right but I mean't being billed twice for one cardiologist's visit in the hospital.

We have been billed by a cardiologist clinic and then just recieved a bill from another cardiologist's office.

We had thought all along the cardiology clinic had provided the cardiologist.

Only one cardiologist (that we saw) was there - but he could have consulted another one, etc...

Good point, many bills come in from different services and as we have learned here can even do so nearly a year later (that concerned us).

We are just glad that they had interest free payment plans.

disneysteve · #11 (**permalink**) 10-26-2009, 07:08 PM

Quote:

Originally Posted by PetMom

I may not have worded it right but I mean't being billed twice for one cardiologist's visit in the hospital.

We have been billed by a cardiologist clinic and then just recieved a bill from another cardiologist's office.

We had thought all along the cardiology clinic had provided the cardiologist.

Only one cardiologist (that we saw) was there - but he could have consulted another one, etc...

This is why you need itemized bills. I can easily think of an explanation for that. You could have gotten one bill from the doctor who actually was present charging for his visit and another bill from the doctor who performed or interpreted a test. For example, if an EKG or stress test or echocardiogram was done, a doctor had to read it and prepare a report. That might have been done by a different doctor than the one who was physically there.