Hospital Bill Nightmare

glc213

Hello to everyone. I have researched online and on this forum and I am at an absolute total loss. I don't even know how to make this story in any way brief, but, here goes!

10/1/2015 I underwent a prophylactic mastectomy. I paid my in network deductible of $1500 to my PS (first one to ask). I have surgery, spend two nights in the hospital and go home for recovery. I was lucky to have no complications and was able to schedule my exchange surgery on 12/28/15. At the end of November/beginning of December I began to peruse my online claims w/Florida Blue PPO. It showed that I owed over $50k to the hospital although I had never received an invoice. I called Florida Blue and they were bleeping clueless. Couldn't tell me any reason for the $50k "amount I owe" and that I should call the hospital. This conversation was at least 45 minutes. I called the hospital and was connected with accounting. The gentlemen said he was "head of accounting" and read off my claim as I saw it online, but, said that the hospital has a contract with my insurance co. and accepted the amount that Florida Blue paid and not to be concerned as I owed nothing. What a relief!

Nope. My exchange surgery was a breeze and at some point in March of 2016 I received a bill from the hospital for $316.00 (from 12/28 surgery) of which I paid. No biggie--what is it for? Once again FB can not tell me anything. So, again I call the hospital and reach a different person in accounting. She tells me it is for something denied completely by my insurance company and narrows it down to something she sees on my invoice for that amount and sends me a copy of that invoice. It turns out to be the anti-nausea patch given to me that is only covered by Florida Blue at the pharmacy level. Want to know how I found that out? I researched the code online then in turn called FB and asked them about the coverage and after one hour the representative was able to give me that explanation. I actually just felt lucky that my in-network deductible and that inflated anti-nausea patch was all I was out for this ordeal.

So, in the beginning of June I open my mailbox to find a bill for $14K+ from a different named hospital. They were bought out or whatever. No idea. This bill is from my 10/1/2015 surgery. I call the number on the bill, but, they are just the billing company and can tell me nothing. The next day I call in vain trying to reach the hospital accounting department, but, no matter how I try I am transferred to this billing company. I call the morons at Florida Blue as a last ditch effort and get the same answer. I am responsible for the $50k as it says on my online claim and all they know is it was either experimental stuff or uncovered. No specifics. Ask the hospital. I did receive my statement from that visit with the hospital which was over $300k and 5 pages.

I'm at an absolute loss. I have not ever received another bill from the hospitals billing company after my initial inquiry when they were to research the claim, but, my online claims continue to say I owe tens of thousands. Has anyone gone through this and have any words of advice? I need someone to point me in a direction? The only thing I can come up with is to contact a patient advocate and pay for them to handle it as I can not get any answers.

SummerAngel

I'm sorry, hospital/doctor billing is a nightmare! I had many mistakes in billing and there is still an issue with one of my Her2 FISH tests that could come back to haunt me any day. (It was because I needed two FISH tests on different tumors only a couple of weeks apart - it threw them off in a big way.) I can only say to keep calling everyone you can and try to remain calm. Call your insurance company as many times as you need to. I had one issue that gave me serious problems a few times until I finally called the insurance for about the third or fourth time and just happened to speak to someone who knew what she was doing. Good luck to you!

Lisey

Did you get pre-authorized for your initial Proph BMX? I know with my insurance.. I have to get pre authorized or I might be on the hook. I get everything in writing, including the pre-authorization

glc213

Thank you for responding!! When you are only prepared for your out of pocket max-receiving bills far exceeding it that no one will or can explain infuriates me. I chuckled when I read "remain calm". I have a hard time of that with this situation!

glc213

Thank you,Lisey. I did not call and ask for anything in writing, but, I did have a generalized conversation with a representative from my insurance company prior to the surgery about what to expect. After the conversations with my BS, PS, etc. I figured that everything would be okay. They would have not have performed surgery on me otherwise being that it was prophylactic. Florida Blue paid both of them (shamefully meagerly) and they paid the hospital also. I am being billed for amounts that no one will or can explain. Amounts that do not match with the EOB's online. I am suspicious that it has something to do with the hospital having new ownership.

ElaineTherese

glc213,

Are you sure that all the doctors (anasthesiologist, surgeon, etc.) were in your insurance network? Sometimes, the hospital is in-network, but the doctors who work there are not. There's been a lot of news coverage lately about patients getting stuck with unexpected bills because of out-of-network physicians/services.

ChiSandy

There is also such a thing as “zombie” or “legacy” debt: bills that have been paid and settled, but entire accounts departments sold anyway for pennies on the dollar to collection agencies to intimidate and squeeze more out of a dead case. John Oliver devoted an episode of his weekly HBO show; he (his production company) bought an entire debt collection company, forgave all the debts and then dissolved the company.

You did not post your diagnosis or other breast cancer profile--unless you make that public, it’s impossible to reliably advise you. Did you have a proven reason for having a prophylactic BMX--family or personal history of breast cancer, genetic testing showing a mutation, ethnicity (Ashkenazi Jewish) or any combination of the above? If you simply wanted a prophy BMX and if you didn’t already have any of those factors, you may well be out of luck. You may need to hire an attorney who specializes in these matters--they take these cases on a contingency basis if they believe you were not legitimately billed. But there is a possibility that you may still legally owe enough that bankruptcy or Ch. 13 might be necessary.

glc213

Yes the anasthesiologist was in network and both of my surgeons were. I would not have done this otherwise.

I think I might be coming off as naive lol. I did most of my homework, but, obviously did not get preauth in writing. I've never read to do that in all of my research. I trusted that when both Drs said they got it that they did.

I most certainly did not want a BMX. It was the hardest decision I've ever had to make and it was the most difficult thing I've ever been through. Just grandmother died of BC but that was not factored in to my lifetime risk of 25%. Lots of evolving micro calcs. So fibricystic that cancer may have never been found. I saw my BS for 4 years before we began to discuss this. Many biopsies. I never had a positive biopsy. If this were the reason for medical bills--then there is an explanation. Both my BS and PS (twice) were paid. My exchange surgery at the same hospital claim was was paid aside from the anti-nausea meds. EOB says I owe nothing from that surgery. It's something else neither the hospital nor Florida Blue care to explain and I haven't really wanted to poke the bear so to speak since I'm not receiving any more bills since my initial inquiry. Credit is intact so nothing is in collections.

I just find it terribly peculiar that both parties have mismatching data and neither can come up with why.

glc213

ChiSandy-so funny that you bring John Oliverup! Someone was just talking about that today at my office. I'm going to research it--sounds interesting.

besa

http://www.patientadvocate.org/index.php?p=757

The Patient Advocate Foundation may be,able to help you with hospital/insurance billing problems. (I have no personal experience with them but their name comes up often as an organization that helps)

badger

hi glc213, FL has an Insurance Consumer Advocate's office. Maybe they can help. Good luck!

Florida's Insurance Consumer Advocate

A Strong, Independent Voice for Floridians

As Floridians become increasingly dependent on quality insurance products, a strong advocate is needed to represent the people when insurance decisions are made. Florida's Insurance Consumer Advocate is an independent leader with an effective and powerful voice for all Floridians.

The Insurance Consumer Advocate is committed to finding solutions to insurance issues facing Floridians, calling attention to questionable insurance practices, promoting a viable insurance market responsive to the needs of Florida's diverse population and assuring that rates are fair and justified.

http://www.myfloridacfo.com/division/ICA/

glc213

Thank you besa and badger, I will certainly look in to that. I am very appreciative of the responses and help.

I have great respect admiration for all of the women (and men) on this forum that help and support others. I am completely aware of how fortunate I am to have never had to endure what many of you have had to endure. I understand that many might feel that going through something like this without a direct family history and not even being BRCA tested let alone having atypia results is possibly crazy. I wonder if others were in my shoes what they would have opted for sometimes. Each biopsy took more of a toll.

Oh--and just a correction of something I typed earlier: I actually did not know that the anesthesiologist (and not to mention my spelling it wrong earlier-thanks ipad) would be in network, but, I did request that he or she be. My BS's office did make me aware a few weeks before the surgery that he would require an assistant. I assumed at the time and believe now that these are the infamous surgical assistants that insurance companies notoriously deny claims with. They notified me in writing and said to contact them if this would be a hardship. I called to ask "how much are we talking here?". The difference between hundreds and thousands and tens of thousands is what defines a hardship. My insurance ended up covering this person. Go figure.

At any rate, I looked at my claims and there are multiple that are incorrect. I need to get started clearing them up.

Thank you all again!

ChiSandy

Hospitals routinely overbill, double bill and incorrectly bill, hoping patients won't notice. This is because they are inadequately reimbursed for personnel and services--they can’t bill for residents, nurses, aides, transporters, etc. (all of whom are salaried), so they make it up by overbilling for tangibles--such as tissues, slippers, aspirin--that insurers do reimburse. Hence the $15 box of Kleenex, the $25 Tylenol and so forth. I know it sounds like a pain, and it might be hard to recall what was actually done & administered way back when, but we need to go over every charge on an itemized bill (and if the hospital won't give you one, demand it) to make sure it was legitimate. For instance, when I was in orthopedic-surgery rehab I was on an opioid painkiller. The nurses had a computerized locked meds cart that had a clock that turned over at midnight--and if you were supposed to get your dose before midnight and the nurse was late, the computer refused to release that dose and you had to wait for the first dose of the new day. It was a case of “use it or lose it." Even if you got your 11:30 dose at 12:05, it was counted as the first dose of the next day and counted as one of the four doses you were allotted the next day. But though the cart couldn't dispense the dose before it was due (so if nurses fell behind they could still administer the pills half an hour late), the dose was still entered in advance into the computer.....and billed. This happened three times during a 14-day stay--and I was billed for six pills I never got. If I hadn't been keeping a diary on my iPad I could never have proven the error.

Another time, when I was still practicing law, I was representing a decedent’s estate, and one of the creditors’ claims was the bill from the hospital where the decedent died. (“Expenses of final illness” are counted as a priority claim). For a two-night stay, the bill was about a third of the entire estate. I thought something was fishy, so I met with the executor who thought so too. For instance, the patient was a double amputee when admitted...but billed for a pair of slippers. We also found numerous duplications and treatments that were never administered. At the first hearing, I told the judge we were contesting the amount of the claim, and he ordered the hospital’s counsel and me to sit down, go over the bill and come up with a settlement. Because I already had a list of suspect items, we were able to cut the claim in half.

If you can pinpoint suspect items and explain why they are bogus, they will almost always be deducted from the total.

badger

glc213, I've gotten a lot of great help & advice here at BCO over the years and am glad to pass it on. Everyone's situation is different but we're all in the same boat.

Wisconsin's public insurance advocate is OCI - Office of the Commissioner of Insurance. It's a good bet that most states have a similar agency, like the ICA in Florida.

edwards750

I can relate to an hospital bill that was a surprise to say the least. My DH had a colonoscopy in February. His doctor was in network but the facility where he did the procedure was not. We were told by BC/BS we were responsible for the $3000 charge. This had never happened before.
Needless to say we were upset and I made multiple calls to BC/BS and appealed the decision. We lost but I didn't give up. A lady who worked for several doctors for years in the insurance department said call and complain to the doctors office. She said maybe we should have known but she said they should have as well. I did that and we haven't heard a word since then.
A friend was declined coverage 3x before she was successful. They were being charged 5k for the Oncotype test. Her husband finally convinced the insurance company it was medically necessary.
This lady's advice was squeaky wheel gets the grease. Worked for us.
I agree with Sandy about checking your bills. FedEx where I worked used to give rewards for finding mistakes on medical bills. Saved the company a lot of money.
Good luck!

Diane

glc213

Thanks to all for the continued advice. I have my medical invoice from the BMX and it is a bit hard to make sense of,but, I suppose I should use google as my translator and get to work! It stinks that it won't show what charges were covered and/or declined so that I can just focus on those.

SanFranKitty

I thought cancer reconstruction was supposed to be covered by insurance companies. That is what it said in my plastic surgeons office. What state are you in. This sounds crazy. I really dislike insurance companies for this very reason!

IHGJAnn49

Hi Sandy and everyone... I'm new to this forum, but i just got my first bill from my surgery... $700+ and I'm trying to find out what else I might have to pay for... changing from a medicare advantage plan to a medicare supplement plan and trying to find someone to cover rx.s too... and nothing will start til Jan... I see my new MO monday and don't know if she will want me to start chemo or rads... I may just wait til january... I just don't have enough to pay for anything additional...

juneping

i called my health insurance and went through item by item of all the bills i didn't understand.

sometimes there's discrepancies of few dollars....