Screwed by major cancer center

JoniB · April 2008

JoniB · April 2008

I was being treated at a satellite office of a major cancer center. Before treatment I confirmed with my insurance company and the cancer center that the doctor and hospital were in-network. My radiation bills were covered at 90%, which I expected because that is my plan. I expected the doctors to be covered 100% - WRONG! I just received my my "Explanation of Benefits" from my insurance company for the last four months and they are showing the doctors as being out of network. How can this be? I would never have gone to this facility if I knew I would have to pay out of network. I live near a major US city with plenty of good hospitals to choose from - I never would have gone here for treatment if I was told I would not be covered. The hospital's explanation? Yes the doctors are in network, but if you have treatment at the satellite office, we bill you out of network! I was never, never told of this and now that I am learning of this after treatment is over, I am facing a bill of over $4,000. I feel like I was screwed by getting cancer and I am being screwed again by the hospital which provided treatment. I cancelled all my future visits and will need to find new doctors. If you would like to know the name of this hospital, private message me. I do not want anyone else to have suffer the way I am now.

AnnNYC · April 2008

Joni, this is HORRIBLE.

larousse · April 2008

Joni, this completely sucks. If I were you, and if you have time and energy, I would contest these charges.

Look up your state Department of Regulatory Agencies, Division of Insurance, your Commissioner of Insurance. You should write a letter to him/her explaining everything in detail. They will respond and they may be able to do something about it.

I contest some crazy charges when one of my daughters was born and it worked going through this process.

Best of luck with this, boy do we need some reforms...

Harley44 · April 2008

I also had problems with my 1st onc. I was told that the cancer center was "in network". Then, when I went to sign in at the front desk, the woman told me that I would be getting a separate bill from Duke, since my onc was with Duke ... I liked the idea of having a dr. from Duke, but I refused tx because the dr. was "out of network".

I was assigned a case manager for my insurance, and she helped me get all the necessary approvals, so I was able to see him anyway. However, after I met with him a couple of times, we really didn't 'connect'. He just wanted me to go ahead and get tx there, and not question ANY of his decisions.

I ended up getting a 2nd opinion onc. who is really quite nice, and even though we had our differences of opinion, we are getting along nicely now.

So Sorry you had to go through all that!

Good Luck!
Harley

NM60459 · April 2008

Joni- I am just joining in on this conversation, but had to give my 2 cents. FIGHT THIS!!! I had something fairly similar happen to me in a completely different situation regarding a surgery. I picked a hospital and surgeon that were in my plan but my anestesiologist (sp?) wasn't in network. I wrote my insurance company and the hospital. I poured out my heart and told them they needed to figure this out together. I NEVER heard from them again. I don't even know who backed down, but they took care of it. I don't know what will come of your situation, but do not give up. You have got to spend time fighting this. My cousin went through a similar situation w/ a $100,000 surgery! Saying it was "preexistant" and they wouldn't cover it. I helped her put a letter together and insurance paid for everything!!! I know I am rambling, but I can not stress to you enough how good your chances are of getting this taken care of. Please let me know if you have any questions.

NancyD · April 2008

On a similar note, as I was lying in the pre-surgical room waiting for my port-insertion procedure, the anesthesiologist came by and the first thing I asked was whether he was in-network for my insurance (I knew my surgeon was).

If he had said no, I think I would have canceled the procedure then and there...but what he told me was that since the anesthesiologists only work through the hospitals (have you ever heard of one having a private practice and seeing patients off site?), they are considered hospital staff and if the hospital is in-network, they are, too, at least at my community hospital. The bill for his work was part of my hospital bill.

snowyday · April 2008

Scream and yell and call a politician it's an election year they might help you, I hope so what a horrible thing to happen. That stinks. Don't give and don't pay.

Little-G · April 2008

Joni

The same thing happened to me!! I paid about $30,000 out of pocket the year I had lumpectomy and radiation. Same thing.."out of network." I don't have any advice for what is going on now, but future advice is to check and double check any new hospital or network they send you to. As with our health, we also need to be our own advocate with the insurance (rip offs) industry. It's sad that with all we have to deal with, this just adds (HUGE) to our pile of crap. Good luck and I hope you are able to beat this!!

g

NatsFan · May 2008

Call your insurance company and ask to talk to a case manager. They can be very good about getting things like this straightened out. Your insurance company may even have a special Cancer Program which encourages treatment at Cancer Centers and if you're accepted into the program, it'll bring certain Cancer Centers and all related services in network for you.

I have an ongoing battle with my insurance company - I'm being treated at a hospital which is in-network and an approved Cancer Center, but they keep denying claims. I just monitor my statements like crazy and the minute one is denied, I'm on the phone. The decisions have always been reconsidered and covered, but it's just a hassle. One of the insurance reps mentioned that provider IDs and billing codes might not match up exactly with what's in the system, and they just look at those codes. No one actually looks at the real name of the provider to see if the names match.

Keep fighting - you even called both the center and the insurance them to check it out ahead of time - it was up to one if not both of them to tell you that they considered satellite centers as being out of network. Good luck and let us know how the fight goes.

mthomp2020 · May 2008

I feel ya! I keep running into my insurance refusing to pay the doctors who read my various scan results because they were not properly referred by the doctor ordering them. Talk about BS! So I keep getting bills from the radiology service, which is in network. Like I'm supposed to know who's going to read the scan? I called the insurance company, and they told me not to pay the bills, that my oncologist who ordered the scans is the one responsible for the screw-up. Doesn't keep the radiology service from turning it over to a collection agency, though. My insurance policy says that diagnostic tests and xrays/scans done in-network are covered 100%.

Makes me want to tear my hair out, except that I don't have any to tear out!

dibel · May 2008

I read somewhere that insurance companies almost always turn things down because they know that most people won't appeal. We have to appeal, appeal and then do it again. I've had a horrid time too. I had to hire a woman at $75 an hour to get my insurance bills straightened out. Insurance is nothing more than professional organized crime, imho.

tmac · May 2008

I had problems where hospital bills were submitted by the hospital under the doctor's name and billed out of network. When I called my ins. co. & doc office it was determined to be considered in-network, it had to be billed thru the facility/tax id #, not the doctor. Don't know if that would make a difference in your situation. The same thing happened with my daughter for a completely different procedure, i.e., billed under the doc and not the facility. My other suggestion is to document every phone call, get names, dates, etc. and insist on speaking to supervisors or appeal representatives if necessary. Luckily, my husband's company has a liason that works w/the ins. co. and the consumer if there are problems.

tmac · May 2008

Oh, and don't let the ins. co. tell you to call the facility and tell them blah, blah,blah, only to have the facility then tell you to call back the ins. co. and tell them blah, blah, blah. This happened to me very early in my dx/tx process and I said no way, I would not do it. I explained I was a third party, and this was how misinformation gets passed along. And it wasn't my responsibility to tell anyone how to bill a service, etc. I refused to be in the middle, and the ins. co. backed down and asked for the name/phone # of the facility billing rep. and called and cleared up the problem.

For a while, all of this felt like a full time job. I was on the phone everyday w/ins. co. or doc offices. Make sure you double check every bill and expl. of benefits you get. I have a notebook w/all my notes, bills & statements documenting everything. It helps from one day/phone call to the next.

Screwed by major cancer center

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