Is anyone generally familiar with the way things are billed?

[KiaKat]

From the insurance provider. I went from uninsured to group insurance (HMO under the Medica* umbrella, is an upstate NYS-specific thing), but never got the "what preexisting conditions do you have" form. That's now been sent.

I've gone through all my mail from the last two weeks, no sign of an explanation. Something else to be annoyed at them about.

[Shalom]

My insurance (call them JKL) has a website wherein you can find explanations of benefits. Perhaps yours does as well. If so, it might be worthwhile to check there. Either you'll find an explanation of why they won't pay, or you won't find anything at all, which would mean the hospital hasn't billed them (yet). Either way you'll know who to talk to next.

(We also happen to have two insurances. One (Azure Crucifix/Azure Escutcheon) for hospital and one (JKL) for medical. Doctors need to be billed to the medical, not the hospital, even if the doctor is in a hospital, and they always get it bass ackwards and bill the facility fee to the medical and the doctor to the hospital, and then wonder how come they didn't get paid for either claim. The exception to this is that ER doctors do get billed to hospital, but AC/AE won't pay them until they first receive a bill for the facility fee, and if the hospital screwed up and billed that to JKL, then AC/AE won't ever pay them until that gets straightened out. I hate insurance companies.)

[Sapphire Silk]

Quoth Food Lady

I'm in the US. I went to X Medical Center to have 3 tests done by Y Medical Group. It was a very short, outpatient visit. I received a bill for the 3 tests that was itemized with amounts adding up to $400 or so. But I also received a bill from X Medical Center for over $700. It's not itemized. It doesn't explain what it's for, except "outpatient services". I will call and ask, but does anyone know if it's possible I am being charged that much simply for walking in the door? It seems like the "service" was that I got to exist in the building while the tests were being done. Is that possible? Does anyone have an idea what it's for? I will call them, but I'd like input from anyone who may have done billing or dealt with medical bills. It seems weird to get a paper saying essentially "pay us for vague service".

Health care in the US is "fee for service." Physicians, hospitals/medical facilities, and other ancillary services all bill seperately based on the service provided via a complicated system of medical codes (Diagnostic Related Groups or DRGs). It's common to get several bills related to one visit.

However, as the patient you have an absolute right to an itemized bill. Write to X Medical Center and demand a line item bill explaining the charges in complete detail. They'll probably send you a general bill with vauge categories like "Pharmacy services." If they do, write them back and say this is not an itemized bill, I want an itemized bill.

Then go over it line by line. Dispute any charge you do not understand, and demand proof the service was actually provided. Doctors, labs, and facilities routinely pad bills to counterbalance shortfalls in insurance payments. If you don't do this, then they can legally assume you do not dispute the charges and go after you for the full freight.

I've disputed bills several times and won. It takes some persistence, but they will back down.

Before filing an official dispute (if you do dispute the bill), go to the place of service and get a copy of the medical record. They have to provide it, though you may have to pay for the copies (at inflated costs per page, I might add). It will be worth it.