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Is anyone generally familiar with the way things are billed?

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  • Is anyone generally familiar with the way things are billed?

    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".
    "Is it hot in here to you? It's very warm, isn't it?"--Nero, probably

  • #2
    I'm not sure where you are located and it may vary from state to state, but, depending on what tests you had run, you may have 1 bill from the hospital and 1 bill from the physician/lab.

    I had a mammogram done and I'll get billed by the hospital for the cost of the mammo, but I'll also get a bill from the radiologist that actually read the films since he is "contracted" with the hospital and not an actual employee of the hospital. If he were to be employed there, I would most likely only receive 1 bill, but it would be for the test and the physician's fee but they would be seperate items on the bill.

    I'd certainly call and inquire as noone should ever pay from a statement not knowing what the charges are for. Also, if you have any kind of insurance coverage, part of that total cost will most likely (not always, though) be a write off to the hospital and/or physician and you would only owe the contracted "allowable" fees. You could only owe a small portion (copay or deductible) or larger (copay and deductible) but most likely not all. Even if you have NO coverage, you could possibly get the total charges reduced some if you call and ask for a cash pay discount.

    Hope that helps.

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    • #3
      Yes--Mytical said there is sometimes a charge for the physician as well as for the actual test. It just seems exorbitant. I have insurance, and it does write off part of the charges. I'm sure I can make a payment plan. Ha--"Can I pay $10 a month for 70 months?" That's about what it will be.
      "Is it hot in here to you? It's very warm, isn't it?"--Nero, probably

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      • #4
        Man, that sucks. So expensive.

        Hope everything is okay with you.

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        • #5
          Thanks, Slayer. If I hadn't gotten in that car accident 2 weeks ago, I'd be fine. Right after this series of tests it resolved itself. (I had a pinched nerve). And at least one of the tests gave me a formal diagnosis of slight carpal tunnel, in case I ever decide to do anything about that (probably won't--it's not generally a problem for me).

          But right after I healed, I got in a car accident (2 weeks ago), so the nerve is re-injured. So I'm dealing with all that on top of these previous bills.
          "Is it hot in here to you? It's very warm, isn't it?"--Nero, probably

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          • #6
            Yes and hospital bills are strange. I've gotten a $1000 bill for a 2 hour ER visit, but the 6 days I was in the ICU came to a bit over 2300...*shrugs*. That is the surgeries, the medicines, the doctors, everything!
            Engaged to the amazing Marmalady. She is my Silver Dragon, shining as bright as the sun. I her Black Dragon (though good honestly), dark as night..fierce and strong.

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            • #7
              I'm currently fighting with my insurance. I had a series of tests ordered (routine, mostly) along with an ambulatory procedure/test (pulmonology). Insurance is refusing to pay for most of it, but they can't tell me if it's because of a deductible (unlikely), bad paperwork (probable), or some random decision on their part due to the positioning of the stars, the speed of the earth through the cosmos, and the particular location of a specific leaf on a tree.

              I'm determined to win this one.

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              • #8
                Food Lady - Check with the hospital to see if it really is a bill - some places mail out an invoice at the same time they send in the claim to insurance. Also, check with the hospital to see if they have a program that helps pay / reduce the bill. When I had to have a $900 test done (no insurance) they had me fill out some financial paperwork - depending on the results they could have written off 20% to all of the bill for me.

                KitKat - Do you have the explaination of benefits for the claim? It should say on there the reason they denied the claim or their CS can pull it up and tell you. If it is something like the diagnosis code doesn't match the procedure code then sometime that can be fixed with a resubmit of the claim. Just so you know, the CS rep can't tell you what the correct diagnosis code is or even what the code currently on it is - even though I got asked that multiple times a day.
                Last edited by auntiem; 05-05-2012, 10:40 PM.

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                • #9
                  Auntiem - I actually never got the explanation from the company, just a bill from the hospital. That's part of what's pissing me off. I'm off work next Tuesday, going to sit down and get this entirely figured out. Part of it might be that they never gave Husband or I the new insurer survey (just got it in the mail yesterday) that I have to fill out and send back, so they're holding a couple of other claims hostage until they get that back from us.

                  So we don't know if it's hospital error or underwriter error or something else entirely. I will ask about the codes, though. That's one thing mom didn't tell me about (she used to be an insurance underwriter).

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                  • #10
                    KiaKat - do mean the form from the hospital? or from the insurance company?

                    If it is the form from the hospital then I can guess what happened - they sent the claim to your (old) insurance - (old) insurance says you aren't one of theirs and deny the claim - hospital claims department tells the billing department that you don't have insurance coverage - hospital sends you the bill. Did you happen to get an EOB from your old insurance company?

                    If it is the (new) insurance company - don't know about that one unless you are required to use a network provider, but then you still should have gotten an explaination.

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                    • #11
                      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.

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                      • #12
                        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.)

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                        • #13
                          Quoth Food Lady View Post
                          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.
                          They say that God only gives us what we can handle. Apparently, God thinks I'm a bad ass.

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