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Health Care Headaches

By Kleinheider Posted on July 6, 2009 at 12:50 pm

Christian Grantham with a first person account a trip through the health care insurance system:

A month ago, I had surgery to remove several fatty tumors known as lipomas. They are typically benign, but in rare circumstances they can become cancerous. The way my doctor put it, “some people grow them like moles.” They grown between the skin and can sometimes become tender and limit movement. When that happens removal is your only real option.

Last week, my insurance company sent me an itemized bill they received from the hospital where the roughly hour long surgery was performed. It was for $14,000. My insurance company said they negotiated that down to about $2,500 and that the hospital may send me a bill for my part: $300, or 10%. I was partly relieved, but still shocked at the amount my insurance company was being billed by the hospitals and doctors.

And what was this “negotiated price?” Is that the amount the insurance company said was the only reasonable amount they are willing to pay, or an agreement they made with the doctor? $2,500 seems reasonable. But $14,000? Does that mean I should expect a bill for the part the insurance company did not negotiate? These are new problems for me that most people only face when they have to.

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Comments

10 Responses to “Health Care Headaches”

  1. Actually... writes
    July 6th, 2009 1:26 pm

    the only people paying list price are the uninsured. They then get to bankrupt on it. It is a complete shell game by the providers.

  2. Bill writes
    July 6th, 2009 2:03 pm

    You will not be billed by the provider for the difference unless they are attempting to commit fraud (or have incompetents in their billing office). There is one provider in Nashville in particular that has more than once billed me for the difference.

    The insurance company negotiates lower prices in advance for all kinds of services - you are part of a large group of potential customers and they negotiate discounts for your future medical care business with a network of providers.

    Save ALL documents you get from the insurance company and the providers. You’ll get bills from the hospital, the doctors, the anesthesiologist, and probably some doctors you never met who pointed theirhead in your direction for a half second. Just because you pay the hospital doesn’t mean you have paid all the bills.

    If you have even the tiniest question, call the insurance company and ask what you really owe. They know. A good insurance company will print that amount on your “EOB” - Estimate of Benefits - and you should NEVER pay any medical provider one cent more than that amount without putting up one hell of a fight.

    Except - some providers very quickly turn your bills over to collection agencies, threatening your credit rating because they do so before insurance has enough time to process the claim.

    And when you do pay, if you can do so, pay in person, keep a photocopy of the check, and get a receipt that specifically details what bill you paid, so they don’t misapply it.

    We’ve seen it happen where they improperly billed us for the difference between the retail price and the negotiated insurance price, then applied payments on other bills to that incorrect old balance, then sent us collection letters for amounts on bills we had already paid.

    The insurance company is the closest thing you have to a friend in this process - they don’t want to overpay and they don’t want you to overpay either. And if you help them catch a provider incorrectly billing you for the difference, they will be happy.

    STAY ON TOP OF IT or it will quickly get out of hand and then you’ll be seeing a shrink and getting meds to help you cope with the stress caused by the medical billing for your surgery.

  3. Emmett Flatus writes
    July 6th, 2009 2:37 pm

    Christian’s hospital and doctor must bill by the individual lipoma. I had one removed in December at an outpatient center and the total facility charge was $2,500 for the prep, anesthesia, OR, etc. I was in and out in about five hours. The surgeon billed $750 separately.

    By the way, Bill, in insurance jargon “EOB” is generally considered to be “Explanation of Benefits” not estimate.

  4. Donna Locke writes
    July 6th, 2009 5:00 pm

    For overwhelming hospital bills the patient is left to pay, you can try calling the hospital and negotiating it down to a certain percentage you offer to pay immediately in exchange for a write-off on the rest. This often works. And the hospital itself may offer the deal.

  5. TNVolunteer73 writes
    July 6th, 2009 6:26 pm

    The Shell game is the Government plan by Obama.

    he wants to spend 1,600,000 MILLION DOLLARS (1.6 trillion dollars) to cover 5,000,000 uninsured.

    The CBO weighed Obama’s plan, and said it’s cost would be 1.6 trillion dollars, and would only give insurance to 5,000,000 of the 45,000,000 uninsured.

    1.6 Trillion dollars and still leaving 40,000,000 people uninsured.

  6. Joseph writes
    July 7th, 2009 7:50 am

    the shell game is that the rest of that $14k will be written off as a loss by the provider. health care providers rack up mountains of write-offs this way and pay virtually no taxes because of it. the taxes are paid by citizens who are already paying huge premiums for insurance that doesn’t pay out. private pay doesn’t work when the game is stacked against the taxpayer/premium payer. something has to be done.

  7. TNVolunteer73 writes
    July 7th, 2009 7:56 am

    Joseph Government healthcare is worse.

    That is why Canada UK Germany and France are moving back to private care.

    Canadians had to go to the Canadian Supreme Court to receive Care.

    Do you want Justice Gensberg, Thomas and Scalia deciding what medical care you need. That is where Obama Care will be heading

  8. Nancy writes
    July 7th, 2009 11:11 am

    TNVolunteer73,

    People who oppose health care reform love to link together those countries who have actually made an effort to take care of their citizens. This decoy they and you use–”had to go to the Canadian Supreme Court to receive care”–is a murderous farce perpetrated on American citizens. Where do you think the uninsured and underinsured in America go to get medical care?

    I’ll tell you. They go nowhere. Or else they go to the emergency room and have it paid for at the expenses of the taxpayer.

    So you “government health care” scaremongers can just shut up and go dunk your heads back in the sand where they belong, while the rest of your fellow U.S. citizens–both those with and without insurance–wait weeks or months to see doctors, receive frequently inadequate care, receive negligent or abusive treatment from medical offices staffs and billing offices, receive padded bills that are jacked up to cover the costs of our dear “system,” or put off care because they have to and die.

    Which of those scenarios is your favorite aspect of our current system? Oh, I get it. You’re one of the people in this country who actually likes your medical care provider and insurance company. Then you’re fortunate and you’re privileged.

  9. Nancy writes
    July 7th, 2009 11:18 am

    Regarding my above comment, I have a blog in which I cover health care and other topics at http://thenationalnerve.wordpress.com/.

  10. dontcallmemikey writes
    July 7th, 2009 11:30 am

    Long lines for health care - check
    Third party determining what health care you’re entitled to - check
    Inadequate care from understaffed, unqualified personnel - check

    And, while you don’t have to go to the Supreme Court for health care decisions, you do have to go to court for restitution when the doctor screws up, or the insurance company lies, etc. - and, of course, the GOP also wants to limit how much you are allowed to sue medical professionals when they, in the course of doing business, kill your grandma.

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