43 ms·

I am having problems with my insurer at this very moment. I went to an in-network hospital for an ER visit, which turned into an 8-day stay (yes, it was seriou

I am having problems with my insurer at this very moment. I went to an in-network hospital for an ER visit, which turned into an 8-day stay (yes, it was serious). Evidently, none of the doctors at the hospital are in-network, however, (claims from various technicians are still "in processing", so I don't know how they will turn out) despite the fact that the hospital itself is definitely in-network. I had no choice as to what doctors came in, and, yes, I can now see them billing $600 for a 1-minute visit ($600 per visit, & they came every morning). This is ludicrous! I have insurance, & still this will completely drain me financially. I'm at the point where I almost think it would be easier to declare bankruptcy and start over!

JustSomeNobody 9y ago
First, hope you're feeling better. This is exactly why Congress should not be exempt from any health care legislation. They need to go through this also, so it can be fixed.
- maxerickson 9y ago
  At the moment they get payments from the government to purchase ACA gold plans from the Washington DC exchange. (the Gold plans are closest to other federal government provided health insurance...) Of course, many members of Congress are quite wealthy and wouldn't be much more than annoyed by a bill in the tens of thousands of dollars.
benmarten 9y ago
This sounds like fraud to me. Fight it legally! A co-worker told me that this happened to her, and that made me not take the in-network only plan, but I got the PPO instead. I still think it's illegal or morally not right what they are doing, so we should all fight this practice!!!
- myke_cameron 9y ago
  Sadly this is how hospital stays are conventionally billed. The cost of being admitted covers only the bed and routine nursing, literally everything else is billed separately. As unfair as it is, the best patients can do is vehemently question the necessity of any interaction with a physician, or else get billed for it. And good luck with that if your case is complicated and you're getting referrals to a wide range of specialists.
  - mjcl 9y ago
    And honestly, when you're admitted to the hospital unexpectedly, you're probably not in the frame of mind to be questioning everyone who comes by. I know when I was in for a few days, I only recognized the name of one of the hospitalist doctors that later billed me. And the bills can come months later!
jetcata 9y ago
Also experiencing something similar right now - pathology for a day procedure ended up being out of network and I have a $3500 bill. This is insane.
astockwell 9y ago
You may have some recourse with the insurance company because for emergency care that leads to an admission, the hospital being in-network is supposed to be what counts. Individual doctors being out-of-network should only come into play if you have a procedure done at their practice's office. I sincerely hope it works out for you. It might not hurt to get a 1-hr consult with a lawyer and send the insurance company a nasty letter?
- vkou 9y ago
  That depends on the state. Most states have no laws against this. Also, if you read your insurer's fine print, you'll find that they will only pay out-of-network providers to some limit that they and the provider agreed to. Even in an emergency situation, you will foot the bill for the delta.
sbov 9y ago
We had a similar experience about 8 months ago, but only one night in the hospital. Raise hell with everyone. The out of network doctors were resolved the fastest for us, and the longest was the hospital stay itself, which our insurance didn't agree to pay until 8 months after the stay. It was a seriously draining experience, and luckily my wife doesn't work so I didn't have to take time off for all the phone calls and following up that was required. I don't fault our insurer. The hospital charged more for our one night stay than another slightly further hospital recently charged us for three nights stay. It was completely ridiculous. But completely out of our hands. I've had to deal with that and more in the last couple years. In my experience there are no "good" or "bad" guys in this fight. It's a bunch of individually rational entities that when taken as a whole are completely fucking over the rest of us.
- astockwell 9y ago
  > luckily my wife doesn't work so I didn't have to take time off for all the phone calls and following up that was required This. This is so horrifically true, it takes call after call after call (and emails, and faxes, and snail-mail claims forms that take "30 days" to "process") to get anything changed, and by then you have collections companies harassing you and your credit goes down the drain. Meanwhile you must keep working and taking care of family and dealing with the actual illness/issue that led to the medical visit in the first place. It is insane.
  - bdamm 9y ago
    A friend of mine was in a sports accident almost two years ago. He had a good medical insurance plan for exactly this possibility. He fractures his pelvis into 14 pieces, and broke another dozen major bones including both femurs. The surgeries are still ongoing although he is mostly himself again. But even two years later, he is facing a daily barrage of calls, being put on hold, no callbacks, paper shuffling, records from hospital to hospital, faxing permission sheets, fighting with the insurance company (who has threatened to drop his insurance multiple times) and on top of it all, his landlord is trying to evict him. It's been horrible to watch. It's like the insurance company is trying to kill him with stress.
jackmott 9y ago
vote for candidates who will support single payer.
- theandrewbailey 9y ago
  It seems like we already have single payer healthcare: the patient. The patient pays up the ass. All the way.
- mistermann 9y ago
  Changing things so all taxpayers are getting robbed rather than just the individual being treated seems like a sub-optimal solution.
  - Devthrowaway80 9y ago
    Yeah, it won't work. It works in every other developed nation in the world, and they all pay less money for better healthcare outcomes, but hey, the US is Totally Special.
    - jsisksod 9y ago
      The US is larger than 50 developed nations combined, so yes, we are Totally Special.
      - icebraining 9y ago
        Then setup a single-payer system per state. What's the excuse against that?
        Spoom 9y ago
        Before I answer this, let me frame my opinion: I very much want single payer in the United States, and were it plausible to do it on a state-by-state basis, I would support it. Apparently, states are unable to restrict entry into state benefit programs such as healthcare. They can't set up a waiting period for people moving into the state before they are eligible; that was declared unconstitutional by a previous Supreme Court. So if states were to do their own single payer system, in theory sick people could move into the state and immediately gain free healthcare simply by virtue of being a resident. Conversely, they could then move back to their home state that doesn't charge higher taxes. So it wouldn't be feasible on a state-by-state basis unless a future SCOTUS reverses their precedent. This is unlikely in the short term, given the current Court's make up.
ydt 9y ago
I had this same thing happen. My daughter was admitted via ER and it turned into a 6 day stay. At the end we received a bill for 40k for being out of network. Luckily I have friends in the industry and it turns out if they fail to inform you within 48 hours that you're not in network you don't have to pay the out of network cost. We ended up paying just our deductible after a letter was drafted. Do not take what the hospital/insurance Co say at face value. Call an attorney.
- mistermann 9y ago
  Can someone knowledgeable on the subject comment on whether the "Obamacare movement" has been up front in acknowledging this aspect of the problem with health care in the US? My perception is that the problem is typically framed as a lack of insurance problem for financially challenged people, but the "abuse" on the billing side to me seems like at least as big of a problem. And if this is being conveniently ignored, it feeds my conspiracy thinking that the Democrats are actually largely indistinguishable from Republicans - they may wear a different mask, but their actions are only slightly different, in this case altering who is getting robbed.
  - heartbreak 9y ago
    Well the progressives including President Obama pushed for single payer (or a public option) which would eliminate abuse on the billing side, at least to the insured.
    - jazzyk 9y ago
      The single-payer option was quickly dropped by the Democrats in Congress. Their sponsors (the health-"care" industry) did not like it.
      - albinofrenchy 9y ago
        It was dropped because it was politically impossible and it wasn't worth burning political capital on it. Even just the public option wasn't able to gain traction; single payer was never going to happen in 2009.
sjg007 9y ago
ER + hospitalization visit should be covered no matter what.
narrator 9y ago
When I had back surgery, there were all these therapists coming in the moment I got out of surgery trying to get their 1 minute in. It was throughly ridiculous. One of them was attempting to do physical therapy and pulled on my leg a little and put me into so much pain I went into shock. She probably got her $600 bucks. I am with Kaiser now and it is the most BS free medical experience I have ever had. To fix healthcare without single payer the government should just make a law that medical insurance can only be offered by hospital chains and the doctors and specialists cannot bill insurance separately, but must be paid by the hospitals. This is how Kaiser works. That way the hospitals can pay a fair market rate to doctors and not have them demanding a surprise emergency room rate from distressed patients.
- et-al 9y ago
  Everyone in the Bay Area loves talking down on Kaiser, but financially they've been the most worry-free experience. Had ringing in my ear for a week, went to the doctor, and she referred me to both an audiologist and MRI. Paid $20 for both of those other visits. If I had been on Blue Cross Blue Shield, I probably would've sucked it up given my super high deductible and navigating the in-network maze.
  - Declanomous 9y ago
    BCBS IL is super straightforward. Every doctor is $20, unless it's a specialist, then it is $40. I've never actually been billed $40, despite seeing many specialists, so I'm not sure what actually qualifies. I've been hospitalized and paid <$1000 for an overnight stay, with visits from specialists, etc, so I'm pretty happy altogether. My biggest complaint about the medical industry is the cost of prescription drugs. It's ridiculous how much we pay for drugs in this country.
    - et-al 9y ago
      Is your BCBS IL plan an HMO? That could explain the simplicity. I used to be on an HMO, but now it's a PPO with BCBS. The flexibility of choosing my provider hasn't been needed for my case.
softawre 9y ago
Do you not have some max out of pocket for the year? Mine is 4000$, or 6000$ out of network.
icantdrive55 9y ago
If you don't have a house that has more than 120k in equity, or a bucnch of expensive personal items; declare a chapter 7. (I believe 120,000 of the personal home is safe in a bankruptcy in California. Texas has has am unlimited homestead exemption. Meaning you can own a mansion, and keep it in a bankruptcy.) Don't pay the paracites a penny. Look into doing a straight chapter 7 yourself. I'm planning on doing mine. You'll save $3000 by doing it yourself. I'm glad you feeling better. They have become weasels. And to those that think hospitals, and doctors don't come after payment; they do. They can be very aggressive. Good luck!
msoucy 9y ago
And heaven forbid you have to take an ambulance to the hospital - ambulances might not be in network, in which case you're looking at a $800 charge for a ten minute drive (that you can't make yourself due to a variety of reasons). I wasn't even in bad enough health that they would turn on the lights, so I didn't even get that small silver lining. Then you get to sit in an "emergency room" for hours, when you're physically unable to move, and with your phone dead so you can't even let anyone know where you are. When you're finally wheeled to where you need to be, you're basically dumped in a hallway facing a wall for half an hour, and you're in a wheelchair and so weak that you can't even turn to face anything interesting. I paid about $1000 for that luxury. At that price I'd expect a decent waiting room... Yes I just needed to vent about that situation. It sucked, especially for a college student. I was hounded for months afterward to pay those bills, because of course when you're throwing up you can pick which ambulance gives you a ride.
ugh123 9y ago
Wait it out until things settle (in processing, and until actual bills come in). I was in a similar situation and claimed this was news to me and inappropriate (others have said they have a window to notify you). Keep pestering them and they'll likely drop it.
will_brown 9y ago
Here is a nice article about that practice: https://fairhealthconsumer.org/reimbursementseries.php?terms=when-out-of-network-care-can-be-covered-in-network https://fairhealthconsumer.org/reimbursementseries.php?terms... Most importantly, most states have laws mandating insurers use in network rates for certain instances of using out of network providers, including in factual instances like you described (i.e. in network hostitals and out of network providers). Seperately, most states have statutes awarding attorneys fees to the insured when claims have been denied in bad faith, like refusing to adjust bills to in network rates when mandated by law.
specialist 9y ago
I'm sorry for your current struggles. I too was recently bitten; billed $4500 for a $40 blood test, with no recourse. -- My state's bad ass Insurance Commissioner is trying to mitigate this problem: Surprise billing legislation passes state House of Representatives https://www.insurance.wa.gov/news/surprise-billing-legislation-passes-state-house-representatives https://www.insurance.wa.gov/news/surprise-billing-legislati... Be sure to call and voice support. Public pressure matters. Long-term fix is single payer, universal coverage. Remove the (worst) profiteering from our healthcare system (racket).
- jrs235 9y ago
  > billed $4500 for a $40 blood test Please elaborate. How did that happen?
  - specialist 9y ago
    Similar story. Lab is "out of network", declined insurance's offer of payment. No one bothered to check coverage beforehand. I didn't even know to ask.
laydn 9y ago
How do they get away with charging $FULL_RATE for a 2 minute visit is a mystery to me. How is that not criminal?
deleted 9y ago
[deleted]
copperred 9y ago
I had a similar experience with some nurses that showed up during my daughter's birth. It was an in-network hospital, pre-approved by the insurance company. The provider that sent the out-of-network bills included a letter with word-for-word what to say to the insurance company (along the lines of "no in-network option was available to me"). I called and opened a grievance because my plan had no out-of-network coverage. Strangely, the insurance company accepted one out of two bills from the same provider. The second bill they passed through against the deductible which I was able to get reimbursed from my employers HRA. Needless to say, this year I moved back to a plan that included out-of-network benefits.
Mz 9y ago
This is ludicrous! I have insurance, & still this will completely drain me financially. I'm at the point where I almost think it would be easier to declare bankruptcy and start over! I worked in insurance for over five years. Not this kind of insurance, but it was a kind of health insurance. a) Get a letter of "medical necessity" drafted by your primary care physician. b) Call the insurance company and ask about the policies concerning emergency treatment. Don't accuse them of anything. They get cussed out all the time and it will not help you. Be nice and start from the assumption that there must be some mistake. c) If you make no progress with that, have a lawyer send the insurance company a letter requesting a copy of your records. This sometimes makes them look very carefully at the bill and sometimes is enough to get you whatever benefits you are legally due. Which may not be your wildest dreams of avarice, but may stave off your desire to declare bankruptcy. If you do have a lawyer request your medical records, expect the insurance company to come back with a form letter stating they need a third party auth. Yes, a lawyer will need a third party authorization to get your medical records, but I wouldn't bother supplying them with one at the start. Just make the request without it and supply it if you really need to. If you get your bill paid because a lawyer wrote them, your lawyer doesn't really need your records. The initial inquiry sometimes gets the claim looked over more thoroughly. I am basically recommending this as a scare tactic. There are actually a lot of errors made in paying complex medical bills at insurance companies for the simple reason that the claims processor may not see an 8 day hospital stay all that often and may have about 10 minutes in which to look your bill over and decide what is payable before moving on. I had to process 60 claims a day to keep my job. This meant I had minutes to decide what the benefits were and people who were very fast were actively rewarded for it. I often cleaned up their messes and, no, this did not get me promoted or anything, even though it sometimes kept the company out of court because the people were threatening to lawyer up. Best.
- rtpg 9y ago
  sounds a lot like there's a startup like that parking ticket startup, but for medical bills.
  - Mz 9y ago
    If you are talking about this: https://nextshark.com/youll-love-what-this-startup-does-with-your-parking-tickets/ https://nextshark.com/youll-love-what-this-startup-does-with... Here are some thoughts: Fixed takes a percentage of the dollar value of tickets that get dismissed and you pay nothing for the service if it is not fixed. Trying to get money out of an insurance company is sort of the opposite problem, though it gets monetized essentially the same way. Independent adjusters monetize by taking a cut of claims paid. This is basically the same monetization scheme that lawyers use for things like suing someone over an accident: They take a cut of cases they win, and you pay nothing if they lose. As far as I know, independent adjusters only work on real estate related claims, not health claims. Last I checked, the only people legally entitled to talk to the insurance company on your behalf are your insurance agent of record, a lawyer or an independent adjuster. So, in practice, you would be talking about independent adjusters for the health insurance space. I am not clear that would even fly, legally. Health insurance is a pain in part because it is very highly regulated. It has to comply with both federal and state laws in all jurisdictions in which it operates and laws for both health companies and financial services companies. Thus, it is subject to both HIPAA (Health Insurance Portability and Accountability Act) and The Gramm–Leach–Bliley Act (GLBA), also known as the Financial Services Modernization Act of 1999. I got annual training in Gramm-Leach-Bliley when I had an insurance job. Furthermore, claims must be reviewed and paid in accordance with various state laws. The company where I worked kept a database of "state exceptions." If you don't know those state exceptions yourself, good luck arguing the matter with an insurance company. You are talking about a very challenging problem space. I have had it cross my mind to offer a service helping people file claims with the company I once worked for. Although I haven't worked there in a while and some things have no doubt changed, I probably could help some people get more money out of their policy. But I have never gotten past the idle thought stage in part because insurance is such a pain of an industry, and in part for other reasons.
Waterluvian 9y ago
My wife and I had a mid-pregnancy scare last year (all is fine). We spent a week as petrified maybe-first-time parents waiting for our turn to get some genetic tests done. I kept returning to the thought about how we had to wait a week, but that people in less fortunate countries might end up facing a massive financial decision. I felt a mix of national pride, relief, and terrible anger for my friends who are forced to intermingle medicine and money.
isostatic 9y ago
"This is ludicrous!" When US citizens en mass realise they pay three times as much as a country for healthcare that other western countries do, maybe it will change.
liveoneggs 9y ago
this situation is illegal in new york. I know that doesn't help you.
dingo_bat 9y ago
> $600 per visit Is this considered normal? I honestly think I'll take my chances than pay that much per minute. Of course I'm thinking in ₹ and my current salary in ₹, which must be vastly lower in absolute terms than the average American.
aaronbrethorst 9y ago
Best lifehack on health insurance: get your government to move to single payer.

JustSomeNobody 9y ago

First, hope you're feeling better. This is exactly why Congress should not be exempt from any health care legislation. They need to go through this also, so it can be fixed.

maxerickson 9y ago
At the moment they get payments from the government to purchase ACA gold plans from the Washington DC exchange. (the Gold plans are closest to other federal government provided health insurance...) Of course, many members of Congress are quite wealthy and wouldn't be much more than annoyed by a bill in the tens of thousands of dollars.

benmarten 9y ago

This sounds like fraud to me. Fight it legally! A co-worker told me that this happened to her, and that made me not take the in-network only plan, but I got the PPO instead. I still think it's illegal or morally not right what they are doing, so we should all fight this practice!!!

myke_cameron 9y ago
Sadly this is how hospital stays are conventionally billed. The cost of being admitted covers only the bed and routine nursing, literally everything else is billed separately. As unfair as it is, the best patients can do is vehemently question the necessity of any interaction with a physician, or else get billed for it. And good luck with that if your case is complicated and you're getting referrals to a wide range of specialists.
- mjcl 9y ago
  And honestly, when you're admitted to the hospital unexpectedly, you're probably not in the frame of mind to be questioning everyone who comes by. I know when I was in for a few days, I only recognized the name of one of the hospitalist doctors that later billed me. And the bills can come months later!

jetcata 9y ago

Also experiencing something similar right now - pathology for a day procedure ended up being out of network and I have a $3500 bill. This is insane.

astockwell 9y ago

You may have some recourse with the insurance company because for emergency care that leads to an admission, the hospital being in-network is supposed to be what counts. Individual doctors being out-of-network should only come into play if you have a procedure done at their practice's office. I sincerely hope it works out for you. It might not hurt to get a 1-hr consult with a lawyer and send the insurance company a nasty letter?

vkou 9y ago
That depends on the state. Most states have no laws against this. Also, if you read your insurer's fine print, you'll find that they will only pay out-of-network providers to some limit that they and the provider agreed to. Even in an emergency situation, you will foot the bill for the delta.

sbov 9y ago

We had a similar experience about 8 months ago, but only one night in the hospital. Raise hell with everyone. The out of network doctors were resolved the fastest for us, and the longest was the hospital stay itself, which our insurance didn't agree to pay until 8 months after the stay. It was a seriously draining experience, and luckily my wife doesn't work so I didn't have to take time off for all the phone calls and following up that was required. I don't fault our insurer. The hospital charged more for our one night stay than another slightly further hospital recently charged us for three nights stay. It was completely ridiculous. But completely out of our hands. I've had to deal with that and more in the last couple years. In my experience there are no "good" or "bad" guys in this fight. It's a bunch of individually rational entities that when taken as a whole are completely fucking over the rest of us.

astockwell 9y ago
> luckily my wife doesn't work so I didn't have to take time off for all the phone calls and following up that was required This. This is so horrifically true, it takes call after call after call (and emails, and faxes, and snail-mail claims forms that take "30 days" to "process") to get anything changed, and by then you have collections companies harassing you and your credit goes down the drain. Meanwhile you must keep working and taking care of family and dealing with the actual illness/issue that led to the medical visit in the first place. It is insane.
- bdamm 9y ago
  A friend of mine was in a sports accident almost two years ago. He had a good medical insurance plan for exactly this possibility. He fractures his pelvis into 14 pieces, and broke another dozen major bones including both femurs. The surgeries are still ongoing although he is mostly himself again. But even two years later, he is facing a daily barrage of calls, being put on hold, no callbacks, paper shuffling, records from hospital to hospital, faxing permission sheets, fighting with the insurance company (who has threatened to drop his insurance multiple times) and on top of it all, his landlord is trying to evict him. It's been horrible to watch. It's like the insurance company is trying to kill him with stress.

jackmott 9y ago

vote for candidates who will support single payer.

theandrewbailey 9y ago
It seems like we already have single payer healthcare: the patient. The patient pays up the ass. All the way.
mistermann 9y ago
Changing things so all taxpayers are getting robbed rather than just the individual being treated seems like a sub-optimal solution.
- Devthrowaway80 9y ago
  Yeah, it won't work. It works in every other developed nation in the world, and they all pay less money for better healthcare outcomes, but hey, the US is Totally Special.
  - jsisksod 9y ago
    The US is larger than 50 developed nations combined, so yes, we are Totally Special.
    - icebraining 9y ago
      Then setup a single-payer system per state. What's the excuse against that?
      - Spoom 9y ago
        Before I answer this, let me frame my opinion: I very much want single payer in the United States, and were it plausible to do it on a state-by-state basis, I would support it. Apparently, states are unable to restrict entry into state benefit programs such as healthcare. They can't set up a waiting period for people moving into the state before they are eligible; that was declared unconstitutional by a previous Supreme Court. So if states were to do their own single payer system, in theory sick people could move into the state and immediately gain free healthcare simply by virtue of being a resident. Conversely, they could then move back to their home state that doesn't charge higher taxes. So it wouldn't be feasible on a state-by-state basis unless a future SCOTUS reverses their precedent. This is unlikely in the short term, given the current Court's make up.

ydt 9y ago

I had this same thing happen. My daughter was admitted via ER and it turned into a 6 day stay. At the end we received a bill for 40k for being out of network. Luckily I have friends in the industry and it turns out if they fail to inform you within 48 hours that you're not in network you don't have to pay the out of network cost. We ended up paying just our deductible after a letter was drafted. Do not take what the hospital/insurance Co say at face value. Call an attorney.

mistermann 9y ago
Can someone knowledgeable on the subject comment on whether the "Obamacare movement" has been up front in acknowledging this aspect of the problem with health care in the US? My perception is that the problem is typically framed as a lack of insurance problem for financially challenged people, but the "abuse" on the billing side to me seems like at least as big of a problem. And if this is being conveniently ignored, it feeds my conspiracy thinking that the Democrats are actually largely indistinguishable from Republicans - they may wear a different mask, but their actions are only slightly different, in this case altering who is getting robbed.
- heartbreak 9y ago
  Well the progressives including President Obama pushed for single payer (or a public option) which would eliminate abuse on the billing side, at least to the insured.
  - jazzyk 9y ago
    The single-payer option was quickly dropped by the Democrats in Congress. Their sponsors (the health-"care" industry) did not like it.
    - albinofrenchy 9y ago
      It was dropped because it was politically impossible and it wasn't worth burning political capital on it. Even just the public option wasn't able to gain traction; single payer was never going to happen in 2009.

sjg007 9y ago

ER + hospitalization visit should be covered no matter what.

narrator 9y ago

When I had back surgery, there were all these therapists coming in the moment I got out of surgery trying to get their 1 minute in. It was throughly ridiculous. One of them was attempting to do physical therapy and pulled on my leg a little and put me into so much pain I went into shock. She probably got her $600 bucks. I am with Kaiser now and it is the most BS free medical experience I have ever had. To fix healthcare without single payer the government should just make a law that medical insurance can only be offered by hospital chains and the doctors and specialists cannot bill insurance separately, but must be paid by the hospitals. This is how Kaiser works. That way the hospitals can pay a fair market rate to doctors and not have them demanding a surprise emergency room rate from distressed patients.

et-al 9y ago
Everyone in the Bay Area loves talking down on Kaiser, but financially they've been the most worry-free experience. Had ringing in my ear for a week, went to the doctor, and she referred me to both an audiologist and MRI. Paid $20 for both of those other visits. If I had been on Blue Cross Blue Shield, I probably would've sucked it up given my super high deductible and navigating the in-network maze.
- Declanomous 9y ago
  BCBS IL is super straightforward. Every doctor is $20, unless it's a specialist, then it is $40. I've never actually been billed $40, despite seeing many specialists, so I'm not sure what actually qualifies. I've been hospitalized and paid <$1000 for an overnight stay, with visits from specialists, etc, so I'm pretty happy altogether. My biggest complaint about the medical industry is the cost of prescription drugs. It's ridiculous how much we pay for drugs in this country.
  - et-al 9y ago
    Is your BCBS IL plan an HMO? That could explain the simplicity. I used to be on an HMO, but now it's a PPO with BCBS. The flexibility of choosing my provider hasn't been needed for my case.

softawre 9y ago

Do you not have some max out of pocket for the year? Mine is 4000$, or 6000$ out of network.

icantdrive55 9y ago

If you don't have a house that has more than 120k in equity, or a bucnch of expensive personal items; declare a chapter 7. (I believe 120,000 of the personal home is safe in a bankruptcy in California. Texas has has am unlimited homestead exemption. Meaning you can own a mansion, and keep it in a bankruptcy.) Don't pay the paracites a penny. Look into doing a straight chapter 7 yourself. I'm planning on doing mine. You'll save $3000 by doing it yourself. I'm glad you feeling better. They have become weasels. And to those that think hospitals, and doctors don't come after payment; they do. They can be very aggressive. Good luck!

msoucy 9y ago

And heaven forbid you have to take an ambulance to the hospital - ambulances might not be in network, in which case you're looking at a $800 charge for a ten minute drive (that you can't make yourself due to a variety of reasons). I wasn't even in bad enough health that they would turn on the lights, so I didn't even get that small silver lining. Then you get to sit in an "emergency room" for hours, when you're physically unable to move, and with your phone dead so you can't even let anyone know where you are. When you're finally wheeled to where you need to be, you're basically dumped in a hallway facing a wall for half an hour, and you're in a wheelchair and so weak that you can't even turn to face anything interesting. I paid about $1000 for that luxury. At that price I'd expect a decent waiting room... Yes I just needed to vent about that situation. It sucked, especially for a college student. I was hounded for months afterward to pay those bills, because of course when you're throwing up you can pick which ambulance gives you a ride.

ugh123 9y ago

Wait it out until things settle (in processing, and until actual bills come in). I was in a similar situation and claimed this was news to me and inappropriate (others have said they have a window to notify you). Keep pestering them and they'll likely drop it.

will_brown 9y ago

Here is a nice article about that practice: https://fairhealthconsumer.org/reimbursementseries.php?terms=when-out-of-network-care-can-be-covered-in-network https://fairhealthconsumer.org/reimbursementseries.php?terms... Most importantly, most states have laws mandating insurers use in network rates for certain instances of using out of network providers, including in factual instances like you described (i.e. in network hostitals and out of network providers). Seperately, most states have statutes awarding attorneys fees to the insured when claims have been denied in bad faith, like refusing to adjust bills to in network rates when mandated by law.

specialist 9y ago

I'm sorry for your current struggles. I too was recently bitten; billed $4500 for a $40 blood test, with no recourse. -- My state's bad ass Insurance Commissioner is trying to mitigate this problem: Surprise billing legislation passes state House of Representatives https://www.insurance.wa.gov/news/surprise-billing-legislation-passes-state-house-representatives https://www.insurance.wa.gov/news/surprise-billing-legislati... Be sure to call and voice support. Public pressure matters. Long-term fix is single payer, universal coverage. Remove the (worst) profiteering from our healthcare system (racket).

jrs235 9y ago
> billed $4500 for a $40 blood test Please elaborate. How did that happen?
- specialist 9y ago
  Similar story. Lab is "out of network", declined insurance's offer of payment. No one bothered to check coverage beforehand. I didn't even know to ask.

laydn 9y ago

How do they get away with charging $FULL_RATE for a 2 minute visit is a mystery to me. How is that not criminal?

deleted 9y ago

[deleted]

copperred 9y ago

I had a similar experience with some nurses that showed up during my daughter's birth. It was an in-network hospital, pre-approved by the insurance company. The provider that sent the out-of-network bills included a letter with word-for-word what to say to the insurance company (along the lines of "no in-network option was available to me"). I called and opened a grievance because my plan had no out-of-network coverage. Strangely, the insurance company accepted one out of two bills from the same provider. The second bill they passed through against the deductible which I was able to get reimbursed from my employers HRA. Needless to say, this year I moved back to a plan that included out-of-network benefits.

Mz 9y ago

This is ludicrous! I have insurance, & still this will completely drain me financially. I'm at the point where I almost think it would be easier to declare bankruptcy and start over! I worked in insurance for over five years. Not this kind of insurance, but it was a kind of health insurance. a) Get a letter of "medical necessity" drafted by your primary care physician. b) Call the insurance company and ask about the policies concerning emergency treatment. Don't accuse them of anything. They get cussed out all the time and it will not help you. Be nice and start from the assumption that there must be some mistake. c) If you make no progress with that, have a lawyer send the insurance company a letter requesting a copy of your records. This sometimes makes them look very carefully at the bill and sometimes is enough to get you whatever benefits you are legally due. Which may not be your wildest dreams of avarice, but may stave off your desire to declare bankruptcy. If you do have a lawyer request your medical records, expect the insurance company to come back with a form letter stating they need a third party auth. Yes, a lawyer will need a third party authorization to get your medical records, but I wouldn't bother supplying them with one at the start. Just make the request without it and supply it if you really need to. If you get your bill paid because a lawyer wrote them, your lawyer doesn't really need your records. The initial inquiry sometimes gets the claim looked over more thoroughly. I am basically recommending this as a scare tactic. There are actually a lot of errors made in paying complex medical bills at insurance companies for the simple reason that the claims processor may not see an 8 day hospital stay all that often and may have about 10 minutes in which to look your bill over and decide what is payable before moving on. I had to process 60 claims a day to keep my job. This meant I had minutes to decide what the benefits were and people who were very fast were actively rewarded for it. I often cleaned up their messes and, no, this did not get me promoted or anything, even though it sometimes kept the company out of court because the people were threatening to lawyer up. Best.

rtpg 9y ago
sounds a lot like there's a startup like that parking ticket startup, but for medical bills.
- Mz 9y ago
  If you are talking about this: https://nextshark.com/youll-love-what-this-startup-does-with-your-parking-tickets/ https://nextshark.com/youll-love-what-this-startup-does-with... Here are some thoughts: Fixed takes a percentage of the dollar value of tickets that get dismissed and you pay nothing for the service if it is not fixed. Trying to get money out of an insurance company is sort of the opposite problem, though it gets monetized essentially the same way. Independent adjusters monetize by taking a cut of claims paid. This is basically the same monetization scheme that lawyers use for things like suing someone over an accident: They take a cut of cases they win, and you pay nothing if they lose. As far as I know, independent adjusters only work on real estate related claims, not health claims. Last I checked, the only people legally entitled to talk to the insurance company on your behalf are your insurance agent of record, a lawyer or an independent adjuster. So, in practice, you would be talking about independent adjusters for the health insurance space. I am not clear that would even fly, legally. Health insurance is a pain in part because it is very highly regulated. It has to comply with both federal and state laws in all jurisdictions in which it operates and laws for both health companies and financial services companies. Thus, it is subject to both HIPAA (Health Insurance Portability and Accountability Act) and The Gramm–Leach–Bliley Act (GLBA), also known as the Financial Services Modernization Act of 1999. I got annual training in Gramm-Leach-Bliley when I had an insurance job. Furthermore, claims must be reviewed and paid in accordance with various state laws. The company where I worked kept a database of "state exceptions." If you don't know those state exceptions yourself, good luck arguing the matter with an insurance company. You are talking about a very challenging problem space. I have had it cross my mind to offer a service helping people file claims with the company I once worked for. Although I haven't worked there in a while and some things have no doubt changed, I probably could help some people get more money out of their policy. But I have never gotten past the idle thought stage in part because insurance is such a pain of an industry, and in part for other reasons.

Waterluvian 9y ago

My wife and I had a mid-pregnancy scare last year (all is fine). We spent a week as petrified maybe-first-time parents waiting for our turn to get some genetic tests done. I kept returning to the thought about how we had to wait a week, but that people in less fortunate countries might end up facing a massive financial decision. I felt a mix of national pride, relief, and terrible anger for my friends who are forced to intermingle medicine and money.

isostatic 9y ago

"This is ludicrous!" When US citizens en mass realise they pay three times as much as a country for healthcare that other western countries do, maybe it will change.

liveoneggs 9y ago

this situation is illegal in new york. I know that doesn't help you.

dingo_bat 9y ago

> $600 per visit Is this considered normal? I honestly think I'll take my chances than pay that much per minute. Of course I'm thinking in ₹ and my current salary in ₹, which must be vastly lower in absolute terms than the average American.

aaronbrethorst 9y ago

Best lifehack on health insurance: get your government to move to single payer.