8 ms·

I was a victim of the surprise out of network bill in the Portland, OR area. I did all my research before hand: hospital in network, surgeon in network, etc. bu

I was a victim of the surprise out of network bill in the Portland, OR area. I did all my research before hand: hospital in network, surgeon in network, etc. but ONE person in that operating room was not in network and SURPRISE i'm out thousands of dollars. The worst part about this is my state passed a bill to stop this prior to my surgery, but the bill's effective date was roughly 3 months later. Talk about bad timing.

sjg007 8y ago
You can try to appeal it.
- y-c-o-m-b 8y ago
  Appealed twice and both times they denied it stating I didn't require the surgery despite the fact they pre-approved it and paid for all the in-network costs. I ended up paying it because I had the money and I couldn't handle the stress of a legal battle (which given what I've read is an uphill battle).
  - sjg007 8y ago
    Sorry to hear that.. you can usually appeal up the food chain sometimes.. e.g. to your states insurance department if the plan is regulated by your state. And at the Federal level you can also submit a ERISA appeal. None of it is fun and then there are deadlines... Also if you are on an employer provided insurance plan, you can talk to your HR who will have an insurance rep who can sometimes make these things go away e.g. get them paid. If you are at a large employer that self insures and uses a third party admin (like Cigna) then they can tell the admin to negotiate with the doctor/hospital and pay it.
wycy 8y ago
From what I understand (which is honestly not much), I think in cases like this you can contact the hospital and just insist on paying the same amount your insurance would have paid, and they'll often take it. That's just what I hear, though.
- manfredo 8y ago
  Regardless of insurance, when you offer to pay cash hospitals will often slash the price considerably. If the hospital has to use a debt collection agency, then they're looking at getting a small fraction of the list price back - sometimes an order of magnitude less. They're willing to negotiate accordingly.
- ben_jones 8y ago
  My last visit to a hospital it was requested I arrive 30 minutes early to "fill out paperwork". After arriving at the radiology department an office assistant took me into a nearby room and had me sign consent forms and make payment on the spot. Anxious for my exam I signed everything and handed over my debit card. Later on I realized one of the forms cemented acceptance of the debt and guaranteed my full payment of it. If I chose to I would have very little ground to stand on disputing the costs ($800 for an ultrasound). Hospitals are for-profit entities that will optimize debt-collection and bargaining power over patients. They will start taking payment upfront as well as influencing patients to choose financing options that are in the best interest of the hospital and not the patient themselves. It's hard not to feel like the whole system is rotten.
  - StreamBright 8y ago
    Yes it is, there are several factors jacking up the price in the US. There are some good videos on it on Youtube. I was always wondering why people think that it is a free market there. In Europe there are several countries that let you use private and public health insurance (even at the same time) and you can go to any healthcare provider and still get a reasonable price. In my country the private provider "industry" is booming and most lab work can be done in a private manner, usually for a very reasonable price. Most of this is accessible in a week ahead booking time.
- MichaelApproved 8y ago
  This is horrible advice. Do not agree to pay a penny of that fraudulent bill. If you didn't agree to the service, you should not be liable to pay. Call the hospital and demand it be removed from your bill. That's what others[1] (including myself) have done and the fraudulent charge was eventually removed. The absurd part is that you would even need to do this. How many people don't understand you can fight healthcare charges and get them removed? How many have the free time that it takes to call the billing department over and over? The whole health insurance system is trash and needs to be replaced. [1] https://news.ycombinator.com/item?id=18719725 https://news.ycombinator.com/item?id=18719725
jclay 8y ago
Exact same thing happened to my friend. He did all his research, and while he was under anesthesia a nurse assisted that was out of network. $5k out of pocket. He ended up getting it removed after some run around between insurance and the hospital.
- noja 8y ago
  Today is "don't believe the comments day" it seems. How is an unconscious person meant to be stop an "out of network" nurse assisting? Is there a tattoo that you can get?
  - hahla 8y ago
    I think OP meant he was able to get the extra $5k removed from the bill after the fact.... not the nurse removed from the operating room.
    - noja 8y ago
      Yes I understood that he got the charge removed. I couldn't understand the initial situation (that such a thing could happen).
  - deleted 8y ago
    [deleted]
  - ceejayoz 8y ago
    > How is an unconscious person meant to be stop an "out of network" nurse assisting? They can't. That's the problem - there's little you can do to stop it from happening, even if you're aware of this sort of billing problem and try to take steps to prevent it. https://www.npr.org/sections/health-shots/2018/08/27/640891882/life-threatening-heart-attack-leaves-teacher-with-108-951-bill https://www.npr.org/sections/health-shots/2018/08/27/6408918... > Surprise bills occur when a patient goes to a hospital in his insurance network but receives treatment from a doctor who does not participate in the network, resulting in a direct bill to the patient. They can also occur in cases like Calver's, where insurers will pay for needed emergency care at the closest hospital — even if it is out of network — but the hospital and the insurer may not agree on a reasonable price. The hospital then demands that patients pay the difference, in a practice called balance billing. https://www.npr.org/sections/health-shots/2015/02/17/386908835/figuring-out-if-a-doctor-is-in-your-network-can-be-perplexing https://www.npr.org/sections/health-shots/2015/02/17/3869088... > The surgeon's office later told her that he belonged to two different medical groups. One was in Morgan's husband's health plan network, the other wasn't.
brightball 8y ago
Even out of network, you are able to bill your insurance directly. There are a lot of private practices not in network with any providers at all where insurance will still cover, you just have to do the legwork yourself usually.
ddebernardy 8y ago
I'm at a loss as to why the US is still dead set to have no meaningful health coverage. I got burned by this in California a decade ago. A dentist charged me $4,500 to fix a broken tooth (panic!) and fill in a cavity on a Sunday. Had I known then what it might have cost I'd have simply flown back to Europe in the next flight ($600-800 at the time) and get the same thing done for under $100-200 with a full refund from my local social security. Adding insult to injury I had a very expensive international health insurance policy owing to my traveling around the world back then. And they didn't cover dental with my plan. I knew they wouldn't. But it was still mind boggling to me in that I never expected a casual procedure that would have cost me €150 at most anywhere in Europe - most of which would have gotten refunded at that - to cost me a whopping $4,500 in the US.
- russdill 8y ago
  The US healthcare system is the equivalent of xkcd's TornadoGuard app. https://xkcd.com/937/ https://xkcd.com/937/ You only find out just how badly it works when you need it the most.
- jessaustin 8y ago
  USA dentists don't work on Sunday. If you had waited until Monday you would have had many more options. Besides what could she have possibly done to "fix a broken tooth" in one day? Nobody was milling crowns in the office a decade ago. If it was really just a filling, wow. Do dentists in Europe work on Sunday? In my experience the grocery stores aren't even open...
  - arethuza 8y ago
    I've had emergency dental treatment in an NHS hospital in the UK for an extremely painful dental abscess - was treated first thing on a Sunday morning.
    - chimeracoder 8y ago
      > I've had emergency dental treatment in an NHS hospital in the UK for an extremely painful dental abscess - was treated first thing on a Sunday morning. Emergency dental care is provided in the US as well. Filling a cavity is not considered an emergency.
doctorpangloss 8y ago
Yes, moonlighters (the surgeon in that room) are expensive (to both you and the hospital). Why do you think that person wound up there? Otherwise underpaid, overworked surgical residents leave either due to truly catastrophic burnout, mental illness, family emergency or pregnancy. They are replaced by moonlighters, because the economics of the surgery are that the nurses and other unionized employees get mandatory breaks, so the seemingly 1-2 hour delay waiting for a different resident to be free balloons into a multi-staff scheduling fiasco. We could amortize all those costs into "surgery minutes" which are paid whether or not the literal room is in use or whatever. It's a math problem if by saving surgery minutes, the hospital saves real economic money for itself, the patient or the state, so I'm not sure if that is or is not the case in your particular case. What's interesting isn't that there's legislation one way or another, or that you feel like you got a raw deal. The legislation isn't going to change what it says it will, because it will still make sense to hire moonlighters. And motivated people like you will still somehow still wind up paying the cost. The real test of your merit is whether or not you think in the grand scheme of things, this is fair. Are you frustrated that there may have been a pregnant resident, and that's why there's a moonlighter in the operating room? What does justice look like there? Cut you a check for thousands of dollars? That never happens. Retribution on residents who might get pregnant? That's what happens. Your situation is shitty. I know in most movies, books and the press, the doctor is usually the antagonist. We live in a world that resents their disproportionately immigrant backgrounds, disproportionately even gender balance compared to other professions, and most of all their pay, despite their hard work. How do you feel?
- SolaceQuantum 8y ago
  Except I highly doubt the staff and doctors are actually being paid in proportion to the charge. I doubt they’re even being paid a significant portion of that bill. We’re not hurting doctors and nurses when people claim to want more efficient healthcare strategies. There are ways to allow moonlighting, such as everyone being in-network to a greater social healthcare system.
cwkoss 8y ago
Maybe I should write "I do not consent to any out of network services" across my forehead in sharpie before any operations.
fitzroy 8y ago
With Medicaid (in New York, at least) a provider isn't allowed to bill a beneficiary for treatment. It is such a huge stress reliever. I can't figure out how so many people continually fall for the propaganda against single payer / Medicaid/care-for-all. Source: https://www.nyacep.org/practice-resources-2/resources/practice-management-resources/medicaid/222-medicaid-beneficiaries-cannot-be-billed https://www.nyacep.org/practice-resources-2/resources/practi...
- conanbatt 8y ago
  Well, the bill gets to the tax-payer instead of the patient.

sjg007 8y ago

You can try to appeal it.

y-c-o-m-b 8y ago
Appealed twice and both times they denied it stating I didn't require the surgery despite the fact they pre-approved it and paid for all the in-network costs. I ended up paying it because I had the money and I couldn't handle the stress of a legal battle (which given what I've read is an uphill battle).
- sjg007 8y ago
  Sorry to hear that.. you can usually appeal up the food chain sometimes.. e.g. to your states insurance department if the plan is regulated by your state. And at the Federal level you can also submit a ERISA appeal. None of it is fun and then there are deadlines... Also if you are on an employer provided insurance plan, you can talk to your HR who will have an insurance rep who can sometimes make these things go away e.g. get them paid. If you are at a large employer that self insures and uses a third party admin (like Cigna) then they can tell the admin to negotiate with the doctor/hospital and pay it.

wycy 8y ago

From what I understand (which is honestly not much), I think in cases like this you can contact the hospital and just insist on paying the same amount your insurance would have paid, and they'll often take it. That's just what I hear, though.

manfredo 8y ago
Regardless of insurance, when you offer to pay cash hospitals will often slash the price considerably. If the hospital has to use a debt collection agency, then they're looking at getting a small fraction of the list price back - sometimes an order of magnitude less. They're willing to negotiate accordingly.
ben_jones 8y ago
My last visit to a hospital it was requested I arrive 30 minutes early to "fill out paperwork". After arriving at the radiology department an office assistant took me into a nearby room and had me sign consent forms and make payment on the spot. Anxious for my exam I signed everything and handed over my debit card. Later on I realized one of the forms cemented acceptance of the debt and guaranteed my full payment of it. If I chose to I would have very little ground to stand on disputing the costs ($800 for an ultrasound). Hospitals are for-profit entities that will optimize debt-collection and bargaining power over patients. They will start taking payment upfront as well as influencing patients to choose financing options that are in the best interest of the hospital and not the patient themselves. It's hard not to feel like the whole system is rotten.
- StreamBright 8y ago
  Yes it is, there are several factors jacking up the price in the US. There are some good videos on it on Youtube. I was always wondering why people think that it is a free market there. In Europe there are several countries that let you use private and public health insurance (even at the same time) and you can go to any healthcare provider and still get a reasonable price. In my country the private provider "industry" is booming and most lab work can be done in a private manner, usually for a very reasonable price. Most of this is accessible in a week ahead booking time.
MichaelApproved 8y ago
This is horrible advice. Do not agree to pay a penny of that fraudulent bill. If you didn't agree to the service, you should not be liable to pay. Call the hospital and demand it be removed from your bill. That's what others[1] (including myself) have done and the fraudulent charge was eventually removed. The absurd part is that you would even need to do this. How many people don't understand you can fight healthcare charges and get them removed? How many have the free time that it takes to call the billing department over and over? The whole health insurance system is trash and needs to be replaced. [1] https://news.ycombinator.com/item?id=18719725 https://news.ycombinator.com/item?id=18719725

jclay 8y ago

Exact same thing happened to my friend. He did all his research, and while he was under anesthesia a nurse assisted that was out of network. $5k out of pocket. He ended up getting it removed after some run around between insurance and the hospital.

noja 8y ago
Today is "don't believe the comments day" it seems. How is an unconscious person meant to be stop an "out of network" nurse assisting? Is there a tattoo that you can get?
- hahla 8y ago
  I think OP meant he was able to get the extra $5k removed from the bill after the fact.... not the nurse removed from the operating room.
  - noja 8y ago
    Yes I understood that he got the charge removed. I couldn't understand the initial situation (that such a thing could happen).
- deleted 8y ago
  [deleted]
- ceejayoz 8y ago
  > How is an unconscious person meant to be stop an "out of network" nurse assisting? They can't. That's the problem - there's little you can do to stop it from happening, even if you're aware of this sort of billing problem and try to take steps to prevent it. https://www.npr.org/sections/health-shots/2018/08/27/640891882/life-threatening-heart-attack-leaves-teacher-with-108-951-bill https://www.npr.org/sections/health-shots/2018/08/27/6408918... > Surprise bills occur when a patient goes to a hospital in his insurance network but receives treatment from a doctor who does not participate in the network, resulting in a direct bill to the patient. They can also occur in cases like Calver's, where insurers will pay for needed emergency care at the closest hospital — even if it is out of network — but the hospital and the insurer may not agree on a reasonable price. The hospital then demands that patients pay the difference, in a practice called balance billing. https://www.npr.org/sections/health-shots/2015/02/17/386908835/figuring-out-if-a-doctor-is-in-your-network-can-be-perplexing https://www.npr.org/sections/health-shots/2015/02/17/3869088... > The surgeon's office later told her that he belonged to two different medical groups. One was in Morgan's husband's health plan network, the other wasn't.

brightball 8y ago

Even out of network, you are able to bill your insurance directly. There are a lot of private practices not in network with any providers at all where insurance will still cover, you just have to do the legwork yourself usually.

ddebernardy 8y ago

I'm at a loss as to why the US is still dead set to have no meaningful health coverage. I got burned by this in California a decade ago. A dentist charged me $4,500 to fix a broken tooth (panic!) and fill in a cavity on a Sunday. Had I known then what it might have cost I'd have simply flown back to Europe in the next flight ($600-800 at the time) and get the same thing done for under $100-200 with a full refund from my local social security. Adding insult to injury I had a very expensive international health insurance policy owing to my traveling around the world back then. And they didn't cover dental with my plan. I knew they wouldn't. But it was still mind boggling to me in that I never expected a casual procedure that would have cost me €150 at most anywhere in Europe - most of which would have gotten refunded at that - to cost me a whopping $4,500 in the US.

russdill 8y ago
The US healthcare system is the equivalent of xkcd's TornadoGuard app. https://xkcd.com/937/ https://xkcd.com/937/ You only find out just how badly it works when you need it the most.
jessaustin 8y ago
USA dentists don't work on Sunday. If you had waited until Monday you would have had many more options. Besides what could she have possibly done to "fix a broken tooth" in one day? Nobody was milling crowns in the office a decade ago. If it was really just a filling, wow. Do dentists in Europe work on Sunday? In my experience the grocery stores aren't even open...
- arethuza 8y ago
  I've had emergency dental treatment in an NHS hospital in the UK for an extremely painful dental abscess - was treated first thing on a Sunday morning.
  - chimeracoder 8y ago
    > I've had emergency dental treatment in an NHS hospital in the UK for an extremely painful dental abscess - was treated first thing on a Sunday morning. Emergency dental care is provided in the US as well. Filling a cavity is not considered an emergency.

doctorpangloss 8y ago

Yes, moonlighters (the surgeon in that room) are expensive (to both you and the hospital). Why do you think that person wound up there? Otherwise underpaid, overworked surgical residents leave either due to truly catastrophic burnout, mental illness, family emergency or pregnancy. They are replaced by moonlighters, because the economics of the surgery are that the nurses and other unionized employees get mandatory breaks, so the seemingly 1-2 hour delay waiting for a different resident to be free balloons into a multi-staff scheduling fiasco. We could amortize all those costs into "surgery minutes" which are paid whether or not the literal room is in use or whatever. It's a math problem if by saving surgery minutes, the hospital saves real economic money for itself, the patient or the state, so I'm not sure if that is or is not the case in your particular case. What's interesting isn't that there's legislation one way or another, or that you feel like you got a raw deal. The legislation isn't going to change what it says it will, because it will still make sense to hire moonlighters. And motivated people like you will still somehow still wind up paying the cost. The real test of your merit is whether or not you think in the grand scheme of things, this is fair. Are you frustrated that there may have been a pregnant resident, and that's why there's a moonlighter in the operating room? What does justice look like there? Cut you a check for thousands of dollars? That never happens. Retribution on residents who might get pregnant? That's what happens. Your situation is shitty. I know in most movies, books and the press, the doctor is usually the antagonist. We live in a world that resents their disproportionately immigrant backgrounds, disproportionately even gender balance compared to other professions, and most of all their pay, despite their hard work. How do you feel?

SolaceQuantum 8y ago
Except I highly doubt the staff and doctors are actually being paid in proportion to the charge. I doubt they’re even being paid a significant portion of that bill. We’re not hurting doctors and nurses when people claim to want more efficient healthcare strategies. There are ways to allow moonlighting, such as everyone being in-network to a greater social healthcare system.

cwkoss 8y ago

Maybe I should write "I do not consent to any out of network services" across my forehead in sharpie before any operations.

fitzroy 8y ago

With Medicaid (in New York, at least) a provider isn't allowed to bill a beneficiary for treatment. It is such a huge stress reliever. I can't figure out how so many people continually fall for the propaganda against single payer / Medicaid/care-for-all. Source: https://www.nyacep.org/practice-resources-2/resources/practice-management-resources/medicaid/222-medicaid-beneficiaries-cannot-be-billed https://www.nyacep.org/practice-resources-2/resources/practi...

conanbatt 8y ago
Well, the bill gets to the tax-payer instead of the patient.