4 ms·

> What are you supposed to do, interrogate every person that comes in the room? I'm curious too. Some people must have tried filing a lawsuit... what do judges

> What are you supposed to do, interrogate every person that comes in the room? I'm curious too. Some people must have tried filing a lawsuit... what do judges think people should be doing?

RHSeeger 6y ago
I had to go into surgery last year and had to sign a "I will pay whatever my insurance doesn't" form. I wrote in a clause saying that any out of network elements (persons, etc) must be personally approved in writing by myself or my proxy before they can do anything they bill for. I don't know if it would have held up in court, but it made me feel a little safer.
cmiles74 6y ago
In my case it was the anesthesiologist who was out of network. Looking at the bill, they looked like just another practice. When I found their phone number and address, however, it turned out that their practice was part of the hospital. I called their number and ended up talking to someone in their office and they agreed to waive the fee. I wonder if this is part of their process: if there's pushback, waive the fee.
- dr_orpheus 6y ago
  > I wonder if this is part of their process: if there's pushback, waive the fee. This is 100% how a lot of medical offices and/or insurance operates. For some practices that perform complicated procedures bills will get sent with a "catch-all" sort of approach of all possible scenarios that could have happened and you have to go back and tell them what treatment you actually got. Insurance companies will also just initially deny claims in the hopes that people won't spend the time to debate it. My wife had to get back injections for a bulged disk and insurance initially denied the claim on the basis that "it was not inhibiting her daily function". The original request from the doctor included the wording of "this is medically necessary because the pain is inhibiting her daily function" because he knew that was their criteria. Insurance still just rejected it because it is easier for them to do that and only accept the claims people fight for. Luckily in this case the doctors office was on our side and called the insurance company to get it approved. The doctor said that this kind of shit happened all the time.
  - ajtaylor 6y ago
    Huh. My wife is actually having the same procedure done for the second time after Christmas. Naturally the doctor is in-network, but his surgical facility (on the same floor, immediately adjacent to the doctor's offices) isn't. So it's fork out $1500 and fight insurance to reimburse us after the fact. In her case, the epidural really does give her life back by completely killing the pressure and migraines that otherwise plague her daily. Insurance can kiss my butt. Single payer would be fabulous in this case.
    - throwaway201103 6y ago
      There's this idea that "single payer" will pay for "anything I want" and it seems to me that evidence for this is sorely lacking.
      - 93po 6y ago
        Does the NHS not cover treatment for documented, debilitating migraines? I would be shocked to hear that it doesn't. In fact I think I would be surprised to hear if the NHS doesn't cover anything as long as it isn't something like cosmetic surgery. There is no reason single payer shouldn't or couldn't cover 99% of most medical needs.

> What are you supposed to do, interrogate every person that comes in the room? I'm curious too. Some people must have tried filing a lawsuit... what do judges think people should be doing?

RHSeeger 6y ago

I had to go into surgery last year and had to sign a "I will pay whatever my insurance doesn't" form. I wrote in a clause saying that any out of network elements (persons, etc) must be personally approved in writing by myself or my proxy before they can do anything they bill for. I don't know if it would have held up in court, but it made me feel a little safer.

cmiles74 6y ago

In my case it was the anesthesiologist who was out of network. Looking at the bill, they looked like just another practice. When I found their phone number and address, however, it turned out that their practice was part of the hospital. I called their number and ended up talking to someone in their office and they agreed to waive the fee. I wonder if this is part of their process: if there's pushback, waive the fee.

dr_orpheus 6y ago
> I wonder if this is part of their process: if there's pushback, waive the fee. This is 100% how a lot of medical offices and/or insurance operates. For some practices that perform complicated procedures bills will get sent with a "catch-all" sort of approach of all possible scenarios that could have happened and you have to go back and tell them what treatment you actually got. Insurance companies will also just initially deny claims in the hopes that people won't spend the time to debate it. My wife had to get back injections for a bulged disk and insurance initially denied the claim on the basis that "it was not inhibiting her daily function". The original request from the doctor included the wording of "this is medically necessary because the pain is inhibiting her daily function" because he knew that was their criteria. Insurance still just rejected it because it is easier for them to do that and only accept the claims people fight for. Luckily in this case the doctors office was on our side and called the insurance company to get it approved. The doctor said that this kind of shit happened all the time.
- ajtaylor 6y ago
  Huh. My wife is actually having the same procedure done for the second time after Christmas. Naturally the doctor is in-network, but his surgical facility (on the same floor, immediately adjacent to the doctor's offices) isn't. So it's fork out $1500 and fight insurance to reimburse us after the fact. In her case, the epidural really does give her life back by completely killing the pressure and migraines that otherwise plague her daily. Insurance can kiss my butt. Single payer would be fabulous in this case.
  - throwaway201103 6y ago
    There's this idea that "single payer" will pay for "anything I want" and it seems to me that evidence for this is sorely lacking.
    - 93po 6y ago
      Does the NHS not cover treatment for documented, debilitating migraines? I would be shocked to hear that it doesn't. In fact I think I would be surprised to hear if the NHS doesn't cover anything as long as it isn't something like cosmetic surgery. There is no reason single payer shouldn't or couldn't cover 99% of most medical needs.