Teresa
TUG Member
This is sorta long. Just a warning!
Background: I live in Ohio and have the Cleveland Clinic healthcare for 2019 (called Oscar). The fine print says you can only go to a provider in their network in order for insurance to be used (an in-network provider) EXCEPT in an emergency (I read this as emergency room visit).
In Florida in February, 2019 and having some chest pains (I'm fine - they found nothing). Husband took me to emergency room. Pain left after about 20 minutes in waiting room but kept being told, 'should get things checked out.' Emergency room doctor said I needed to stay because it would be nearly impossible to see a cardiologist in the next six months without seeing one while at the hospital. I was incredulous and she (emergency room doctor) said, 'you sound surprised?' I was.
I shoulda left (1st lesson) but everyone there kept insisting 'better check - you don't want to take any chances.'
They put me in a room in the cardiology wing. Had several doctors come to visit - 2 hospitalists and the cardiologist. People also woke me up during the night to take blood pressure and occasionally blood.
Next morning there was a stress test (which the cardiologist said I should have before I left the hospital - just to be sure).
Left late morning. No diagnosis except that I seemed fine medically. Blood tests fine (except for high triglycerides - which didn't get treated except to have them say, 'get retested when back in Ohio).
Bills start rolling in. Over $14,000 for the hospital bill (Oscar knocked it down to just under $7K). My deductible is $7,900 per individual and $15,800 for family - network only.
Got a bill from a non-network doctor (even though I was treated through the emergency room). I believe it was the emergency room doctor (the one who told me to stay). That's separate from the hospital bill but was not written up as 'emergency' but as a consult. Denied by insurance. Talked to insurance. They said it was not coded as an emergency so denied. 'Just tell them to change the coding.' Talked to the third party billing office and told them insurance company said to change the coding to 'emergency'. Said they couldn't do it as the doctor didn't say that. Transcript says 'female presented through emergency department ....'. Billing company wouldn't budge. BUT they would talk to higher ups and call me back. No calls. I got a collection letter from a collection company. GRRRR. Called them and told them I was expecting a call back - not a collection company contacting me. Woman I talked to saw they had not followed through (notations on account). She applied Medicaid discount and then, because I was paying the bill instead of insurance company, took 20% off of that. Bill was less than half of original. They took it back from the collection company and I paid that lower amount. 2nd lesson (persistence is important - although it is almost like talking to a cell phone company or cable company).
Had previously paid $3,000 on the hospital bill (from HSA account) and then set up a payment plan with them at $100/month (my plan was to pay more but that was the minimum per month). Asked for an itemized bill in the meantime.
When I was 'barking' at the hospital for having this non-network doctor bill me like they did (see 2 paragraphs up), the woman at the hospital mentioned to me that since I was paying their bill (not insurance company) I could take 20% off. Huh? She explained to me that anytime someone is self-paying (even if insurance has knocked it down) there is a 20% discount to pay the entire bill. Hmmm. When I was first making that $3,000 partial payment, no one mentioned that I could get 20% off the bill if I paid it in full. Nor when we paid an additional $1200 over 4 payments. 20% of $7K is $1400 BTW. 3rd lesson (ask about a discount for self-paying early on).
Last week (mid-November) got a bill for the cardiologist for close to $1,000 for an office consultation, a follow-up office visit and the stress test (I'm guessing for his time at the stress test). Hey-I didn't go to his office for a consultation or visit. Because these were not listed as 'emergency' the claims were denied. AND this is the first time they sent a bill. I called them and they said because of Medicaid and Medicare rules regarding coding properly for insurance, since I was being held for 'observation' (as an OUTpatient even though I stayed overnight) they couldn't code it as an emergency so it gets coded as a consultation or a visit. My contention is that I would never had been seeing this doctor except for the emergency. They say they understand but 'this is the way it works.' They will check and see what they can do (probably NOT change the coding). Lesson 4 - use other lessons to get this bill reduced.
I hope somebody learns some things from my experience.
This has been soooo frustrating. The words that come to mind are 'racket', 'locked-in', 'trapped' and 'bait-n-switch'. The hospital KNEW I had out-of-state insurance and still assigned doctors that would be out-of-network. I had no choice and no say in the matter. I'm gonna see if there is ANY insurance that doesn't penalize you if you travel. I will definitely think 2-3 times before going in (even though 'they' say you shouldn't mess with chest pain - 'they' are probably hospital people).
Background: I live in Ohio and have the Cleveland Clinic healthcare for 2019 (called Oscar). The fine print says you can only go to a provider in their network in order for insurance to be used (an in-network provider) EXCEPT in an emergency (I read this as emergency room visit).
In Florida in February, 2019 and having some chest pains (I'm fine - they found nothing). Husband took me to emergency room. Pain left after about 20 minutes in waiting room but kept being told, 'should get things checked out.' Emergency room doctor said I needed to stay because it would be nearly impossible to see a cardiologist in the next six months without seeing one while at the hospital. I was incredulous and she (emergency room doctor) said, 'you sound surprised?' I was.
I shoulda left (1st lesson) but everyone there kept insisting 'better check - you don't want to take any chances.'
They put me in a room in the cardiology wing. Had several doctors come to visit - 2 hospitalists and the cardiologist. People also woke me up during the night to take blood pressure and occasionally blood.
Next morning there was a stress test (which the cardiologist said I should have before I left the hospital - just to be sure).
Left late morning. No diagnosis except that I seemed fine medically. Blood tests fine (except for high triglycerides - which didn't get treated except to have them say, 'get retested when back in Ohio).
Bills start rolling in. Over $14,000 for the hospital bill (Oscar knocked it down to just under $7K). My deductible is $7,900 per individual and $15,800 for family - network only.
Got a bill from a non-network doctor (even though I was treated through the emergency room). I believe it was the emergency room doctor (the one who told me to stay). That's separate from the hospital bill but was not written up as 'emergency' but as a consult. Denied by insurance. Talked to insurance. They said it was not coded as an emergency so denied. 'Just tell them to change the coding.' Talked to the third party billing office and told them insurance company said to change the coding to 'emergency'. Said they couldn't do it as the doctor didn't say that. Transcript says 'female presented through emergency department ....'. Billing company wouldn't budge. BUT they would talk to higher ups and call me back. No calls. I got a collection letter from a collection company. GRRRR. Called them and told them I was expecting a call back - not a collection company contacting me. Woman I talked to saw they had not followed through (notations on account). She applied Medicaid discount and then, because I was paying the bill instead of insurance company, took 20% off of that. Bill was less than half of original. They took it back from the collection company and I paid that lower amount. 2nd lesson (persistence is important - although it is almost like talking to a cell phone company or cable company).
Had previously paid $3,000 on the hospital bill (from HSA account) and then set up a payment plan with them at $100/month (my plan was to pay more but that was the minimum per month). Asked for an itemized bill in the meantime.
When I was 'barking' at the hospital for having this non-network doctor bill me like they did (see 2 paragraphs up), the woman at the hospital mentioned to me that since I was paying their bill (not insurance company) I could take 20% off. Huh? She explained to me that anytime someone is self-paying (even if insurance has knocked it down) there is a 20% discount to pay the entire bill. Hmmm. When I was first making that $3,000 partial payment, no one mentioned that I could get 20% off the bill if I paid it in full. Nor when we paid an additional $1200 over 4 payments. 20% of $7K is $1400 BTW. 3rd lesson (ask about a discount for self-paying early on).
Last week (mid-November) got a bill for the cardiologist for close to $1,000 for an office consultation, a follow-up office visit and the stress test (I'm guessing for his time at the stress test). Hey-I didn't go to his office for a consultation or visit. Because these were not listed as 'emergency' the claims were denied. AND this is the first time they sent a bill. I called them and they said because of Medicaid and Medicare rules regarding coding properly for insurance, since I was being held for 'observation' (as an OUTpatient even though I stayed overnight) they couldn't code it as an emergency so it gets coded as a consultation or a visit. My contention is that I would never had been seeing this doctor except for the emergency. They say they understand but 'this is the way it works.' They will check and see what they can do (probably NOT change the coding). Lesson 4 - use other lessons to get this bill reduced.
I hope somebody learns some things from my experience.
This has been soooo frustrating. The words that come to mind are 'racket', 'locked-in', 'trapped' and 'bait-n-switch'. The hospital KNEW I had out-of-state insurance and still assigned doctors that would be out-of-network. I had no choice and no say in the matter. I'm gonna see if there is ANY insurance that doesn't penalize you if you travel. I will definitely think 2-3 times before going in (even though 'they' say you shouldn't mess with chest pain - 'they' are probably hospital people).
