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Post Info TOPIC: Hospital-Bill Sucker Punch
ed11563


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Hospital-Bill Sucker Punch
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Hospital-Bill Sucker Punch

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The latest health-care trap: What starts out as an in-network hospital visit fully covered by insurance turns into a surprise out-of-network bill for hundreds or even tens of thousands of dollars. That's what many patients are discovering after they undergo treatment and/or surgery, especially in emergencies. The reason: Doctors and hospitals belonging to your insurer's network may use out-of-network specialists, consultants, assistants and other hospital employees without you knowing it. The insurer then covers only a small portion—or none—of the out-of-network provider's fee, and you are billed for the rest. Example: One ER patient got a bill for $937. Insurance paid $151.02. The patient owed $785.98.

More on Understanding Your Medical Bills
  1. Your Hospital May Be Ripping You
    Off: Medicare “Observation Status”
  2. Beware of Out-of-Network Rip-Offs
  3. Be Wary of Low-Price CT Scans
  4. Is Your Doctor Scamming You
    with “Self-Referrals”?
  5. Torn Meniscus? Common Surgery for Knee Pain
    Works No Better Than Fake Surgery
  6. Get Your Health Insurer to Pay Up

Patients typically don't realize they are authorizing this when they sign hospital consent forms. Unlike in-network providers who agree to discounted rates negotiated with the insurer, out-of-­network providers charge their full fees, which may be 20 to 40 times higher.

There is some legal protection. Medicare doesn't allow providers who accept Medicare payments to bill patients beyond what Medicare covers. And 13 states have a variety of ­restrictions on whether and how much patients can be charged for medical services such as anesthesia that often are ­provided by out-of-network providers.

To protect yourself…

• Know which hospitals are in your network in case of an emergency. Then ask what percentage of ER doctors and other personnel there are out of network. If most are out of network, consider choosing a different hospital.

• If you're having a planned procedure, ask your doctor well in advance who else might be involved in your case, and insist that everyone be in-network unless there is an overriding need for someone out of network to take part. Seek to work out terms in advance with out-of-network providers.

If you do face out-of-network fees…

• Your insurer may be willing to cover more of the cost and/or convince the provider to lower the bill. You also can file an appeal with the insurer.

• Ask your state attorney general to intercede.

Source: Health consumer advocate Elisabeth Ryden Benjamin, vice president of health initiatives at Community Service Society, a nonprofit advocacy group, New York City.

 



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aergia


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If you are in a hospital and receiving treatment because of an emergency, your plan WILL cover you. You cannot be expected to rise up, say never mind and walk on over to another hospital. WHile you are in the emergency admission, if the only physicians surgeons to be used are out of network, they have to be paid. Can they balance bill you?
DOnt think so.

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ed11563


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I learned the hard way to ask the right question of my dentist and endodontist.

The wrong question is, "Do you take my insurance?"

The RIGHT question is, "Are you a participating preferred provider in my insurance plan, in THIS office? "

 

And THEN ask the same question EVERY TIME you/we walk in.

First, the dentist and endodontist were participating preferred providers.

THEN  the endodontist billed my insurance for his FULL FEE and cleaned out my annual allowance ... because he was a participating preferred provider, but ONLY in his other office.

Was that fraud?

 

THEN the next time I saw him, in his other office ... Guess what, he "took" my insurance ... ALL of it ... because he'd dropped out of the plan.

THEN my dentist dropped my insurance company too. Did they tell me? NO, because I didn't ask the right question EVERY TIME I walked in the door.

 



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Lady Gaga Snerd


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If u like your plan , you can keep your plan.

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ed11563


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Lady Gaga Snerd wrote:

If u like your plan , you can keep your plan.

Well, to keep my dentist (who does excellent work) I had to add a second dental plan (the first one is through my employer). 

But I'm done with the endodontist, I'll find someone else next time there's a need.

I just firmly believe he deliberately misled me about the insurance money.

 

 



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The Principle of Least Interest: He who cares least about a relationship, controls it.

Always misinterpret when you can.
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