Healthcare Nonsense...

[Marilyn. 340]

Well, we got the bill for hubby's little procedure he had at UCLA about a month ago..... it is around $15,000 and we have till September 12th to pay it

well, that isn't even the worst of it....

a few weeks ago I noticed something as I as checking the claims on our health care site...

I noticed two different claims amounts for the same period and time and for the same thing...

upon closer inspection I noticed that the higher amount claim which was about $30, 000 more was sent in about two weeks after the first claim that was sent in...

well, this was the little amendment our health care site attached to this higher claim....

Our Records Show That We Already Processed An Identical Procedure For This Date Of Service. The Only Change We See Is A Different Billed Amount. Since We Have Not Received Any Supporting Documentation For Reconsideration, No Benefits Are Being Allowed.

and you guessed it, the bill UCLA sent us was for the higher amount....

the amount we owe according to our health care site is about $1600.... according to the lower billed claim that UCLA sent in first....

we only pay 10 percent of all surgeries /procedures , hospital stays etc... so even 10 percent of the higher billed amount is not $15, 000

hubby or I has to call on Tuesday to try ad get this straightened out....

this is all really infuriating...

Edited September 2, 2007 by MarilynP

[Kathryn41 3,205]

Yep - been there, done that! Welcome to the world of US 'insurance' health care! I have been on the phone so much correcting incorrect information submitted by both doctors and health insurance providers - double billing, disallowed amounts that are actually covered, yes - it is infuriating, big time! Good luck at getting it all sorted out - it is so surprising that with the inefficiencies in the insurance system they are still in business - but I suspect all of the 'errors' turn out in their favour rather than the other way around, so they are sweeping in even more profit than they are enttiled to. Why fix it - for them, it isn't broke.

[Marilyn. 340]

i really don't understand how the hospital thinks they can get away with double billing or trying to increase the amount that is owed...??

[Heracles 417]

Clearly the free market does not work with stuff like this.

I also don't think it's right that the insurance companies get all the blame when the hospitals and doctors are the ones sending out the invoice. Hence why I did not bother watching Michael Moore because he is focusing on the insurance companies. Realistically the government should setup its own non-profit hospitals..

Edited September 2, 2007 by Boo-Yah!

[Jamie76 0]

Yep, parents are going through the same thing with insurance. They are trying to charge them $5000 for a procedure my mom had that IS covered by insurance. What pisses me off is that, one, they can't afford to be paying $5000, and two, they talked to the doctor and the doctor was supposed to take care of it because it was HIS fault for the way it was filed. They are all a bunch of crooks in my opinion.

[Heracles 417]

Yep, parents are going through the same thing with insurance. They are trying to charge them $5000 for a procedure my mom had that IS covered by insurance. What pisses me off is that, one, they can't afford to be paying $5000, and two, they talked to the doctor and the doctor was supposed to take care of it because it was HIS fault for the way it was filed. They are all a bunch of crooks in my opinion.

Above point proven.

[Caladan 19]

i really don't understand how the hospital thinks they can get away with double billing or trying to increase the amount that is owed...??

Either someone's double-billed you on purpose, or (more likely) someone fouled up and double-clicked twice. You can get this sorted, just be prepared to dig in and b!tch at people.

[slbois 0]

I am a Medical Biller and Coder. If it makes you feel any better, this is a common error. Sometimes claims get sent twice not due to human error but computer error. Usually the duplicate claim rejects. Sometimes the claim rejects for being a duplicate even when it is not. It's all a big headache, but usually these things get sorted out before the patient gets any kind of bill or explanation of benefits. Glad you got it straightened out!

[Marilyn. 340]

things is, it isn't just that they double billed but the second claim was almost 30,000 dollars more and sent in two weeks after the first claim....

I am a Medical Biller and Coder. If it makes you feel any better, this is a common error. Sometimes claims get sent twice not due to human error but computer error. Usually the duplicate claim rejects. Sometimes the claim rejects for being a duplicate even when it is not. It's all a big headache, but usually these things get sorted out before the patient gets any kind of bill or explanation of benefits. Glad you got it straightened out!

we haven't got it straightened out yet ... have to wait until Tuesday..

Edited September 2, 2007 by MarilynP

[Jasman0717 9]

Health care really sucks in this country! I had a run-in with an HMO a few years ago and it took3 years to get it resolved

[Widge 0]

Hence why I did not bother watching Michael Moore because he is focusing on the insurance companies. Realistically the government should setup its own non-profit hospitals..

How can you say you what somethings is focusing on when you state you didn't bother watching it ??????????

[Marilyn. 340]

well, I called our health care insurance today and they were really helpful although I was put on hold for awhile while they did some research...

anywho, they transferred my call over to their rapid resolution department and the lady there was very nice....

she did some checking of the claims and found out that the second claim was actually an amendment to the first claim.. there was some extra charges that UCLA forgot to add to the first claim...

the lady said they are supposed to send these amendments through the mail but they sent it electronically and the person looking over the claim thought it was a duplicate claim and denied it....

anywho, the lady said they are going to send another payment to UCLA as soon as possible... she said they should get it by the 18th but then I mentioned that UCLA wanted payment by September 17th.. the lady said I should call back on Monday and they probably will have the check number by then and then I can call UCLA with the check number...

geez, I hate dealing with all this #######

[thetreble 19]

You are going to have to call back a bunch of times. Insurance companies are always slow to award payment to outstanding bills you have. Just keep on their #######! It took me 5 months to sort out my last bill.

[Mr. Big Dog 10,747]

Isn't is just great how private companies have created such a marvellous system that puts the consumer front and center? The American health-care system: A beacon of efficiency and customer service.

[Kathryn41 3,205]

I know - it is the constant acting as a go between between the insurer and the recipient that really bugs me - like, this is supposed to be THEIR job. They are supposed to be able to handle basic communications between a medical provider and insurer, but it seems like I have to phone insurer A to find out why provider B is charging patient C (me) what insurer A is supposed to pay, to discover that Provider B charged the wrong amount or used the wrong code in their submissions to Insurer A, so you call back Insurer A with this information to find out that Provider B needs to forward evidence D in such and such format to Insurer A so that Provider B can be properly reimbursed for services to patient C, so you call back Provider B to request them to re-submit the correct information to Insurer A (and if you are lucky, they get it right and you don't have to repeat this procedure the next month when you receive the next invoice from provider B that Insurer A was supposed to pay!) - and for this I am paying a premium and a co-pay and the difference between what is owed and what is insured!

(I'm glad you appear to have it sorted out).

Edited September 4, 2007 by Kathryn41