re: Unreasonable medical bill

I just sent in a mortgage statement and check with PAID IN FULL IF CASHED written in the memo line. I hope they dont notice and cash that one.

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Anyone have experience with something like this?

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Every day, unfortunately. Several of the entities I help manage are out of network facilities.


Balance billing (what happend to you) is a fu***** plague in TX.

So I'll save all the shite you could have done beforehand.

First thing you should try is to negotiate. Tell them you'll give them Medicare + 20% for the billed codes. That's about what your insurance would pay. They can accept that, or expect to write it off as bad debt.

Next step is to make sure they know you are planning on contacting the Texas Medical Board (or TDI) b/c they balance billed you for OON services, and you believe they have an unfair pricing structure. Make sure you get the superbill so you know exactly what codes were billed. Definitly follow through and call them. They will listen, and probably perform an inquiry with the clinic. No real change or punishment will come, but it's just a pain in the arse when that state agency is asking questions.

Your only other option is to appeal with your insurance to cover a portion of the OON costs, which probably won't work if you have zero OON benefits and there are other urgent care centers in teh area that were in network.

I'm guessing, but your description of the visit was probably a level 3 or 4 with an "urgent" modifier. Could easily be a >$200 allowable even with insurance. The "urgent" modifier gets an increased reimbursement.

Good luck. And always check in network status at those stand alone urgent care or emergency clinics.


ETA: This may help to

LINK

Unbelievable. Healthcare is a total scam in this country. 500 for a service that should cost no more than 40.

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As a physician, I agree that this bill is unreasonable. Of course, I am not an urgent care doc. I would call again and ask them to review the services rendered and see if the bill can be adjusted. I often help my cash paying patients get Medicare rates. It is in both of your interests to resolve this matter amicably. Good luck.

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I agree as well. Work frequently in urgent care, and that seems really high if no tests/shots, etc were done. I would keep contacting to negotiate a lower bill.

A latex glove balloon animal in my clinic will set you back another $150....
Seriously though that's really high, I think I need a new billing person, sounds like I'm missing out
GL with fighting it though

Related to the Time article, another recent article on the NY Times about absurd medical costs for standard procedures.

LINK ;

I work in an out of network clinic but we inform everyone beforehand that we are out of network and typically collect money upfront for the first visit. I think it is bullshite that they didn't explain this when you came in.

If it's gone to collections, I think it's too late to negotiate with the hospital anyway.

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Do you charge $500 for a 5 minute visit?

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My office is not urgent care, but we are a specialist.

Our self pay rates for exams are:

New Patient
L1 = 101
L2 = 124
L3 = 182
L4 = 198
L5 = 290

both docs and EMR's have a tendency to upcode, so assume he billed a level 4. $500 is still way too much.

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As a physician, I agree that this bill is unreasonable. Of course, I am not an urgent care doc. I would call again and ask them to review the services rendered and see if the bill can be adjusted. I often help my cash paying patients get Medicare rates. It is in both of your interests to resolve this matter amicably. Good luck.

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I actually have some experience (shall we say...) questioning medical bills. Here is what I would tell you based upon my experience...

When you call about a bill you going to talk to a billing service. Chances are if you call 10 different times you will talk to 10 different people. As the good doctor said in the above referenced quotes, call to "review the services". This is a very non-threatening term and you do not want to alienate the billing person on the other end of the line. Also, ask for some form of a detailed breakdown of what your charges represent. I should add that as a consumer, you have a right to that info and they are obligated to provide that info should you ask for it.

I am going to assume ( and I could be wrong...) that if and/or when you get an itemized breakdown of your charges, there will be items on that list (such as a test or some other service) that were not performed. Under those circumstances, contact the billing office again, and (very nicely) tell them no one recalls these tests or services being performed and would like to see copies of the results of said tests or services to confirm.


That approach may help to get the bill adjusted.

Let me add that consumer protection law basically states than any business that bills you for goods and/or services has to be able to produce some form of documentation to prove what they are billing you for. If they cannot come up with the documentation then you are not obligated to pay the bill. I "disputed" a $3200 medical bill for 2 years based upon this premise and finally was able to resolve it by paying a $32.00 balance.

Good luck