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re: Help me understand this medical billing situation involving my family member...

Posted on 3/16/18 at 2:27 pm to
Posted by MSMHater
Houston
Member since Oct 2008
22776 posts
Posted on 3/16/18 at 2:27 pm to
Disclaimer: I 100% agree with your sentiment with regard to our bullshite billing systems.

quote:

This makes sense but why would they use codes that were not accurate? We didn't have a surgery as scheduled. There was no procedure done.

You're right, but your thinking is only applicable to the doctor. HE didn't perform a procedure. So HE won't bill your insurance.

For the facility (entirely separate entity), in their eyes, they started the procedure. They got her checked in. Got her IV done. Did her pre-op physical. And reserved an OR for her at a given time slot. A slot they could have given to a different patient if your doctor hadn't had whatever "issue" he had. They experienced cost and have no means to recoup it from the physician. Frankly, neither do you. But I'd still love to know what "issue" caused the aborted procedure and how much responsibility the physician takes. That's kind of bullshite if it's not something medical. Every situation I've seen like this was a result of a poor cardio eval from the anesthesia team or poor vitals.

quote:

I simply don't agree with being made to pay the full price for something that I didn't need.

Please understand, it should not be full price. There was an allowed facility fee for this procedure. The aborted procedure will reduce the amount that insurance pays to the facility. They are GUESSING that the amount they receive will be equal to or greater than your deposit. They very well could end up owing you a refund after insurance processes the claim. Keep an eye out for your EOB in the mail, and compare it to the office billing. And DEFINITELY express your displeasure with the operating physician and ask for an explanation. Doctors cancel procedures same day all the time, but without waiting until the patient was actually prepped. Why did they wait so long?

This post was edited on 3/16/18 at 2:32 pm
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