re: What in the hell is wrong with medical billing?

It's been my experience the issue is with the Hospital Clerical Staff not properly "coding" claims.

Had a procedure to have 1 of my Thyroids removed and was told by the Hospital I have a $200 deductible thru BCBS. I paid and 2-3 weeks later received a check from BCBS for the $200. Called BCBS to verify and was told Hospital used the wrong "code" on the filing and should not have been charged the $200.

90 days later had to have the other Thyroid removed and again was told I owed $200. Told the hospital clerk about the previous experience and what BCBS told me and she assured me they are coding correctly and that I had to pay the $200. I paid the $200 and sure enough I received my refund 2-3 weeks for that procedure.

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Why does it seem in the last few yrs I’ve been inundated with medical bills? I have 3 kids between the ages of 4 and 12, but every visit any of us go to I seemingly pay a copay and still get these stupid bills? Some I’ll even go, they tell me nothing is owed and still end up dealing with this nonsense. I guess I need to start keeping records of all of this to make sure I’m not being double billed, but why can’t they get it right from go?

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Can't speak to anyone else's experience but about 10 years ago I started paying attention to EOBs and have not had a bill from a medical provider that was legit since. I get billed every single time one of us goes to any doctor...makes no difference, they are all the same in my experience, and when they find you have the EOB handy they usually make out as if they will waive the unpaid amount, as if they are doing you a solid. Sometimes they will attempt to stick to their guns...but if you stay the course they will finally admit they just sent the bill by mistake...each and every time a patient has an appointment they send the bill by mistake.

My Dad, 84 years old, is on Medicare. He goes to a doctor at least 4 days a week. They ALL, every last one of them, send him these billing "mistakes"...every single time...sometimes they sell those "mistakes" to collection agencies. Medicare sends EOBs just like ALL insurance companies do and every one of them say he owes the provider nothing.

Systematically sending erroneous bills through the mail has been called mail fraud when others do it. Medical professionals, again anecdotally for everyone I ever knew, routinely send these billing "mistakes" to their patients. I am certain some will come here and claim this never happens and that providers would never ever do such a thing and to you I say bless your heart...in my 58 years everyone I ever talked about this with has experienced the exact same thing.

Keep you EOBs and know what is in them. Know what your provider is doing and what they are charging for. You will save yourself a heap of money. It is a systematic fraud perpetuated by every provider I ever dealt with or any that anyone I ever knew dealt with.

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The issue could just as easily be due to the doctor's billing.

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It is 10-20 times a year with us and it does not matter which provider or how often you change they all make these "mistakes" and they do so in every market we have lived in. They make these "mistakes" multiple times a month with my Dad who is 84 and spends most his time at doctors offices. In 10 years of reconciling 10-5 EOBs a year for us and my Dad not once was it not a "mistake" on the part of the providers...and before someone chimes in and claims it was a small number of providers it is not, it is every last one of them spread out across the United States. In our experience. Maybe we are just unlucky and only go to providers who systmatically send fraudelent billing statements through the US mail...but everyone I know who has ever discussed it with me has had the same experience.

You definitely need to compare any bills you receive with the EOB from your insurance company to see what the insurance paid and what they didnt, then see what you're billing billed for and whether or not the insurance company deems it something you're responsible for.

What you will want to watch for is being charged for services from a medical provider that you're insurance company denied (improperly billed, prior authorization not obtained, etc).

I've also seen one doctor bill my wife under two different tax IDs for office visits in the hospital on the same day.

So yea, if you're still on paper communications save all paperwork from every day of service and compare each bill against your EOBs. Should you need a new EOB they can almost always be downloaded fro their website or portal or requested by calling the number on your ID card.

Lastly, if you have questions about whether you are responsible for something youre being billed from a medical provider, call your insurance company and ask. Do not be bullied into paying a bill by the threat of being put into collections. It's the most common approach by billers to receive payment on something to close their book without actually fixing whatever the issue was in the first place.

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Maybe we are just unlucky and only go to providers who systmatically send fraudelent billing statements through the US mail

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Your experience is extremely common.

"You don't get paid what you don't bill for"

There are classes and conference on how to bill and code things to the maximize the reimbursement, regardless of condition or patient coverage. Some of these actions can cause frequent denials if not done correctly or appropriately and the response in many instances is to just bill the patient and then threaten to turn them over to collections.

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The entire system is broken

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When you but a pound of ground beef at Walmart you reach in your pocket and pay the price that was on the package. I have never gotten a bill from Walmart for a pound of ground beef.

When we go to the doctor there is no price tag, we pay part of the bill, the provider bills the insurance company for the rest and no one has any idea what it actually cost and what services, if any, were actually rendered. If Walmart sold ground beef that way no one would tolerate it and they'd be out of business in 90 days.

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it's failure by design

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In any industry there is cash in chaos. If you have a perfect storm where the customer has no idea what they need and no one knows what anything costs it is a ready made situation rife for fraudulent activity.

You should have access to a portal from your insurance company and see all the EOB’s and statements. If your provider in contracted with the insurance providers and you have met your out of pocket obligations you should not owe anything. Most people have met those requirements by the end of the year.

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Wait wait, in February of this year I got a bill with my wife's name and social on it for an epidural that occurred in January for nearly $2k.

She had our child 5 months before that date, and I had already paid for the epidural and had it filed away.

Wife contacted them and they apologized and said to simply disregard.

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Of course they did...had y'all paid it they would have NEVER said boo about it. They are either criminals or they are incompetent, there is no third answer.