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

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. 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.


The fee for service payment system is one of the biggest fraudulent payment systems in the entire country.

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Even giving the health care industry the benefit of the doubt the room for era alone would create far to many opportunities for good intentioned mistakes to be made...because no one has any idea what is being done and what anything costs. Most people do not have any idea what their insurance costs them...they know what is withheld from their salary but what their employer is paying on their behalf (which is part of their salary also) they have no idea...many do not even know there is anything more being paid. If you sold gasoline in the same manner it would cost $12 a gallon....

This is anecdotal of course but in November my wife had surgery that had been planned for nearly 10 months. Our insurance company told us 10 months ago that the procedure would cost us about $300 out of pocket. Provider agreed 10 months ago, in writing, because we had the good sense to ask about it. Fast forward to November the provider calls to confirm the pre-op appointment and in passing mentions that there will be $6500 due at the time of the pre-op appointment in order for the procedure to be carried out the next day. When she produced the written acknowledgement of it costing us $300 from the provider with his signature on it they said that was a mistake and the $6500 was what we would owe prior to the surgery or the surgery would not be done. Contacted insurance company and they again said it was $300. Got them on a conference call and the provider and the insurance company all agreed, $300. 30 minutes pass and the providers office calls and reminds her that she will need to pay $6500 prior to the surgery being performed. When the conference call was mentioned the provider said that was a mistake and without the $6500 payment the surgery would not be performed. This went on 4 times over the course of about 12 hours. Finally got it in writing again from the provider and the insurance company that we needed to pay the provider $300 out of pocket for the procedure. Go to the hospital the next day and the provider starts calling me...asking me how I wanted to pay the $6500. I told them I did not want to pay it. They said the surgery would be cancelled...with the surgeon in the pre-op room with us. I asked him about it, he gets on the phone with them and says its a mistake and it was worked out yesterday. They agree. Surgery starts and they call back....again asking about the $6500. Told them the surgery was in progress and if they wanted that $6500 they better call the surgeon and tell him to close her up 'cause they ain't getting no $6500. This was last month. I fully expect to get a bill from a collections agency from this provider and will have all of the written correspondence ready for them when we do. I would not be shocked if we did not wind up paying at least part of that $6500 because collections agencies have no regulation in Georgia, they can do anything they damn well please and use the power of the state as their muscle.

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Print a current EOB off your carrier site account or call to have one sent. Reconcile as you go.

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This is what I do and do not pay any bills until I reconcile them. Errors are usually billing company wanting money when they are not owed any or a less amount.

I quit going to a doctor over it. My wife and I both went for an annual check up in the same week. $0 with insurance. Hers goes fine. I got a bill for $50 roughly for blood work. After many conversations with the billing people and insurance, my insurance company is the one who said the billers are idiots. They coded it wrong and didn’t understand why. So my insurance told me what code needed to be used so I could have them fix it.

Next year it was the same mess so I stopped going there. That and they test for Covid anytime you enter the building now.

Y’all wouldn’t need to go to the doctor if y’all laid off the carbs and lifted weights

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I have to keep records and notes on all the bills I get.

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This is my problem. I’m not an employee of my health insurance company. I already pay them far too much, anyway. Do your fricking job.

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AwgustaDawg

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Who are you calling the provider in this story? You mention the doctor, who is considered the provider, agreed to $300 twice.

A lot of times, our docs / hospital have just stopped collecting a co-pay at time of service. They just file the claim and later send us a bill for the co-pay.

Medical billing practices are fukn criminal.

Medical/Healthcare/Pharma is preying on society.