What The.....???????

MyKdsDad · 02-02-2006, 11:35 AM

OK, I'm just going to throw this out there and see what all the "experts" have to say about it.

My DW was approved by BCBS of Texas, via her surgeon's office. When he sent in HIS bill, it was for $12,000. The Medical Center sent in their bill for $30,000. BCBS posted the explanation of benefits on their website and they are going to pay a grand total of......wait for it......for BOTH bills......$1,638.....? Excuse me, but, what the F*#@?????? Who are they trying to fool? According to the approval letter, with a ZERO deductible and only $1,000 out of pocket limit.

What should I do? Wait and see if the medical center and the doctor resubmit? Get a lawyer? Call them myself? Jeeeeeeeeeeeeeez! :angry

At least they can't come and reposses her band. All they can do is ruin my credit. And all I can tell them is "You can't get blood from a turnip, hon"

Kryssa · 02-02-2006, 12:39 PM

My out-of-pocket maximum is $1800. I will end up paying closer to $5K by the time it's paid off. Rip-off artists!

**Alexandra** · 02-02-2006, 12:49 PM

Hi Randy,

Look on the explanation of benefits and see if there's a line that says "patient responsibility." It's not terribly surprising that BCBS is only paying the providers pennies on the dollar, but if they're in-network and everything was correctly precertified, this should NOT affect the amount YOU will have to pay. Your expenses are dictated by your contract, not the amount the hospital or doctor has charged. The providers have negotiated rates with the carrier, and while we may think they're shockingly low, that's what the agreement is.

Don't worry unless the "patient responsibility" section of the EOB says something other than what you expected to pay. And if it does, YOU call BCBS and see what's going on. But what the provider receives is really not your concern, heartless as that may sound.

lotsofkids · 02-08-2006, 12:48 AM

you are hitting it on the head.....I deal with Insurance Companys all the time and many times.....I find and correct mistakes...whether human or computer generated. If you know your rights...it is easy to get things fixed.

Do know your policy and your annual deductibles/copays and any other amounts that may be related to your procedure. They cannot charge YOU "over" what is in your contract.

The negotiated amount between the Insurance and the provider can be significantly less than the billed amount and the provider must "write off" that difference. The provider is not allowed to bill the patient for this amount...if a provider did bill you for this...then bring it to their attention...that this is incorrectly billed and you have your EOB from the insurance and they must re-adjust your billing accordlingly.

hold on to your wallet LOL

diane

BTW:....if the provider is not an in-network provider...then you may have to pay the difference of what is considered reasonable and customary charges for the particular billing. However, do not stop there....many times you can negotiate with the provider to accept the Insurance amount as is....or work on a discount of that amount...let's say meet in the middle and split the difference. Nothing is written in stone....and do speak directly with the physician....as they can be very understanding in these situations and if you speak directly with them...they might work something out in your favor.

I tell my friends that do not have insurance....always make that known to the doctor and ask if he has a cash discount....they will usually take off 20% (and doc is still making more money on your visit than from his patients with insurance that might take 40-50% off his billed amount!)

MyKdsDad · 02-08-2006, 08:44 AM

Thanks Diane for some GOOD information. I've been talking with my insurance lady at the doc's office and basically what she said was, until they come knocking on my door wanting more money, don't worry about it. That's why they have insurance people in the office. They do the calling and negotiating with the insurance company. And, according to her, the lady "we" have is one tough old lady....LOL

sunsett · 02-08-2006, 08:54 AM

I was going to say exactly what diane and alex said. I worked in a dr.s office and the insurance companys never pay what the bill is. It shouldn't effect you...hopefully GL

MyKdsDad · 02-08-2006, 09:03 AM

(Have you noticed how many Diannes and Dianes and Dis there are on this forum....hehehe) Thanks Dianne. I had a similar experience when Joy had her gall bladder out. When I went to finish paying my bill at the hospital, the poor woman was surprised that I wanted to pay it off. She went to talk to her supervisor and when she came back they (the hospital) took 30% off of my balance. Go figure!

lotsofkids · 02-08-2006, 11:24 AM

at how bills in the health industry can be discounted....but most people feel somewhat shy to ask.....or feel as if they are asking for a charity.

Don't feel this way.....the prices are way over the top....and if you or your insurance has already paid a major portion....then go and see what more they can do for you.....I'm sure you can all find better places to spend that money! LOL

Hospitals especially have funds to help out patients with income issues...and you don't have to be at poverty level....it is a much higher scale...for everyday working people. If you don't ask.....you may never know what you might have saved.

good luck...Diane.....(with one ~n~ and an ~e~ ....LOL)