HELP ! got a 76,000 Dollar invoice yesterday

Yesterday I received a $76,000 bill (sort of) from Carolinas Medical Center, saying that North Carolina Blue Cross Blue Shield was only paying a potion (40,000) for my ablation! and that while it is still under negotiation I may be responsioble for the remainder.....I called NCBCBS and they are telling me that Carolinas Med Center did not get appproval? I was called 2 days prior to the 8/21 ablation and was told my portion would be 6000 to 6500.......now this, I freaked out................my converstion last night with NCBCBS was weird, she would go silent at times? what is going on here?

How could a major hospitol not have prior approval before doing a 100,000 dollar ablation?

Tom P

"I was called 2 days prior to the 8/21 ablation and was told my portion would be 6000 to 6500"

Tom,

Who called and told you this? If the hospital, it would imply they'd talked to the insurance co.

In my state, there is an insurance commission you can appeal to for help in resolving these kinds of issues.


George

Any conversations not in writing should be recorded henceforth. If you do not have a digital recorder with USB port to computer for audio files I would get one. I do not know what the law is in your state, but here in Ontario only one side of any telephone or other conversation needs to konw that it is being taped. No announcement is necessary.

I use the Sony memocorders as they are small and thin and can be set to make no noise nor light up. It has saved my butt on more than one occasion when trying to relay information from one party to another. I don't generally let anyone know that I am taping an important conversation (and any conversation with the hospital, the insurer, etc., can suddely become important). And I do not use it wantonly to record conversations with friends, my doctor, lawyer, etc.

Good luck. I am sure it will sort out.

Murray L

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Tikosyn uptake Dec 2011 500ug b.i.d. NSR since!
Herein lies opinion, not professional advice, which all are well advised to seek.



Edited 1 time(s). Last edit at 11/29/2012 12:47PM by Murray L.

Tom,

My guess is that BCBS is negotiating new rates with CMC and CMC is jacking up some of the Blue Cross patients as leverage.

Did you buy your coverage through an independent agent? If so that would be another person to contact.

CMC does dozens of EP procedures each day- they know all about pre-approval and if they dropped the ball you aren't on the hook (which I still think there's some other game going on here). Don't let it freak you out-

EB

That is a big difference Tom B,

Even the $6K extra is a lot for you to have to pay!

And I record every conversation with medical or billing people by habit as it has come in very handy sooo many times! Saves effort in writing notes like mad in the middle of a conversation as well.

Shannon



Edited 1 time(s). Last edit at 11/29/2012 09:07PM by Shannon.

It is against the law in some states to record a telephone conversation without the knowledge of the other person.

Liz

Tom,

I hate that you're having this problem with your insurance. I love that you're getting lots of great advice from people here. I think there's lots you can do to get this straighten out; I hope it gets resolved soon so it doesn't eat into your time and energy.

Here are some of my thoughts for whatever they're worth.

1. Have you talked with Carolinas Med Center (CMC) yet? If not, I think I would call them and ask for the current status of my bill. If needed, identify the people who handle billing problems and talk to them. They should be able to give you their version of what's going on. Tell them you're shocked and dismayed at the bill because they (CMC) called you two days before your 8/21 ablation and said your portion would be 6000 to 6500. In talking with them, do not accept it if they try to shift responsibility for getting approval to you. Just keep saying, over and over and over (repetition argument), you (CMC) told me my portion would be 6000 to 6500. If there's still a problem and they haven't set next steps for you and/or themselves, ask for the name of their supervisor.

2. I like FiveBox's suggestion to contact your independent insurance agent, if you have one. I live in NC and have one for NCBCBS. He's absolutely great.

3. If you don't have an independent agent (and maybe even if you do), call NCBCBS again and ask for the current status of your bill. Ask whether their records show that CMC got permission. I know you've already discussed this, but I have dealt with NCBCBS several times over the years when I didn't have an independent agent. I've called and gotten one answer from a representative, called back ten minutes later, talked with another representative and gotten a different answer. I learned never to accept their first answer if I didn't think it was correct. Of course, their computer data system may be improved by now and you may get the same answer from everyone, but even so, I would call frequently to check the current status. Once I also asked to be connected to a supervisor, but that was several years ago. That's as high as I ever needed to go in the appeal process, but I would have gone higher if necessary.

3. I'm glad that GeorgeN pointed you to the NC Insurance Commissioner. I think it's a little early in your process to contact his office, but I had wonderful experiences with that office when Jim Long was Commissioner. I suspect you would get equally great service under Wayne Goodwin. BTW, there are regulatory and credentialing overseers of hospitals, too, but I'm thinking you'll get this resolved long before needing to involve organizations like these.

My very best wishes to you,

Jann

Hi Liz,

I inform everyone when and if I do record a call and always use Skype with the Pamela Recorder option to make those recordings, its great too for any kind of lengthy conversation which you need to remember and don't want to scribble notes. I've never had anyone refuse to speak with me after letting them know its to make sure I get the full picture of what they are saying.

And Tom P, another tid bit in addition to all the good advice above like this last post from Jann, it is not your responsibility to confirm insurance coverage. Once you give the EPs office in charge of your ablation and the hospital your correct insurance card info, it is up to both of those parties to confirm with BCBS what plan and coverage you have and how much they will be reimbursed .. not you!

I would refuse to pay anything beyond what you were quoted as a maximum charge without some itemized proof of excess charges beyond what you were quoted due to unforeseeable additional treatment required.

What kind of plan at BCBS do you have .. is it a really comprehensive coverage with low deductables?

Shannon



Edited 3 time(s). Last edit at 11/29/2012 10:16PM by Shannon.

As I bow on bended knee to the Canadian medical system and give thanks for my no-bill procedure.....

Shannon, I really hadn't realized that "it is not your responsibility to confirm insurance coverage. Once you give the EPs office in charge of your ablation and the hospital your correct insurance card info, it is up to both of those parties to confirm with BCBS what plan and coverage you have and how much they will be reimbursed .. not you!" But, now that I think about it, that's how it's always worked for me. For example, I didn't confirm insurance coverage for my colonoscopy and I would have been devastated if I had been required to pay a large part of its cost. Looks like something valuable for Tom and others in his situation to use with their hospitals ("You mean you conducted my surgery without having prior approval from my insurance company in hand!?!) Given Tom's experience, I think I'll double-check before any expensive medical procedures, but I greatly appreciate your pointing this out.

After posting my comment, it occurred to me that the hospital had told Tom the price for him. In a strict sense (not sure if it's in a legal sense, but it might be under contract law) that places the burden on the hospital to only charge him the stated cost and to obtain any additional payment from the insurance company. Of course, as has already been well discussed, he has no written or recorded documentation of the stated cost, but I think this situation underscores the need for Tom to emphasize the hospital's quoted cost to him.

Looks like I need to learn to use Skype with the Pamela Recorder option and to remember to get people's permission to record.

Jann

One or two more thoughts - I seem to remember that some insurance policies (or is it medical institutions?) state that it's the insured person's responsibility to ensure that insurance approval has been obtained before receiving any medical service. Anyone know about this? Tom, you might want to check your policy and anything you signed at the hospital to see what's there, if anything. Even if there's something there you know the hospital and NCBCBS already are in negotiations about your bill. I still think it's key that the hospital told you what your cost would be and you proceeded in good faith based on this. Also, I'm wondering how the hospital employee came up with 6000-6500 without getting NCBCBS approval?

Jann

Elizabeth H. Wrote:
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> It is against the law in some states to record a
> telephone conversation without the knowledge of
> the other person.
>
> Liz


By all means check state law before proceeding. I was sharing Ontario law, where only one side of the conversation, either by telephone or in person, must be aware that the conversation is being recorded. Some years ago I had taped a conversation on the telephone and one in person and they were actually transcribed into the court record, giving me a very favourable outcome. Thank goodness for my wee Sony memocorder. Electronic, good for something like 24 hours at high quality, very sensitive and USB connectivity to the laptop and thence onto a CD (or memory stick) in whatever format you wish. More recently, we had some fun with a hearing aid dispensary that had changed their pricing for us several times over the course of a few weeks; for $0 upgrade to $350 upgrade (which we were fine with) to $600 (which we quibbled about) and finally to about $1600 (which we refused of course). When we told them we were going to the licensing body with tape recordings of our conversations they quickly backpeddled to $500+taxes which we paid just to settle the matter and get on with life, even though we had the quote of $0 upgrade on "tape".

Not too often do we pull out the memocorder but for important conversations we sure do. Sits in the shirtpocket quietly and records without lights or beeps. Learned this from a business associate many years ago who used it to confirm his notes on business deals. His was an old squeaky tape recorder in the desk drawer that he would turn on before a personal or telephone conversation.

Today, unfortunately, insurance companies lack morals and scruples to the nth. degree and we record EVERY conversation with an insurance company. My son had a minor car accident two years ago. No injuries. No police. No charges. Our contention was that the other party HIT HIM. The other party's contention was that he hit THEM. In the end the insurance company, just because it's policy, decided my son was at fault... TAPE EVERYTHING. We have them on tape stating that it is their company policy and 'standard' in the industry to adjudge fault, regardless of what the police have to say. And then they get to jack up your insurance rates for ten years..... and make bigger money on you. It is sickening that one has to do this to have even a smidgen of a chance of fighting this nonsense.

Murray L

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Tikosyn uptake Dec 2011 500ug b.i.d. NSR since!
Herein lies opinion, not professional advice, which all are well advised to seek.

Justfibbin:

As I bow on bended knee to the Canadian medical system and give thanks for my no-bill procedure.....

What do you think of the following, costs are cut somewhere along the line.


A British physician’s disturbing testimony is shedding light on the increasingly common practice of National Health Service (NHS) hospitals sending sick or severely disabled newborn babies home or to hospices to die of starvation or dehydration.

Newborn babies are being being placed on the Liverpool Care Pathway for end-of-life care, a system originally allotted and designed for elderly or terminally ill adults. That end-of-life care involves the removal of food and fluid tubes, a method which can take an average of ten days to result in death.

The Daily Mail reports an investigation is being launched to determine “whether cash payments to hospitals to hit death pathway targets have influenced doctors’ decisions.”

The physician, who wishes to remain anonymous, recounted his experience in a submission to the British Medical Journal, titled “How it feels to withdraw feeding from newborn babies.”

Elizabeth

Britain's NHS is full of stuff like that (I have family there). Anyway so far no bills for mine (keeping fingers crossed)..

Between Medicare and Blue Cross Medex they seemed to have fattened the coffers of the Massachusetts General Hospital by about the same amount as quoted in this thread..

Elizabeth,

Canada is actually an independent country and has nothing to do with the British NHS. I very much doubt that the cases you discuss as happening in Britain would ever happen in Canada. I fully agree with Murray "Thank God for the Canadian health care system".


Hans