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Another Horrific Day At the Hospital

At 10:30 this morning I received a phone call from the hospital. The receptionist informed me that my insurance company denied coverage for an upcoming procedure. The procedure was scheduled only three hours later at 1:30 in the afternoon. In order to be seen I had to authorize direct billing. If I didn’t agree my appointment would be canceled. What choice did I have? I agreed to pay out of pocket.

I figured I had three hours to get the problem resolved with my insurance company. My husband contacted the insurance company as soon as I hung up the phone. Two hours later after speaking with 5 different insurance representatives and the doctor’s office at least 5 times we believed the issue had been resolved. That is until I attempted to check-in.

When we arrived we found out that the manager, who is the only one who can authorize billing decisions had already left for the day and that no one else in the entire hospital could authorize the claim to our insurance company. We were rudely told to go back to the first floor to pay the cashier $500. We were not told why we needed to pay that amount or what that amount covered.

When we arrived downstairs the cashier didn’t understand why we had been told to pay $500. She said we had a $100 hospital copay. Nothing more. The cashier was extremely helpful and truly tried to help us resolve the issue. She informed us to go back to the receptionist and inform her that we were cleared for the procedure. But when we returned to the receptionist she refused to hear what we had to say, despite the fact that we handed her the business card of the cashier and urged her to call for confirmation. She informed us that we had to pay $500 to the cashier and $500 to the doctor performing the procedure or our appointment would be canceled.

At this point we had been going back and forth between the receptionist and the cashier for 50 minutes, in addition to the original two hours of calls to the insurance company, and my appointment was fast approaching. My husband wanted to walk away. He wanted to reschedule for a different day, even though the soonest appointment was a month away, so that we could resolve the billing issue prior to the procedure. But I stubbornly had my mind made up that the procedure would be completed today. So he begrudgingly went with me to pay the cashier.

We paid $1000 out of pocket. I was later informed that $1000 was the minimum payment, although I still don’t know what I paid for, and to expect a larger bill sometime in the future. But the chaos didn’t end there. After talking with the doctor I was informed that a CT scan, which is a vital part of the procedure, had not been ordered. Since the initial part of the procedure was not covered by insurance it seems the CT scan would not be covered either. My husband was later informed that the scan will cost us at least $1700. That’s just for the CT itself, who knows what the doctor and technician fees with be.

If anyone has gone through a fight with doctors and insurance companies before I would love to hear your thoughts. I am going to try to call both parties tomorrow to get the issue resolved.

Anonymous

Friday 11th of January 2008

Even if there was an issue with your insurance company and your physician, there is NO NEED for receptionists to be rude with patients. Medical procedures lead to enough stress as it is, and to add to the frustration with a bad attitude is inexcusable. I hope that you informed the doctor/nursing staff about your experience with the front desk - she needs to be reprimanded, at the very least!Jerry

One Frugal Girl

Friday 4th of January 2008

Thanks for all your good wishes.

Today I found out that I can file a claim with my insurance company as soon as I receive an itemized bill from the hospital. I'm hoping the total will be less than $3000, but I'm guessing it will be closer to $4000.

If this procedure does not work my surgeon suggested I try again in a few months. I'm crossing my fingers that it works the first time!

Becky

Friday 4th of January 2008

That is outrageous! I hope everything gets figured out :(

M

Thursday 3rd of January 2008

It's kind of hard to tell if your procedure was denied or if there is just some holdup that wasn't cleared up by the time of the appointment. Of course you should first find out what the problem actually is, then see if you actually need to fight them. It might be a matter of just waiting?

Because of too many experiences like that, I make sure my procedures and surgeries are okayed officially through insurance long before the actual appointment. Often the facility where it's to be done will get a preauth. from your insurance. The key is to follow up long in advance and make sure it is all okay before showing up for the procedure. That of course assumes you don't need an emergency appointment, but even then, you can try to follow up and put pressure by calling regularly and making sure they are doing when needs to be done.

If you have to fight them start with their own basic appeal procedure, that is what has worked best for me. Working within their system is easiest b/c usually they have policies in place for such situations and I've surprisingly been successful i think every time I've had to contest a charge.

That doesn't mean all my procedures were well covered, far from it, but somethings are clearly outlined in my plan and I have to make the choice to pay out of pocket for the procedures that clearly are not covered by the plan I have.

Good luck, your day at the hosp. sounds incredibly frustrating. I can totally relate. I am mired in this stuff day in and day out!

Anonymous

Thursday 3rd of January 2008

My dh and I once ended up with a whole pile of doc. bills that the insurance company had denied. Everything should have been covered so we called the insurance and they said they would not pay any of our bills because we had not filled out and returned a survey they sent to us. We never received the survey. So dh asks if he can just answer it over the phone. The girl said yes and so she asked him one question. "do you have any other insurance?" he said "no". Then she tells him to have the doctors resubmit all the bills and everything would be taken care of. I could not believe it they had suspended our insurance over something that ridiculous. Double check with your insurance company they may be have denied your procedure over something stupid. I would also call someone in charge at the hospital to get your money back!! talk to someone higher up than a receptionist.