Beware Balance Billing

When insurers don’t pay the full amount of the bill, health-care providers are going after patients to make up the difference. It’s known as “balance billing,” and it’s often illegal, BusinessWeek reports. Under state and federal laws, doctors and hospitals generally need to be dealing with the insurers, instead of pressuring vulnerable patients. Have you had any success with fighting balance billing? Leave your story in the comments.

Medical Bills You Shouldn’t Pay [BusinessWeek] (Thanks to Eric!) (Photo: jgodsey)

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  1. OzoftheJungle says:

    i had this happen to me while i was in therapy after my father passed away suddenly.

    while the therapist told me that the insurance company only paid her X amount and she would bill me the difference, i didn’t understand that was unusual until i called my insurance company and asked them why my copay was so high. they called the doc and a week later i had the difference back in my mailbox in check form. needless to say, i didn’t go back.

    the insurance company told me they would’ve dropped the doc from their plan had she not given me back the money.

  2. Blitzgal says:

    This happened to me 10 years ago when I was in college. I was having some issues and wanted to see a counselor. Because I wasn’t living at home I contacted my insurance provider to get documentation that I’d be covered if I saw the person they required me to see. They authorized five visits; I stopped after three. When I got home that summer I started getting bills for over $300 from the clinic. Thankfully because I’d gotten permission in writing beforehand, all I had to do was produce the letter. The insurance provider had a mediation meeting about which I was not required to attend, and they paid the bill. But for those several months that I kept getting collections letters, I was almost frightened into paying it myself just to “get it over with.”

  3. Ihaveasmartpuppy says:

    I think our dentist is doing this. Every single time we have anything other than a cleaning done they bill us for much more than our EOB from the insurance company says we are responsible for. This is AFTER they have received the check from the insurance company. Every time it happens I have to fax the EOB to the dentist as proof. I’m sick of doing it, need to find a new dentist I guess. I knew we were not supposed to pay more, but I didn’t know this practice was illegal.

  4. winstonthorne says:

    This happens to me every time I go to the ER, because the doctors there typically are out-of-network doctors. It’s evil and stupid and I hate it, but there’s nothing I can do – the law appears to only cover this situation if the doctor in question is in the managed care network.

  5. WeirdJedi says:

    About a month ago, I had some form of food poisoning. I didn’t have any medical insurance, but I was supposed to be covered through a special “handicap” service. All I had to do is fill out some paperwork. Within the first week, we got a bill through the hospital stating that we were supposed to pay x amount of dollars per month (which was actually twice the alloted money you could pay). We called the hospital to try and straighten the matter out, but they acted as if they never received the paperwork. We called the company back to see if they were supposed to cover it and found out, and I’m not kidding, their “computers were down and it would take another two weeks to straighten out the matter”. Since the total of the bill is divided out, we had to basically tell everyone to hold on until the company recovers the information. On the positive, within a month they were able to get the paperwork over and get the bill officially paid.

  6. rpm773 says:

    Just happened to me last month after going to ER for some MRIs. But it was at an out-of-network ER, so I figured I didn’t have much of a case to battle it.

    I paid it, thinking I don’t really have an excuse. I have insurance but went to an out of network ER for something that wasn’t really an emergency. If I was more proactive I would have a primary care physician who could have referred me to an in-network neurologist.

    BTW, how about hospital charges on MRIs? That’s an eye-opener. It knocked me off of the high-horse used to ride about people going into debt…

    • summerbee says:

      @rpm773: Wow, how much was your bill? An outpatient MRI/MRA once cost me $3,800 out of pocket…until I wrote to the VP of my (completely BS) student insurance company.

      I can’t imagine what an emergency one would cost, then!

  7. About he only good thing I’ll say about CIGNA is that they are very supportive of patients and aggressive when this happens. I had eye surgery, and CIGNA paid their contracted rate, minus my out-of-pocket deductable. The Explanation of Benefits they send for each visit clearly states that once CIGNA pays, the provider can’t bill you for more. The anesthetist billed me for more than the contracted price, and CIGNA sic’d their lawyer on his office. End of harassment.

  8. Fujikopez says:

    This happened to me with my midwife. I paid what I was supposed to pay, but then they tried to “negotiate” with her for the rest. I use the term loosely because they basically said, “We’ll only pay you this percentage, too bad.” Then she tried to get me to pay the rest. I don’t blame her, she’s got bills to pay. So she just upped her prices and sent them a new bill, so she got her money in the end. (Yes, I know that is illegal, but jeez, they should have just paid up.) The stupid thing was that this “insurance” isn’t really insurance, because my husband’s company has to pay the balances in the end. So what were they trying to do??

  9. krom says:

    If you are in a PPO or HMO, and your provider is in the network, they are obligated to honor a set price. They violate their agreement (and the whole point of a PPO or HMO) if they try to bill you the difference between their regular rate and the PPO/HMO rate. That doesn’t mean that they won’t try, either due to bad accounting or just plain sliminess.

  10. Just reading some of the comments about ER visits and not having a primary care physician…I’m not yellin’, and I’m not pointin’ fingers, but you do realize that using an ER as primary care contributes to higher medical costs for all of us, don’t you? Also, having a regular primary care physician generally means you’ll get better care, since she can get to know you and treat you better.
    Getting off my high-horse….

    • rpm773 says:

      @Sir Winston Thriller: Oh, I understand. But where are the chances better of hooking up with a hot coed internist? As you’re lying there uncomfortably wearing a hospital gown. With an IV in your arm…

      My ER trip incident has gotten me to go out and get a primary care physician.

  11. pjsammy says:

    So if I understand this correctly, my wife’s regular OBGYN billed us for the difference in their rates and the insurance-approved amount for her recent check-up. Given the Dr. being in-network and it was a routine visit, we shouldn’t be paying the difference here, right?

    I just want to make sure that it isn’t just out-of-network and ER kind of visits to watch here.

    thanks

    • johnva says:

      @pjsammy: I’m pretty sure they can’t do that as an in-network provider. They obvious can bill you for deductibles and coinsurance, but not a difference in their rate vs. the negotiated rate.

    • cf27 says:

      @pjsammy: It all depends on the situation. If your doctor has an agreement with the insurer with a payment schedule to be charged for certain procedures, then the doctor can’t collect for more than that amount. But, say you have a 20% co-pay. If the doctor normally charges $100 for a procedure, and the insurance contract says $80, but you have to pay 20% co-insurance, then the insurance co. will pay $64, and you have to pay $16 (the diff. b/w $80 and $64), NOT $36 (diff b/w $100 and $64).

      Now, if the insurance company doesn’t have an agreement (i.e., you’re “out-of-network”), then you will have to make good the full difference between the doctor’s normal fee and what the insurance company pays.

      Some doctors have discounts for paying in cash. So, if you’re out-of-network, pay cash, get the discount, then submit to the insurance company.

    • theblackdog says:

      @pjsammy: I think that would be correct, unless the terms of your insurance state you have to pay a co-pay or a percentage of your visits.

      I have to pay a $15 co-pay whenever I visit my regular doctor, the rest is taken care of by insurance. However, when I had to go to the ER for a kidney stone, I had to pay 15% of the bill and insurance covered the rest, as per the terms of my insurance.

  12. Crymson_77 says:

    I have one that is still ongoing from 2 years ago…they just can’t seem to get it through their heads that insurance pays the bill, not me. I am not that far from taking them to court over the matter…(and they freakin’ called CPS on us to boot! Never mind the fact that the doctor was an asshole who thought setting an arm PRIOR to taking a fucking XRay was a good idea. Oh, and thank Bush for removing my right to sue the fuck out of them for causing harm to my son!)

    • balthisar says:

      @Crymson_77: What are you on about? We’re still waiting for tort reform to happen. You have every right to sue today as you did three years ago, at least according to national legislation. If your own state did something stupid to the laws, you can’t blame the federal government on that. ::rolleyes::

      • Crymson_77 says:

        @balthisar: I live in Texas and Bush was the governor that screwed me. Of course I can blame him, ninny.

        • thelushie says:

          @Crymson_77: Ohhh, name calling, classy. Still, governors do not have absolute power. There still are state legislatures. As popular as it is to blame Bush for everything including the sun not shining (as anti-intellectual as that is), you might want to try blaming all the parties that are involved in the decision making process.

          • Crymson_77 says:

            @thelushie: “::rolleyes::” wasn’t exactly complementary, you realize? As for my son, the ER “doctor” attempted to set a ligament that wasn’t out of place on a broken elbow. This caused serious pain to my son, emotional distress to my son and wife (who I wish had called me sooner as I would have had that doctors ass in a sling in seconds if I had been there when this was occurring) and possibly (most likely) even exacerbated his injury because they didn’t bother with that useless wonder known as diagnostics that would involve such excessive things like a f-ing XRay to see what the problem ACTUALLY is prior to just f-ing assuming. Whereas this incident pales in comparison to others that have happened to other people, it is my son, the doctor hurt him (to possibly include “injured”), and to me that is all that f-ing matters. Before the laws were put in place, we could have had SOME f-ing remedy (we didn’t want to get rich off of it, that is stupid), but as it stands today the hospital in question wont even acknowledge that the doctor was in the wrong. So, our solution is to never return to that awful fucking place.

            • thelushie says:

              @Crymson_77: I am sorry your son had to suffer like that. Doesn’t do much for his future trust of medical professionals either (and much of that paranoia is justified!).

              There were (and are) many people who took (and take) advantage of the term “emotional distress” and that is why those laws have been put into place. Unfortunately, some do experience real emotional distress and they have to pay for what stupid people do.

              I think the best thing to do is never to go back to him and then tell every single person who will listen what he did! Hugs to your son.

              (And when I asked, I was not being sarcastic. I really wanted to know.)

              • Crymson_77 says:

                @thelushie: :) I appreciate that very, very much. My sons are both extremely special for me and I am very protective. I too dislike those that have gamed and abused the system. It is a HUGE part of the reason our healthcare system sucks so completely.

                @Tankueray: His part was limited to just not signing the bill. That would have killed it and given us an option for recourse. Since he was an asshat that, probably, made money off it…he signed it and we got screwed.

                @dragonfire81: The best advice I can give you is to go back to Canada. It eats everyone alive whether they want it to or not…

                @thomas_callahan: DC law applies here, I think. As for the payments due to the service, I believe you are out of luck. I have seen it go both ways, but most of the time an ambulance ride is considered and out of pocket expense because most of the time, people should just take a cab. For me? I think the $330 would be worth my wife’s and daughter’s peace of mind. I know it hurts, sorry man.

        • balthisar says:

          @Crymson_77: LOL. I’m duly humbled!

          • Crymson_77 says:

            @balthisar: Sorry for so, um, directly going about that…but it was my son and, even though it is 2 years later, I still get incredibly pissed about the stupidity that we were forced to endure. Not to mention that it could have potentially caused my brother some issues with his security clearance (and yes, for those that are about to argue, it absolutely can cause issues for a family member…this according to the FBI). Since then, not only was the CPS investigation lackless and quick (meaning they only ever spoke to me and then closed the case, even though they were supposed to also talk to my wife), but the entire thing has been expunged from the system and anybody who even so much as brings it up can be slapped with a huge lawsuit in nothing flat. (Yes, I was VERY serious about dealing with it)

        • Tankueray says:

          @Crymson_77: @thelushie: Actually, the Governor in Texas doesn’t have that much power. Only to sign the bills that the Legislature gives him. The problem is that the Legislature only meets every two years, getting very little done. The Lt. Gov. is where the action is.

          • Greasy Thumb Guzik says:

            Balance billing is flat out illegal for Medicaid too.

            @Tankueray:
            Yeah, if the MSM had understood that, they might not have given junior such a pass.

    • thelushie says:

      @Crymson_77: If harm was done to your son by something that the doctor did (or ordered), that is malpractice and you can still sue for that. How did Bush take away your right to sue? If anyone took it away (if they did), it was that wonderful Congress that everyone voted in.

      • Crymson_77 says:

        @thelushie: I consulted with 5 different lawyers, all in the medical malpractice field, and was told in all 5 cases that there was nothing we could do. And that the reason we couldn’t do anything was the recently added laws on the books blocking action against doctors that obviously shouldn’t have a job….

  13. dover says:

    Wait, isn’t this how it’s supposed to work? Hospital bills the insurance company, insurance company pays their share, I get a bill showing the standard rate, the insurance contract adjustment, and the difference, which is my responsibility. If I think the insurance company didn’t pay correctly according to my coverage, I call them and they fix it or explain it.

    On a related note, I’ve had pretty good experiences with United Healthcare. Had a doctor’s office that didn’t bill in time, so UHC refused to pay them. The billing company gave me all sorts of reasons why I needed to take care of it. United told them to suck it and they went away.

  14. Well-Dressed Geek says:

    Healthcare costs are one of the few things that drive me beyond nuts – enough so to actually create a Consumerist account to comment!

    About six months ago, some routine lab work was performed and I received an “Explanation of Benefits” (EOB) statement from my insurance, as well as a bill from the lab outfit. Of course the member’s responsibility amount from the EOB was about 5% lower than lab bill amount. As an experiment to see what would happen, I paid about 3% less than the EOB amount (remember, bill > EOB > amount paid). So far, no follow-up bills or collections (well, we are talking about a dollar or two less here!). It would be interesting to do a follow-up with larger dollar amounts.

    Frankly, I’d like to see posted prices and rates at healthcare provider’s offices. It’s probably wildly impractical and would cause the fall of the free world, but at least I’d know with certainty how much a procedure costs!

  15. dover says:

    Okay, I didn’t RTFA before and the summary is a little misleading. It’s not insurance companies failing to pay the bill, it’s doctors offices not willing to accept the ‘discount’ rate they negotiated with the insurance company.

  16. juri squared says:

    I wasn’t concerned before, but I am now.

    That, and I am still fighting bills with my doctor’s office on a weird technicality… My doctor opened her own practice and said she was still in-network. Insurance says no, she signed up two months later. Guess who’s holding the bill right now? Yep, it’s me!

    • johnva says:

      @jurijuri: I can’t imagine that they should be able to bill you for the difference between in-network and out-of-network if they actually misrepresented their status. Of course, it could also be your insurance company that is lying.

  17. SkokieGuy says:

    What about the form that every healthcare provider makes you sign about financial responsiblity, (that I agree to pay if the insurance company doesn’t)?

    I understand their need, as sometimes insurance may be declined or invalid, but does this waive our rights to not pay any insurance shortfall?

    • johnva says:

      @SkokieGuy: Don’t think so. I think that just means you’ll pay if the insurer refuses the claim, and that you’ll pay your deductible and coinsurance. I don’t think they can just bill you for whatever they want above what their negotiated rate with the insurer is. They’d be breaking their contract with the insurers.

      • johnva says:

        @johnva: I should clarify that I’m talking about in-network providers in my last post. I’m less clear on how it works with out-of-network physicians, except that I know my insurance pays a helluva lot less.

  18. IC18 says:

    Absolutely perfect timing for this post. My wife gave birth a couple of months ago, helathy baby boy. We have PPO BCBS of MI. I got several reports from BCBS a month ago indicating how much the hospital billed and how much they paid and how much I owe $0. Just last week I get a bill from Spectrum Health, an in-network hospital, indicating I owe them $600. Am I obliged to pay them the fee or are they trying to scam me for the difference BCBS didn’t pay???

    • Crymson_77 says:

      @IC18: They are trying to scam you. If you have a statement from your insurance stating that you owe $0, then that is how much you owe. An increasing practice by hospitals today is also to send out the bill to you at the exact same moment they bill your insurance. Double-dipping for the win!

      • floraposte says:

        @Crymson_77: That depends on how the insurance co formats the billing. I’ve had claim statements that essentially treated out of network as in network in doing the math, so that the closing number was $0 on what I owed, but since it wasn’t in network I was actually responsible for the difference.

        In another recent “be warned” story, both my doctor and I called my insurance prior to an outpatient surgery procedure, and we were both told that pre-approval wasn’t necessary. After the procedure, they balked at payment because I hadn’t gotten pre-approval. Fortunately we had names and dates, but really, there’s no way I could make them pre-approve me when they claimed it wasn’t necessary.

        • Crymson_77 says:

          @floraposte: All the more reason to check with your insurance company upon receipt of this kind of bill. Good point.

          Sucks about that other thing, glad you were a good Consumerist and wrote down who and when you spoke with someone!

    • IC18 says:

      @IC18: I forgot to add that I have a $300 In-Patient Hospital stay Co-Pay only. So they are still billing me $300 more..

    • Carabell says:

      @IC18: Do not pay it. Call BCBS and tell them that they are trying to balance bill you. Insurance co’s/PPO networks generally take this very seriously, and if they don’t stop trying to balance bill you, they will likely sic their legal dept on the provider.
      If this is happening to anyone, please please please call your insurance company and discuss it with them.

  19. shimsham says:

    This happens to us on a monthly basis, at least. We just call Aetna and they give the provider a courtesy call to remind them to leave us alone. Aetna is great in that regard.

    • johnva says:

      @shimsham: My question is how do you effectively identify it on the doctors’ bills? A lot of my bills from doctors are almost indecipherable, don’t match up to the EOBs from my insurer, and are not itemized by what was billed for.

  20. e6matt says:

    My wife gave birth to our son at the end of last December, and several weeks later we learned that the anesthesiologist that administered her epidural was an out-of-network doctor. Although the hospital was in-network, the anesthesiology group that the hospital contracts with was having problems getting our insurance provider to agree to a new contract. In that type of situation our insurance company will still pay as if the doctor was in-network, but they will only reimburse at the rate the insurance company feels is fair. The number they came up with was about half of what the anesthesiologist wanted, so the anesthesiologist’s office contacted me directly to let me know I needed to pay up. For a limited time only, they say, I could get a 20% discount if I paid the other 80%.

    This smelled like a rat, and I embarked on a quest. The insurance company (Principal, which was helpful the whole time) says that they will pay up to 3 times the rate of Medicaid for that anesthesiology (as opposed to other services which are usually 1.5x), but they couldn’t tell me how that rate was calculated. The anesthesiologist’s office was aware of this, although they said that the rate for Medicaid was practically nothing and that my insurance company was being ridiculous.

    I was able to find the appropriate documentation on several Georgia government websites, and deciphered the cryptic code information in the billing statement. No matter what I tried, I couldn’t make the numbers line up. It looked like the insurance company should be willing to pay up to 3 times what the anesthesiologist is asking for. A quick phone call later and I find out that the anesthesiologist didn’t submit the “service time” correctly, which is a key part of the equation- they were off by a decimal point. After I called the anesthesiologist office back, they resubmitted the claim and got the rest of their money.

    I never received an apology from the anesthesiologist who bad mouthed my insurance company the whole time while trying to strong arm me.

  21. speedwell (propagandist and secular snarkist) says:

    I showed up on the day of surgery to have my kidney removed because of a life-threatening infection, and the receptionist called me up to the desk a half hour later to tell me the hospital needed 300 dollars immediately or they would cancel the surgery. This was absolutely a hundred percent news to me. Given that I was in pain and unable to walk, and left my debit card, checkbook, and all but a few dollars in cash at home like they TOLD me to do, what was I supposed to do then?

    I called a friend, who got hold of my boyfriend, whose college-age sister lent me the money out of her tuition money for the next quarter (YES, I bloody damn well paid her back with interest the next week). What if I couldn’t find anyone?

  22. speedwell (propagandist and secular snarkist) says:

    By the way these were the same jerks who came to my bedside while I was on narcotics, demanding that I sign payment forms. The narcotics simply made me too tired to restrain myself from telling them exactly where they could shove their paperwork.

  23. Evil_Otto would rather pay taxes than make someone else rich says:

    Don’t know if this is related, but not too long ago I had a lab send me a bill for the full cost of some blood work. I called them and let them know it should be covered by my insurance, and they should send the bill to them, and was told that it was a technique they use to try to get insurers to pay in a timely fashion; if a subscriber calls them up and bitches that they haven’t paid for some covered care, it gets processed faster than if the lab calls them directly.

    I resented being drafted into helping them with their paperwork, but I can understand their frustration with the medical insurers. Health care reform won’t happen in this country until we pull all the CEOs of the big insurers from their cars and beat them to death.

    • johnva says:

      @Evil_Otto: Or they could just be attempting to “double dip” (bill both you and your insurer) and commit billing fraud.

      My state actually has automatic penalties under the law for late payment by insurers to providers. But my insurance still seems to pay late anyway most of the time. And the penalty is tiny (it usually is like $1.50 or something on a $200 bill). So maybe the penalty needs to be upped until it hurts them.

    • bwcbwc says:

      @Evil_Otto: Yeah, there are bad apples in all parts of this industry. The insurers drive down the contracted rates payable to doctors to bare sustenance levels, the doctors try to scam their way out of their network agreements and bill the patients extra so they can pay off their loans from medical school (or the loan on their Lamborghini). The patients (or doctors) try to scam the insurance for services that were never performed.

      It seems like everybody in the country is so obsessed with squeezing the last possible dollar out of everyone else that they’ll go to any lengths to obtain it. From the weasels at Comcast and the airlines to the folks who return weighted boxes of junk for a refund, it seems like everyone has the “street mentality” that exploitation of customers and vendors is justified for their own survival and convenience.

  24. twid says:

    I had this happen just a few months ago with a minor surgery my daughter needed. We pre-qualified the surgery and United Healthcare told us we would just need to pay the $300 deductible and that was it. A few weeks after the surgery the hospital (O’Connor Hospital in San Jose) sent us an itemized bill showing that we owed nearly $1,500, which was the balance left after all the insurance deductions they did.

    I contacted UHC. They were very responsive and told me that they would handle it. They sent a real letter to the hospital and cc’d me telling them that I only owed $300, period. A few weeks later we recieved an updated bill for $300. We paid and have had no troubles since.

    Overall it was the best experience I’ve ever had with an insurance company, I was ready for a fight and totally surprised when they were actually helpful.

    My tip to consumerist readers: if you’ve got a planned procedure coming up, call your insurer first and get an idea of your coverage and whether you have to pre-qualify. Despite being evil most of the time, insurers at least usually have people answering the phones who know the ins and outs of your coverage.

  25. mac-phisto says:

    wait – this is illegal? there aren’t enough jails to hold the violators in my neck of the woods. some in-network physicians around here are even requiring cash (or credit card) payment up front before they even submit to the insurance.

  26. pearlie69 says:

    my husband had an emergency room visit around just before christmas of last year. the total bill came to just under $1000. we had a deductible and paid that when the invoice came. but that combined w/ the “negotiated” fee from our insurance company did not add up to the the total charge, so we got another invoice asking us to pay the balance. i got aetna if i was obligated to pay the balance and the csr told me “no”. in fact, he was nice enough to call the hospital billing to set the record straight. it took two billing cycles and a couple of calls to get the hospital to lay off and stop asking us for payment. it seems that everything should have been taken care of when aetna had the conversation w/ the hospital billing dept. it just took them 3 billing cycles to rectify the situation.

  27. redqueenmeg says:

    I’m having trouble with this from my allergist and am now in collections because of it. My allergist never billed me, they just sent me to collections. This is money the insurance co. owes them, and the insurance co. has admitted this and said they will pay if the allergist will resubmit, but it is easier for the allergist to send me to collections and send me a nasty letter firing me as a patient for being such a deadbeat.

  28. deadandy says:

    My story is similar to many above: We received a “balance” bill from one of her doctors to cover what the insurance company had not paid. I was ignorant, though, and went back and forth between the doctor and the insurance company many times. The doctor was nice and would agree to “re-bill” the insurance company, at which time the insurance company would confirm they already paid the bill. After many calls to Unicare, I finally got the “right” CSR who told me they paid the negotiated rate and that the doctor should not be charging me any more. They sent a letter to the doctor to this effect and I stopped hearing from them.

    Moral of the story: Educate yourself, and keep calling until you get someone who knows what they’re talking about. Don’t take “I don’t know” for an answer.

  29. Consumerist-Moderator-Roz says:

    Let’s not turn this into a tort reform debate, folks. Keep it on topic, please!

  30. TGT says:

    This is slightly different from the post, but it is related to shady billing practices.

    I was recently injured at work and had to visit both the local ER immediately and later my PCP. Both were given workmen’s comp insurance information for billing. The hospital didn’t receive a response from the insurance company, and when it wasn’t paid, they sent me a bill, with a note explaining it wasn’t paid and to call the billing department. Turned out they didn’t update my billing information when I called them back after leaving the ER. No big deal, and easily fixable.

    My PCP was worse. They sent me a bill immediately for the visit, with no notes. When I called their billing department, I found out that for all accident related visits, they bill both the insurance and the patient immediately, because sometimes the insurance doesn’t want to pay for a while. Um, what? To me, that seems an awful lot like double billing. The person in billing told me I can just ignore the bill for 3 or 4 months if I want… plenty of time to make it past due. It’d be enough to make me want to find another doctor, but I’m already working on that. (The doctor’s commment of “What do you want me to do?” when I told her I was having servere, delerium inducing head pain in certain, specific, job required situations 1 week post-concussion was the straw that broke the camel’s back. When a doctor says “that’s odd” and “that doesn’t make sense” about your head pain post-concussion, and recommends ignoring it, something is not right.)

  31. _NARC_ says:

    Doesn’t every single hospital do this? I have honestly never seen a provider (that was not your regular doctor) actually bill me for the correct amount. I know exactly what my deductibles are before I even go to the doctor, and I know what hospitals in my area are in-plan and out.

    I always pay my deductible at the point of service, and basically ignore any invoices that I get.

  32. PageCashman says:

    I am a breast cancer patient less than one year out of Chemo. My Oncologist
    has been balance billing and although has received over $80,000 in payment.
    The balance is over $12,000 and I was just informed that due to this
    balance, I am he will not see me unless I pay a chunk of the bill.

    I am sorry for the office assistant who had to deliver this news to me, and
    sorry for a doctor who practices medicine in a world where patient care is
    secondary, or maybe tertiary.

    I have explained to him that I am not working, I am raising my daughter full
    time. My husband just opened his own business, we are cash poor and already
    in credit card debt just to keep afloat. I am sure this is all temporary and
    in a year I will be able to review the balances and pay the portion that I
    actually owe. But to refuse my three month check up to make sure I am
    cancer free? What am I supposed to do now?

    THE MD WHO REFUSED TO SEE ME!!!!!!

    Dr. Jeffrey Tepler, MD

    310 East 72nd Street

    New York, NY 10021

    212-650-1780

    Angry cancer girl.

  33. kitykat70 says:

    I have worked in medical billing for 15 years and have had to straighten out many a relative’s bills with their doctor.
    If you go to an in-network provider, the provider is only allowed to bill you what is on the eob as patient responsibility. However if you go to an out-of-network dr or you have something done that they have you sign an ABN (advanced beneficiary notice) then you are responsible for the balance. Most providers will work with you on it if you are willing to pay them some of it.
    Lastly, the provider is only required to file your primary insurance, if you have secondary insurance they will usually file once as a courtesy but after that it is your responsibility to get your insurance company to pay the bill.
    Amazing how many times patients don’t give us correct insurance information and then wonder why it is their responsibilty when we can’t get the insurance to pay on a policy that expired.

  34. mike says:

    Most Health Providers I visit make me sign a form saying that I’ll pay anything that the insurance doesn’t cover.

    Is that illegal?

  35. nicemarmot617 says:

    Wait – I’m confused. This happens to me constantly. My favorite is my current one, $10 from some lab that I have a cancelled check showing I paid them the copay over a year ago. And they keep sending the invoice to my old address even though I changed the address with my health insurance more than a year ago. The very first invoice I received was last week, warning me it was my last notice for that $10 and they were going to send me to collections. If it’s illegal I’m hiring a lawyer! He’ll be on call for my constant BS medical bills!

  36. ohiomensch says:

    I have run into a lot of problems with our employees regarding new baby wellness. In Ohio, the minimum required by state mandate that insurance has to cover is $1000 (it went up last July from $500), and of course that is the limit that the provider sets as well.

    But I see a lot of pediatric billings for well over that amount for required immunizations. When the clinics do this, they are in violation with the contracts they made with the Health Insurance provider, and they should be reported.

  37. angelman says:

    Having moved here from the UK with our terribly flawed “socialised healthcare” (who the hell wants poor people to be able to get healthcare anyway?) I very quickly realised the massive scam that is the US healthcare system after I received a bill for $2500 for a strained wrist where they just took a look at it, prodded it and wrapped it in a bandage. Fortunately I was covered but it took about 4 months to resolve the bill. Now I check every bill I receive and every EOB. I question EVERY bill I receive. I simply refuse to pay anything until the numbers add up. I question the insurers if I think I am not being covered correctly for something and I question the doctors on everything. I would say that probably 60% of bills I have got are either wrong, scammy or confusing. Often I have received bills that say pay this amount or else.. Then when you call up the hospital for an explanation they say something like “oh that’s just a courtesy bill you don’t actually have to pay that, we havent even sent the bill to the insurance company yet”.

    So check everything, assume every bill is wrong and only when you have exhausted every avenue and checked everything do you pay any of your own money.

  38. joemama321 says:

    We got roped into this with my wife’s birth of our child a few months ago. I’ll preface this with stating I am one of the oddballs that actually has a Ph.D. in risk management and insurance with close to a decade of employee benefits industry experience, so in theory, I should understand the practices more than the everyman.

    We’re in an HMO due to being in a small town where the network blanket covers all providers we could possibly care about.

    I call the hospital beforehand to make sure that the anesthesiologist was in-network. (Side note: beware that anesthesiologists, radiologists and ER physicians working within an in-network hospital may not be in-network, leaving you over a barrel.) Her guy is. Great. Go to hospital, have baby, come home, enjoy baby, get bill. I call the hospital.

    Me (to hospital billing): “Why did I get this bill?”
    Them: “Uh, you need to call anesthesia billing.”

    This should be my first clue that confusion will be coming if the department has its own billing dept.

    Me (to anesthesia billing): “Uh, why did I get this bill?”
    Them: “This was for the nurse anesthesist. The doctor that did the spinal was in network, the nurse who monitored your wife was not.”
    Me (on soapbox): “As a non-physician who was doing his due diligence, how the hell was I supposed to realize that her monitoring would be done be a nurse in a different practice than the anesthesiologist?”
    Them: “Oh, well insurance will always pay one but not the other. We bill faster than the nurse’s practice, so that’s why we got paid. Don’t pay it. They’ll write it off.”
    Me: “Fine. But out of curiosity, if you always bill faster and they always write off the charges, how do they stay in business.”
    Them: “Medicaid will pay both.”
    Me (to self): “WTF?”

    As it turned out, they hassled me twice more at which point I appealed the claim with the insurer, who paid it.

    The bill was $1200, which was worth the couple hours of my time fighting it, but I would be willing to be there are a ton of elderly and less savvy people who just pay these bills. This is probably particularly true in PPO or POS setups with partial out-of-network coverage. If this would have been covered at 70%, I might not have fought it. At 0%, you bet your ass I did.

  39. BoraBora says:

    So, who do you go to, when you believe the doctor is balance billing and you’re not sure if it’s legal? I live in California if anyone knows. 2 years ago, I accidently cut off the the tip of my thumb. I was rushed to an in-network ER. However, I found out 6 months later that the on-call reconstructive plastic surgeon was out of network. The doctor’s office tried to bill me, even though they hadn’t received payment from my insurance company. It was particularly annoying because from the get-go, the were threatening me with collections. When I called them (repeatedly) about it, they just claimed that is was a standard thing on all bills and to ignore it. The insurance company paid what they thought it should cost, which was far below (by several thousands) what the doctor was asking. I worked out a deal with a “discounted” amount from the office, by paying $500 a month. I always paid my $500 when I got the bill. Then the bills stopped arriving for about 6 months. About 6 or so months ago I get a new bill (this is 1 1/2 years after the surgery) now from another doctor who assisted on the surgery. I smelled something fishy and called up the billing office. I asked for an itemized bill and told them I was highly suspicious of their billing practice. I have not heard from them since. I’m not sure if i’ll go to collections over this, and I have documented who I talked to. But it’s a bit hard to pay them if they don’t bill me, and I don’t really want to pursue it, since I’m suspicious of the whole thing anyway.

    • ohiomensch says:

      @BoraBora:

      Call your insurance provider. They know what the doctor has agreed per their contract. If they are billing more, they are in violation of the price agreement they made with the provider.

      Also, you have to watch for strange charges on your bill, in the case of the baby wellness I addressed above, the clinic was charging for immunizations, and then seperately charging for the administration of those shots (every provider I know pays for imms with those charges included in the price they have contracted)

  40. bagumpity says:

    Personally, I believe the doctors should be able to charge what they want. The price is the price, and that’s the price.

    However, I also believe that if they’ve signed a contract with a health insurance provider whereby they agree to accept some other price, they should honor that agreement. Any attempt to do otherwise is fraud. Telling someone they owe you money when you know (or should know) that they do not is fraud. There’s no other word for it.

  41. bairdwallace says:

    I was in a bike accident and woke up in the ER. They screwed up my billing, so I had to take each individual bill and call them and put them on the right track. I’m still getting billed $200 from one of the companies, after my insurance paid them some money. It seems to me the ER was out of network, but am I being balance billed? Do I have any recourse?

    Does anybody have any links to more information about this?

  42. LoLoAGoGo says:

    Is it possible to recoup any money you may have paid as part of “balance billing” if you can prove it was so? I think my hospital screwed me out of some extra money earlier this year.

    • @LoLoAGoGo:

      I totally just called my insurance (Aetna) because my eye Dr from cataract surgery a few months ago totally billed me for an extra grand after insurance had paid up. I paid it like a chump intending to look into it when I had a chance (work is really busy atm).

      They said just to take my “Explanation of Benefits” forms into the Dr. and insist on a refund. If the Dr refuses call Aetna back, and they will “explain things” to the Dr’s office.

      Looking forward to this.

  43. unholycinna says:

    I had a D&C performed in April due to miscarriage (with an approved insurance, thanks Aetna, doctor and have not stopped receiving bills. Albeit, they are not huge in total but it is annoying after we paid our deductable and then the hits keep on coming. I hate insurance companies. My husband pays quite a lot for us and our son in monthly payments and not insignificant deductable. Bastards.

  44. MomInTraining says:

    My HMO took a long time to pay the doctors and other medical providers. When the HMO went bankrupt, we still had months-old outstanding bills after my husband’s emergency appendectomy. The hospital tried billing me for nearly $13,000 that it wasn’t collecting from the HMO.

    A call to the state insurance commisioner and a certified letter later, the hospital’s tune changed pretty quickly. The hospital ultimately had to deal with the HMO and the bankruptcy courts, but I wasn’t responsible for the bill.

    My best advice is to keep your documentation and get the state insurance regulators involved just by cc’ing them on a certified letter. The insurance companies don’t want that hassle, especially if what they are doing is clearly in the wrong.

  45. solidstate42 says:

    Does anyone know of a website that summarizes providers billing practices for the various states? Thanks.

  46. hills says:

    Happens often – I just fax my EOB showing how much I owe (or don’t owe!). Sometimes it takes several times, but only once have I had to remind an office it’s not legal.

  47. pal003 says:

    Really aggravating! My yearly look at my credit reports showed a negative collection item for a $60 medical bill that I knew nothing about. Apparently, the doctor’s bill went to collection – faster than the insurance company corrected its mistake, and paid it.

    Seriously, no collection items for medical bills should be allowed on your credit report – for at least a year. That is how long it takes the Insurance company to deny, deny again, then admit their mistake and pay the bills.

  48. mariospants says:

    Having moved to Canada, I’ve found that my take-home pay isn’t noticeably much smaller due to the supposed taxes (although not being able to deduct my mortgage insurance at tax time is sorely missed), cost and variety of goods is pretty much the same, quality of life is the same and there is no such thing as “balance billing” unless you’re getting something like plastic surgery done.

  49. You-Me-Us says:

    I’ll try to give you the condensed version. Went to an approved ophthalmologist for a routine procedure that should have been covered at 80%. At the time, I paid my co-pay plus the 20% I expected to owe. The doctor’s office was to file a claim for the balance.

    More than four years later, having never heard a peep about it, I get a notice from a collection agency saying that I owed a little more than $300 from this long-ago procedure. I had never gotten a bill from the opthalmologist, never received any kind of notice that any money was (supposedly) owed. By this time, I was at a new job and covered by a different insurer.

    I wrote to the collection agency and explained that this was supposed to have been paid by my insurer years ago. I asked for copies of the claim that should have been filed and whatever response the doctor’s office got from the insurer. A few days later I received a barely readable copy of some internal document from the doctor’s office. Much of it had been redacted and what had not was internal codes that were essentially gibberish to me. No mention of when or if a claim was filed and nothing from the insurance company. So I wrote to the collection agency again and made it very clear that this should have been paid by the insurance company and that I wanted to see documentation from them showing either the amount paid or a reason payment might have been declined.

    All along I suspect that the doctor’s office simply failed to file the claim, then one day, yeas later, found their mistake but knew that so much time had passed that the insurance company would never pay.

    Then one day I got a call from my company’s HR person letting me know that the collection agency had called to verify my employment. Knowing what was about to happen, I caved in and paid, but I sent a letter to the collection agency and the doctor promising them that I would make it my life’s goal to cost them far more than they got from me.

    I can’t tell you how, but one day years later I was presented with an opportunity to exact a very satisfying revenge that did indeed cost them more than ten times what they had essentially stolen from me. A short time later, the doctor’s practice filed for bankruptcy. I like to think I played a small part in that.

    They’re back in business now, though, so if you’re a Consumerist reader in Nashville, TN, my advice to you is to avoid the Arrowsmith Eye Institute.

  50. chartrule says:

    thank gawd for O.H.I.P.

  51. waystland says:

    Hello,
    I feel lucky i live in Canada, i have never ever seen a hospital bill for anything.
    i only once got a bill for the dentist for 25.00 for missing an appointment but i knew that was comming, i have not recived bills from the dentist for any work done.

    • dragonfire81 says:

      @waystland: I am on the other side of the coin. I am a Canadian who recently moved to the U.S. and I’m TERRIFIED that I’m going to end up getting eaten alive by the U.S. health care system before I even know what’s happening…

      Anyone have any tips for someone who has NEVER used U.S. style healthcare before? I have a feeling it will be a rough transition.

  52. k6richar says:

    Stories like these make my glad to live in Canada, The only medical related bills we get are dental work (depending on province) and glasses. Fortunately almost any job you have covers dental and at least part of your glasses.

  53. BluesFan says:

    I am a near professional insurance user since my 17 year old sons first open heart surgery was when he was 5 days old. And he has had 4 more plus some other surgeries and many cath lab procedures since. Nearing $950,000 so far.

    Deductibles, co pays, expenses, gas, parking, etc. almost bankrupted us. But I don’t think we ever paid more than the EOB required.

    That took some work. But I’m sure it saved us a fortune.

  54. ScarletsWalk says:

    Had a surgery a few years ago. Anesthesia billed separately, and as I’m reading the other posts, not an uncommon thing.

    My insurance covered things pretty well and I set up a payment plan with the hospital for my portion. But since other services (anesthesia, x-ray) bill separately, I couldn’t finance in one big lump.

    I got a bill from one of them after I met my deductible, called my insurance, who walked me through line by line of all they were billed for and how I didn’t owe that bill. Called the billing office and the woman SCREAMS at me, telling me I have to pay it or I’ll go to collections. I explained that I didn’t owe it, it was owed by my insurance and asked her to re-send the itemized bill and she refused, saying they had already sent a bill.

    Threatening people with money they don’t owe, refusing to send a bill, all while someone is recovering from major surgery. Just wrong. And the refusal to send a bill? I believe that’s illegal. Definitely felt like extortion at the time

  55. padams89 says:

    Happened to me about 6 months ago when I had knee surgery. I was getting bills that far exceeded my responsibility. After getting run around from both the insurance company and the hospital/doctors billing dept (one of the few instances where both bill through the same office). I decided enough was enough and wrote an EECB to the entire hospital board (university affiliated hospital, so since im a student at this university, all i needed was a name to get their email and direct office phone number through our online system), the entire board of the local version of the health plan (it was an out-of-area, but still in-network set of claims), and the entire board of my local version of the health plan. The next day the home plan called the local plan, and both of them conference called the hospital. Then after sorting everything else out on their respective ends they all called me (4-way call) and apologized profusely. Each then separately followed up about two weeks later to ensure I had received corrected bills and that everything was correct.

  56. nix-elixir says:

    I seem to have a similar problem. Any advice? I had to see a dentist this year and specifically got insurance to cover it (the most expensive insurance available through my job). Well, my network had the closest PPO dentist as being listed in another town about 12 miles away and they wouldn’t even accept me as a new patient! They refused! The next one was 24 miles away which is, of course, too far for me to even consider driving to. I decided to go with a Non-PPO dentist and now I’m getting the balance billing too. Is there a recourse for this? I feel like my insurance provider should have more dentists listed on their network; not that I’ll be able to do anything about it of course.

    • hills says:

      @nix-elixir: It’s my understanding that when you’re out of network the office may balance bill you – they have no agreement on contracted fees that in-network providers have. Sounds like your only recourse is to pay your bill. ,,,maybe driving 24 miles to the in-network dentist would be worth it:)

  57. nix-elixir says:

    BTW, I have a deductible and have met said deductible.

  58. DrDigg says:

    A lot of people hear are describing normal co-payments and the extra cost of going out of network. If you see a doctor out of network your insurance company does not have a contract with them. Thusly your insurance company (and in turn you) are responsible for paying that bill. Balance billing is illegal, but if your contract states you have to pay 20% of your bills (like mine does) you have to pay 20%.

  59. Paxtez says:

    Ok, work in the medical field (durable medical equipment) and unless you are going to Bob’s House of Medicine this practice is pretty uncommon. Medical billing is crazy complicated.

    Companies know what insurances pay for goods and services. Based on the HCPC code of the good/service and your copay, they know what the insurance will pay before the submit the claim. Normally they will bill for the exact amount that the insurance will pay, so if you asked the insurance they will say you owe $0.

    Medicare has very strict rules about this, patient’s files are very detailed and if medicare was to audit them they would be put out of business.

    Not to say billing errors don’t happen, but they are just going to be honest mistakes.

  60. From the article:

    “AMA member David McKalip, a neurosurgeon in St. Petersburg, Fla., says patients can trust doctors to behave ethically and not gouge the poor: “Doctors will know up front which patients are willing to pay” beyond what the government reimburses.”

    HAHAHAHHAHAHAHAHAHAHAHHAHAHAHHAH

  61. vladthepaler says:

    This has happened to me several times. It takes literally months of phone calls and letters etc. to get it straightened out. I didn’t know it was illegal (or had a name)… frankly i just thought it was common practice in the industry. Figure hospitals and insurance companies both love it…. I’d love to see a Consumerist article about the laws that make this illegal, so I have something to cite when it happens again… like you’ve done for debt collection problems.

  62. thomas_callahan says:

    OK, so what happens in this situation (timely article, this is, I was just dealing with this this morning!): On vacation out of state (in D.C.) I had to take my daughter to the ER — she hit her head on the hotel coffee table and had a nasty cut just over her eye. The hotel called an ambulance — total overreaction on their part but having no idea where the hospital was, screaming child, nervous hotel staff, etc., we went.

    When we get home I get a bill from the DC ambulance service. I fill out my insurance info and return it (BCBS of Rhode Island). BCBS paid the ER, doctor, and hospital bills just fine, we paid our ER copay to the hospital, I thought we were all set.

    Weeks later I get a bill from DC Ambulance where BCBS has paid about 2/5 of it, leaving a $330-some balance (yes, the full bill was $530 for a three mile, 10-minute ambulance ride with no emergency services provided, plus a separate $18 for mileage! Basically a really expensive taxi ride). Really should have just taken a taxi but you try telling that to your frantic wife and screaming 3-year-old.

    Anyway, BCBS denies responsibility for the remaining balance saying the DC ambulance service (a city service, not a private company or anything) is not a “participating” provider.

    Rhode Island law says ” § 27-41-26 Enrollee liability. – No enrollee is liable to any provider for charges for covered health services, except for amounts due for copayments, when provided or made available to enrolled participants by a licensed health maintenance organization during a period in which premiums were paid by or on behalf of the enrollee.” (see: [www.rilin.state.ri.us])

    Can’t find anything on DC law so far. Which applies, RI or DC? And does “any provider” in the law mean ANY provider, or just any in-network provider?

    • hills says:

      @thomas_callahan: If they’re not a participating provider, they have no contract with your insurance carrier, and can bill you the balance. The law you quote says “No enrollee is liable to any provider for charges for covered health services” – problem is your insurance is saying this isn’t fully covered (b/c it’s out of network). You may be able to work out an arrangement to accept less $ with the ambulance provider, or you may appeal the decision with your insurer.

      • thomas_callahan says:

        @hillsrovey: Thanks, that’s what I figured, I just find $530 for what they did to be ridiculous. A couple of 20-something EMTs glancing at it, shrugging their shoulders and saying “I dunno, might need stitches” should not cost $530, and driving me three miles should not cost another $18. They didn’t even bandage it or anything, and start to finish it took them well under half an hour.

        @Crymson_77: I know, I know, and in hindsight given what little I knew at the time I’d make the same decision again. But had I known the hospital was only 3 miles away I would have opted for the cab… I have appealed but I’m not holding my breath.

        It does hurt though, and feels distinctly “unfair” somehow given that I wasn’t told the hospital was basically down the street, had no way of knowing how much it would cost, etc. — I’m considering writing to the hotel since I think they only called the ambulance to cover their own a** when it clearly wasn’t necessary, but that’s probably more trouble than it’s worth.

        • Crymson_77 says:

          @thomas_callahan: That may even be your out. Write a letter to the hotel and lay it all out. Request they pay the difference as it happened on their property and they should have known better. You are a good person btw…most people would have thought of suing the hotel before even calling 911…

  63. CorrieCJ says:

    I have been through this so many times for so many different reasons….

    Recently had a bill for the doctor at my husband’s ER visit, in network – The bill was $655, the insurance paid $235 and the doctor’s office wanted the rest, despite an EOB saying I did not have to pay. I called and explained this, but the accounting person had the nerve to tell me, “Well, $235 is really an unfair amount, it is much less than we can accept. I’m sure you understand.” I called United Healthcare right away, and they conferenced me in with the office. The office was MUCH nicer to them, and took care of the balance right away!

    Another example… I gave birth to my son at a network-hospital using network providers, but a specimen (retained placenta) was handled by a non-network pathologist, who billed me $700… UHC helped me fight that one too.

    One time my husband got sick on a flight from FL to NY. He mostly slept on the plane – but when we arrived, he was having chest pains and the airport had him sent to ER… I got a bill for $800 for medical services rendered in the airport (basically, listening to his chest with a stethescope and calling paramedics to transport him) and I gave them my insurance info. Months later, I got another bill. Apparently they had not submitted the propery documentation to the insurance, so they were denied payment and wanted the $$ from me. They hounded me for months. I finally sent them a cease and desist letter…

    I agree with the poster who said never ever pay until you are absolutely sure it is your responsibility!

  64. rainbowsandkittens says:

    If anyone is legally inclined, I too would appreciate some choice words that I can use in this all too frequent situation.

    My in-network PCP, after a routine physical, where my $20 copay was paid on the spot, is now sending a bill for $37.

    My in-network OBGYN, after my yearly check-up, where my $40 copy was paid on the spot, is now sending me a bill for $45.

    From what I am reading here, what both of them are doing is illegal, especially if my EOB states that I owe nothing. Do I ignore these bills, or sic the insurer on them? Do I need to do this every single time? I mean, this is disheartening. I trust these people with my CARE, they know very private things about me. And yet, they aren’t above trying to gouge me, unsuspecting consumer, for more money? This isn’t just wrong, it’s unethical and violates the trust I had for them.

    • CorrieCJ says:

      @rainbowsandkittens:
      My first step is usually to call the doctor’s office and point it out to them. Sometimes it is an honest mistake and they will fix their records. (Or they may be trying to gouge you and hoping you wouldn’t notice – and will drop the matter if pursued.) They may ask you to send them a copy of the EOB for their files (they should have already gotten one from the insurance, of course). If they are insistent on you paying the bill, I would send them a firmly worded letter enclosing a copy of the EOB, and reiterating that you do not owe them any money, according to the terms of their contract with your insurance company. If it continues after that, sic the insurance on them.

  65. ThunderRoad says:

    Isn’t it mail fraud to send a bill knowing the person doesn’t have to pay it? If it’s a pattern at the company, isn’t this a RICO violation?

  66. felixgolden says:

    I had abdominal surgery (ruptured appendix) a number of years ago. All the doctors involved were part of the same large medical group with centralized billing. My policy paid was paying 100% since I had already met my deductible for the year prior to the surgery. I also had no copay.

    Sure enough, I start getting bills from the medical group for the balance. At first, they tried to tell me that the amount was either due to my deductible or a copay. When I pushed it, I was told that since the insurance company doesn’t pay the full billed amount, I have to cover it. The main sticking point was the surgeon’s bill which was more than double the covered amount.

    I called the insurance company, to discover that the amount they paid was because the code on the bill was for an appendectomy, not the more intensive surgery I had. They did say the would review it and pay the proper amount if the medical group submitted a corrected bill with a surgical report to verify.

    The billing department refused to do this. I had a long recovery time with a number of followups. When I showed up for an appointment with the surgeon, someone from billing came up to his office and refused to let him see me until I resolved the bill. I told them I would come down AFTER my appointment. The nurse said she could not allow me to do that, since the system would not let them update my records until the billing hold was removed.

    At this point, my mother, who had driven me to the office for the appointment, walked in from parking the car. Unfortunately for the person from billing, my mother is a paralegal and at that time was a patient ombudsman at the hospital down the road. She told the nurse to take me into the exam room as she grabbed the other woman’s arm and walked off to her office. Never got billed again, but they didn’t get paid either because they refused to submit a revised bill.

  67. hotrodmetal says:

    I had a surgery, paid my portion, insurance paid their part, and received a zero balance statement from the hospital.

    Here is the good part. Later, I received a bill from the hospital indicating that the insurance company decided that they wanted money back from the hospital, and they were going to bill me for this. This was based on the hospital renegotiating their contract with the insurance carrier.

    I indicated to them they need to go back to the insurance company & get the money.

    Don’t ever pay for a medical bill unless you are absolutely positive it is your respponsibility. Don’t get sick either.

  68. Anonymous says:

    I have been balance billed a few times and caught it right away. My insurance pays %100 after we meet our deductable and that is how I caught it. I called our insurance company and THEY called the hospital trying to balance bill me. It was resolved immediately with the help of our insurance company. I would suggest if you are being balance billed, call your insurance provider and tell them the situation. They will be most willing to help when they find out that it is happening.