You Moist Likely Can't Afford - ROLLED: A Medical Billing Thread

[WillieMcFML]

Advice needed -

Long story short I had to get a CT scan on my side. I talked with my insurance company about a week before the scan to get pre-registered or whatever they call it and they told me my estimated co-pay was $100

So about a month after the scan I get a bill for $500. What was fucked up was the way they itemized it on the bill. The scan was something like $4374.72 and it showed my $100 payment, and that my insurance was covering $3774.72 leaving an exact $500 balance that I am responsible for.

I don't understand how they can get away with this shit. I mean, I understand they tell you beforehand the co-pay is "an estimate", but how the fuck can you be off by a factor of five??? It's not like there were any complications to the scan, or they had to do any additional testing - I was in and out in like 10 minutes.

Do I have any recourse besides not paying and defending myself in court when they eventually sue me? I'm not broke, I can pay the $500 but I sure as shit don't want to cause I feel like I'm being bent over.

[WillieMcFML]

Henry Highbrow: "long story short" arguably too long

long story short = not going to bore you with two paragraphs leading up to why i had to get the CT scan

[Henry]

zzz

[vegas1369]

In before the inevitable Rollo Obamacare post.

[Walter Sobchak]

Advice needed -

Long story short I had to get a CT scan on my side. I talked with my insurance company about a week before the scan to get pre-registered or whatever they call it and they told me my estimated co-pay was $100

So about a month after the scan I get a bill for $500. What was fucked up was the way they itemized it on the bill. The scan was something like $4374.72 and it showed my $100 payment, and that my insurance was covering $3774.72 leaving an exact $500 balance that I am responsible for.

I don't understand how they can get away with this shit. I mean, I understand they tell you beforehand the co-pay is "an estimate", but how the fuck can you be off by a factor of five??? It's not like there were any complications to the scan, or they had to do any additional testing - I was in and out in like 10 minutes.

Do I have any recourse besides not paying and defending myself in court when they eventually sue me? I'm not broke, I can pay the $500 but I sure as shit don't want to cause I feel like I'm being bent over.

Maybe you have a co-pay and a deductible? Get our your insurance plan and read it carefully. They make mistakes all the time. Why the fuck does a simple CT scan cost over $4K anyway.

[tommyt]

Advice needed -

Long story short I had to get a CT scan on my side. I talked with my insurance company about a week before the scan to get pre-registered or whatever they call it and they told me my estimated co-pay was $100

So about a month after the scan I get a bill for $500. What was fucked up was the way they itemized it on the bill. The scan was something like $4374.72 and it showed my $100 payment, and that my insurance was covering $3774.72 leaving an exact $500 balance that I am responsible for.

I don't understand how they can get away with this shit. I mean, I understand they tell you beforehand the co-pay is "an estimate", but how the fuck can you be off by a factor of five??? It's not like there were any complications to the scan, or they had to do any additional testing - I was in and out in like 10 minutes.

Do I have any recourse besides not paying and defending myself in court when they eventually sue me? I'm not broke, I can pay the $500 but I sure as shit don't want to cause I feel like I'm being bent over.

Maybe you have a co-pay and a deductible? Get our your insurance plan and read it carefully. They make mistakes all the time. Why the fuck does a simple CT scan cost over $4K anyway.

'Merica

[Faduniak]

This for sure. $500 deductible sounds most reasonable. Good news is, you did it on the first of the year so you are good for the rest of the year (if that is how your plan is set)

Advice needed -

Long story short I had to get a CT scan on my side. I talked with my insurance company about a week before the scan to get pre-registered or whatever they call it and they told me my estimated co-pay was $100

So about a month after the scan I get a bill for $500. What was fucked up was the way they itemized it on the bill. The scan was something like $4374.72 and it showed my $100 payment, and that my insurance was covering $3774.72 leaving an exact $500 balance that I am responsible for.

I don't understand how they can get away with this shit. I mean, I understand they tell you beforehand the co-pay is "an estimate", but how the fuck can you be off by a factor of five??? It's not like there were any complications to the scan, or they had to do any additional testing - I was in and out in like 10 minutes.

Do I have any recourse besides not paying and defending myself in court when they eventually sue me? I'm not broke, I can pay the $500 but I sure as shit don't want to cause I feel like I'm being bent over.

Maybe you have a co-pay and a deductible? Get our your insurance plan and read it carefully. They make mistakes all the time. Why the fuck does a simple CT scan cost over $4K anyway.

[tony bagadonuts]

Advice needed -

Long story short I had to get a CT scan on my side. I talked with my insurance company about a week before the scan to get pre-registered or whatever they call it and they told me my estimated co-pay was $100

So about a month after the scan I get a bill for $500. What was fucked up was the way they itemized it on the bill. The scan was something like $4374.72 and it showed my $100 payment, and that my insurance was covering $3774.72 leaving an exact $500 balance that I am responsible for.

I don't understand how they can get away with this shit. I mean, I understand they tell you beforehand the co-pay is "an estimate", but how the fuck can you be off by a factor of five??? It's not like there were any complications to the scan, or they had to do any additional testing - I was in and out in like 10 minutes.

Do I have any recourse besides not paying and defending myself in court when they eventually sue me? I'm not broke, I can pay the $500 but I sure as shit don't want to cause I feel like I'm being bent over.

It's likely your deductible, as was said before read your policy and call the insurance company and get an explanation.

[rum dick]

Let's just have cla donate his badguy winnings to the save willie fund.

Also, are you alright?

And what flavor milkshake did they make you drink before the scan? Ass or vanilla?

[Dan Druff]

You have ZERO recourse here, other than demanding an exact copy of the terms of your policy. There is often a specific co-pay involved in procedures such as CT scans. If it's listed as $500, you're fucked, and that's what you owe.

So what about the rep who erroneously told you $100? They usually have a disclaimer on these insurance phone numbers that information is not guaranteed or any promise of coverage. That's to cover their asses if some slug gives you the wrong info.

So here is what I would do:

1) Demand a copy of your policy (online, e-mail, faxed, or mailed) so you can see exactly what your co-pay is.

2a) If it's $100, no sweat. Call them and they are legally required to fix it.

2b) If it's $500 (more likely), you are likely fucked. However, call up and complain, and ask them to pull the call. Tell them that you wouldn't have had the procedure done if you knew it was $500, and you want them to cover the other $400 due to the erroneous information provided to you. If they can pull the call and find that you were given this erroneous information, they might send you the $400, but it might be a bitch of a fight to make it happen. You also have no legal standing to force them.

You should also find out what they mean by "estimated co-pay". Estimated based upon what?

If it's "estimated based upon total cost", then you're fucked. They might have estimated it would be a $800 procedure when it was really $4200. Anyway, you really need to see your policy.

I have my own CT scan horror story, from about 6 years ago.

I went to a hospital facility that claimed to take my insurance, but when the bill came, it showed that my insurance denied the claim because the facility was NOT a preferred provider! I was told to pay $3800.

The hospital billing department refused to work with me. I got a really obnoxious rep who, after hearing my entire story about being given the wrong information regarding my insurance being taken, replied, "Well, I have good news for you. Instead of requiring the $3800 payment immediately, we can break it up into up to five easier payments!" She intentionally ignored my point -- that their own employees gave me erroneous insurance information. Finally, after it was clear she was intentionally ignoring my point, I called her a "moron", and she called me disrespectful. I told her that intentionally ignoring my point and repeatedly telling me to simply make payments is also disrespectful. I eventually hung up on her.

Hilariously, after a lot of investigation, it turned out that I was given the right information after all. The hospital had temporarily dropped the insurance company for 6 months, but had reinstated their contract about 4 months before my scan. Yet their computers were still showing no contract, and it took a lot of investigation on the insurance company's part to come up with this. So I seemed like I was in great shape.

BUT...

It turned out that the "allowable charges" for this CT scan were a laughable $900, and I was supposed to be responsible for the difference. (It was some weird situation where there was no maximum, and the insurance just paid up to $900 and I would be responsible for the rest, despite it being in-network!)

I asked, "So if there's no maximum, what if they billed for a million dollars? I would be responsible?" They told me yes.



I told them that this made zero sense. After months of more investigation, they came up with the conclusion that the hospital mis-billed the CT scan, and that it should have been $1800, not $3800. This left my balnace as $900.

However, with all the confusion, the insurance company accidentally paid the hospital twice, leaving me with a zero balance. Obviously I kept my mouth shut at this point, and that was that.

See, Willie? It could have been worse.

[Sanlmar]

You have ZERO recourse here, other than demanding an exact copy of the terms of your policy. There is often a specific co-pay involved in procedures such as CT scans. If it's listed as $500, you're fucked, and that's what you owe.

So what about the rep who erroneously told you $100? They usually have a disclaimer on these insurance phone numbers that information is not guaranteed or any promise of coverage. That's to cover their asses if some slug gives you the wrong info.

So here is what I would do:

1) Demand a copy of your policy (online, e-mail, faxed, or mailed) so you can see exactly what your co-pay is.

2a) If it's $100, no sweat. Call them and they are legally required to fix it.

2b) If it's $500 (more likely), you are likely fucked. However, call up and complain, and ask them to pull the call. Tell them that you wouldn't have had the procedure done if you knew it was $500, and you want them to cover the other $400 due to the erroneous information provided to you. If they can pull the call and find that you were given this erroneous information, they might send you the $400, but it might be a bitch of a fight to make it happen. You also have no legal standing to force them.

You should also find out what they mean by "estimated co-pay". Estimated based upon what?

If it's "estimated based upon total cost", then you're fucked. They might have estimated it would be a $800 procedure when it was really $4200. Anyway, you really need to see your policy.

I have my own CT scan horror story, from about 6 years ago.

I went to a hospital facility that claimed to take my insurance, but when the bill came, it showed that my insurance denied the claim because the facility was NOT a preferred provider! I was told to pay $3800.

The hospital billing department refused to work with me. I got a really obnoxious rep who, after hearing my entire story about being given the wrong information regarding my insurance being taken, replied, "Well, I have good news for you. Instead of requiring the $3800 payment immediately, we can break it up into up to five easier payments!" She intentionally ignored me point -- that their own employees gave me erroneous insurance information. Finally, after it was clear she was intentionally ignoring my point, I called her a "moron", and she called me disrespectful. I told her that intentionally ignoring my point and repeatedly telling me to simply make payments is also disrespectful. I eventually hung up on her.

Hilariously, after a lot of investigation, it turned out that I was given the right information after all. The hospital had temporarily dropped the insurance company for 6 months, but had reinstated their contract about 4 months before my scan. Yet their computers were still showing no contract, and it took a lot of investigation on the insurance company's part to come up with this. So I seemed like I was in great shape.

BUT...

It turned out that the "allowable charges" for this CT scan were a laughable $900, and I was supposed to be responsible for the difference. (It was some weird situation where there was no maximum, and the insurance just paid up to $900 and I would be responsible for the rest, despite it being in-network!)

I asked, "So if there's no maximum, what if they billed for a million dollars? I would be responsible?" They told me yes.



I told them that this made zero sense. After months of more investigation, they came up with the conclusion that the hospital mis-billed the CT scan, and that it should have been $1800, not $3800. This left my balnace as $900.

However, with all the confusion, the insurance company accidentally paid the hospital twice, leaving me with a zero balance. Obviously I kept my mouth shut at this point, and that was that.

See, Willie? It could have been worse.

Well, the test could have revealed a serious or terminal condition. Hopefully, WillieMc is ok.

Daughter is in Vegas and is at the ER this Saturday night with Strep Throat. Can't eat or drink feels like crap. ER visit Blue Cross & Blue Shield $200 copayment. For a sore throat!

Willie strikes me as a young guy. As such, he will assuredly experience many more outrageous health care expense in the years to come. You're gonna get fucked huge.

Lay off the bacon wrapped, grass fed sirloin followed by a fine scotch & cigarette Willie!