Thursday, January 17, 2008

And I Should Know This... How?

I still haven't blogged my bill for having my appendix removed, because I've been waiting to tie down the bill itself. The hospital I chose was in-network for my health plan, but I'm getting a bill for a little under $800 for the ER services.

So, it turns out that while the hospital is in-network, the doctor in the Emergency Room is not. The doc is not employed by the hospital, but instead is essentially a consultant.

How I'm supposed to figure that out I have no idea. How I'm supposed to find an in-network ER doctor during an emergency I have even less of an idea.

Back when I was a consultant, tax law requires that if I work a certain number of hours for one employer I cannot claim self-employment or consultant status as that would essentially allow corporations to evade employment costs. I wonder if this applies to ER doctors?

Do ER docs work at multiple hospitals, multiple employers?

But still, my main point is that I chose a hospital that is in my health plan's network, but the ER doctor is not being paid by my health plan because she's not in their network. Hence, I have a bill for $900.

How the heck am I supposed to avoid that?

It's an EMERGENCY room. I had appendicitis. I assumed once I was past the front desk and my health card had been entered into the system and approved as a method of payment, that my care was going to be provided by in-network staff. Why should I believe any different? How could I possibly choose which doctor attends to me in the ER?

And had I known or found out, what should I have done? Gone to a different hospital?

I received two bills from the generically-named billing company and I thought I was safely ignoring them, that my insurance would figure it out and kick in at some point. Now I'm getting collection threats which prompted me to follow up and find out that the health plan considers this doctor out of network.

This is the same insurance company that paid the $16,000 appendectomy bill no questions asked, but they won't pay the doctor bill that was submitted for service on the same day as the operation.

Make sense?


And people ask me why I think it's important to bring transparency to health care...


Anonymous said...

Essentially, this is a fight between the doctors and the insurance companies where the patients are the losers.

It has been suggested that when one is put in your position, you should call the office handling the billing for said physician. Tell them that you can not afford to pay the bill as is but you are very concerned about not defaulting and maintaining your good credit rating. They should offer you a rate equivalent to insurance reimbursement agreements they would find acceptable and/or set you up with a feasible payment plan.

Jaz said...

Well, I actually ended up calling the billing company, then Cigna, then the billing company, then Cigna again. Cigna figured out that it wasn't out of network and resent the claim as in network. That knocked it down. The billing company still sent me a statement for the full amount, so I ended up calling Cigna again today and got a very helpful lady called Katy who figured out that this provider agreement was for negotiated rates and therefore I owed nothing, she even called the billing company and took care of that for me. I'm going to give it a couple of days then call the billing company just to be sure they have it down, but all in all I think it got fixed.

This makes me sad because the doctor in question was truly great on the day, she took extremely good care of me, she was the model of what I want a doctor to be.

Nonetheless, she also contracts with this company to collect this money, who have sent me a bill for $800 and a threat that if I don't pay within 15 days I'm in collections.

It reflects on the doctor, I don't care what anyone says, it's a reflection of the doctor's business practices and that sullies the experience. Yes, it's a crappy system. And yes, the doctor plays a part. I don't really know how large a part, but it's a part.

Jaz said...

Alas, I spoke too soon. The billing company have revised their bill down to $358.00, but still won't let m eoff the hook. I just don't get this. I went in network. Why am I being billed? Agh!

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