mcjeff215 Posted May 4, 2009 Posted May 4, 2009 Anyone know anything about this? My wife gets really bad migraines, two or three a week. A friend of ours recommended one of those supplement/natural places. Both being fairly sceptical folks, we decided to check out, but take it all with a grain of salt. This crap is fairly fruity in my opinion. At the first visit, they had this patient advocate give us the run down on insurance coverage and total out of pocket costs. They told me that my plan was actually very good about stuff like this and would cover at the standard out-of-network rate. They would cut the remaining balance and that's how it would work. At that, we decided to let them take some blood and do some initial tests. We're only out a couple hundred bucks if it turns out to be total quackery. We wound up going to two appointments. Fast forward to now. My healthcare insurance has denied the first claims while the others are in "review" after requesting more info from the provider. The provider lists us as owing 5k (Yes, after two visits and some damn blood tests). I did a bit more research, it turns out the guy that runs this outfit also owns the lab that they send a good chunk of their samples off to. That sounds totally shady to me. They kept referring to her case as "easy", yet never *did* anything. Just ordered more and more tests. If they had been honest up front, we never would have gone through with any of the initial stuff to get a feel for it. We would have just walked out. I'm inclined to believe they knew that. They knew enough about my deductible, one would think they would know more about the plan. I'm sure they deal with this every day. Do I have any recourse? Is it time to contact a lawyer who deals with this crap? Or, am I just out 5k?
stuckincincy Posted May 4, 2009 Posted May 4, 2009 Anyone know anything about this? My wife gets really bad migraines, two or three a week. A friend of ours recommended one of those supplement/natural places. Both being fairly sceptical folks, we decided to check out, but take it all with a grain of salt. This crap is fairly fruity in my opinion. At the first visit, they had this patient advocate give us the run down on insurance coverage and total out of pocket costs. They told me that my plan was actually very good about stuff like this and would cover at the standard out-of-network rate. They would cut the remaining balance and that's how it would work. At that, we decided to let them take some blood and do some initial tests. We're only out a couple hundred bucks if it turns out to be total quackery. We wound up going to two appointments. Fast forward to now. My healthcare insurance has denied the first claims while the others are in "review" after requesting more info from the provider. The provider lists us as owing 5k (Yes, after two visits and some damn blood tests). I did a bit more research, it turns out the guy that runs this outfit also owns the lab that they send a good chunk of their samples off to. That sounds totally shady to me. They kept referring to her case as "easy", yet never *did* anything. Just ordered more and more tests. If they had been honest up front, we never would have gone through with any of the initial stuff to get a feel for it. We would have just walked out. I'm inclined to believe they knew that. They knew enough about my deductible, one would think they would know more about the plan. I'm sure they deal with this every day. Do I have any recourse? Is it time to contact a lawyer who deals with this crap? Or, am I just out 5k? Generally, your provider has a web site that lists authorized providers. And it can be quite specific - Doctors often have multiple offices they show up at during the week, and one that is on their approved list for renumeration at location A, B, C might not be authorized for coverage at D. If you visit office D - you are not covered. Doctors are continually setting up this or that corporation to get more cash out of the system. Several times, I've noticed delayed billings so they can toss their receivables into another tax quarter. Folks like to bash Big Insurance, and Big Pharmaceuticals, but Big Doctor is the source of most rip-offs, IMO. I can't begin to tell you the number of phony billings I've got from physicians through the years, charges from their sweetheart labs and so on. And you must arm yourself with info about lab work coverage and approved suppliers, too. I pay 5K for coverage with a 5K deductible. 2 months ago, my hematologist drew near a half-pint out of me for analysis (they did give me an 8 oz. box of apple juice so I wouldn't pass out, since I don't eat before I visit per their advice - and charged me 9 bucks for that 50 cent juice box). I asked where my blood would be toodling off to for testing. When they told me, I said no - not on the coverage list. I said, send it to this outfit, like before (the hemo/onco outfit I go to recently re-incorporated and struck new deal for pushing lab work to their new lab buddy). Had I not, the $91.44 bucks I did pay would have been $1,125.11. Funny, eh? Amazing, isn't it? That the lab with arrangements with my provider accepts 91 bucks and makes a profit on it, and one not approved would gladly raid my wallet for over a thousand bucks for the same service. Hmmm...kickback $$$ for Dear Old Doc, anyone? Also - be sure to look into your plan's Rx coverage - the formulary. That company rep that walks in with a bag of take-out for the staff while you wait and wait, gets his cost back from forking over trips, all-expense paid "seminars" in Hawaii or similar, when Dear Old Doc writies tons of Rx for their products. Always ask for generic alternatives, and/or say, why this, why not this product? A tip: Buy the Pill Book: http://www.epill.com/pillbook.html The paperback version is under seven bucks. Do not trust a physician to be especially knowledgable about interactions. Always ask the Pharmacist - and they generally let you know before you ask.
KD in CA Posted May 4, 2009 Posted May 4, 2009 Do I have any recourse? Is it time to contact a lawyer who deals with this crap? Or, am I just out 5k? You're not out $5k until you write a check which obviously you are not going to do for a scam artist. I'd call a laywer for advice and to be on standby in case he tries to sue you for the $.
MarkAF43 Posted May 4, 2009 Posted May 4, 2009 Folks like to bash Big Insurance, and Big Pharmaceuticals, but Big Doctor is the source of most rip-offs, IMO. I can't begin t Stuck, thanks for this, as someone who works for big insurance, i know we aren't the good guys however the people i deal with find it easier to blame us, then even begin to think the doctor could be part of the problem as well. It's good to see that not everyone blames the insurance company right away
mcjeff215 Posted May 4, 2009 Author Posted May 4, 2009 Stuck, thanks for this, as someone who works for big insurance, i know we aren't the good guys however the people i deal with find it easier to blame us, then even begin to think the doctor could be part of the problem as well. It's good to see that not everyone blames the insurance company right away The insurance shop has been fine, it's this provider that's been a pain. I'm always one to just man up and pay when I need to, but in this scenario, I really feel like I've been screwed. I talked to them again today and they told me they always have trouble like this with my insurance company and they're dealing with the appeal process and all that. I told them I was going to wait and see how it unfolds before I do anything and they were okay with that. Depending on that outcome, I told them we would address the balance. I didn't say I'd pay it, though. Like I said, I feel screwed. I called the insurance company and they told me that it was mostly under review still with the exception of a couple claims that have been denied. I explained the situation to them, but most of it lies with the physician's office and not the insurance company. Her suggestion was that I file an appeal. They didn't tell me anything more than what it says on the insurance company's website, though. She was reading from a screen, it was obvious. So, now it's wait and see. If it's still not covered, then I'll see if I can't get some real (non TBD!) legal advice. Damn it. This isn't the kind of stojan I want to deal with!
stuckincincy Posted May 4, 2009 Posted May 4, 2009 Stuck, thanks for this, as someone who works for big insurance, i know we aren't the good guys however the people i deal with find it easier to blame us, then even begin to think the doctor could be part of the problem as well. It's good to see that not everyone blames the insurance company right away Yep. My provider has an easy mechanism to report fraud. I've used it several times, which personally got me some bucks back. They blacklist the perps, although they resurface as a new LLC or some sort. The last one was some bunch of fleas that claimed that they rented the hospital space for a colonoscopy procedure and provided post-procedure care. I checked their claim numbers on the bill they sent me - they falsified diagnostic codes and put out numbers that didn't jive with my providers' Explanation of Benefits mailing. These crumbs really play on the facts that folks are concerned about their health, and that they don't want to get in trouble for not paying. And if Congress wanted to do something worthwhile - I recommend a "Universal Billing Format" or some such. This $91 I recently paid...it was for "Hospital". Not what it was - blood work. And no date of service. A rule for everyone: Check before you cut that check. Contact your provider before any procedure.
BillsWatch Posted May 4, 2009 Posted May 4, 2009 My recommendation is that you talk to your company's representative; they may be able to help and make sure you pass name of doctor and lab around at office. My company insurance office was able to help straighten it out after company and insurance company talked. Doctor was told to correct or be removed from plan. Some doctors will constantly have extra uncovered charges or will label charges differently in attempt to get multiple charges for same work. I have run into same problem as you before and I started including under signature and all forms "Use only Health Insurance approved labs". One time said it was not binding and I told them I was not approving ANY lab work then so they changed their tone. One doctor wouldn't so I told them I was not getting any lab work and ended appointment. Next doctor asked me for previous records and I told doctor no for the previous doctor had inflated charges for paperwork and it would be cheaper to do it again.
Fezmid Posted May 4, 2009 Posted May 4, 2009 Stuck, thanks for this, as someone who works for big insurance, i know we aren't the good guys however the people i deal with find it easier to blame us, then even begin to think the doctor could be part of the problem as well. It's good to see that not everyone blames the insurance company right away I blame the entire medical industry -- doctors, hospitals, insurance, the whole thing. They're all a bunch of crooks, IMHO.
Just Jack Posted May 4, 2009 Posted May 4, 2009 So, now it's wait and see. If it's still not covered, then I'll see if I can't get some real (non TBD!) legal advice. What's wrong with our advice? Sometimes it's legal.
MarkAF43 Posted May 4, 2009 Posted May 4, 2009 I blame the entire medical industry -- doctors, hospitals, insurance, the whole thing. They're all a bunch of crooks, IMHO. Fez, like i said, i know the insurance companies share a lot of the blame, but when it comes to billing, doctors and hospitals deserve their share of the blame and it's good that some people recognize that....
/dev/null Posted May 4, 2009 Posted May 4, 2009 That's what you get when you go to this Doctor http://www.slotcargarage.com/jon/DrNickRiviera.jpg
Fezmid Posted May 5, 2009 Posted May 5, 2009 Fez, like i said, i know the insurance companies share a lot of the blame, but when it comes to billing, doctors and hospitals deserve their share of the blame and it's good that some people recognize that.... That's why I'm blaming everyone in the medical industry
mcjeff215 Posted May 5, 2009 Author Posted May 5, 2009 That's what you get when you go to this Doctorhttp://www.slotcargarage.com/jon/DrNickRiviera.jpg Yeah, you laugh at that... The first time we were there it was very much a respectable place. Kind of a holistic approach, which makes sense for things like migraines as it addresses issues like diet sensitivities and whatnot. The second time? It reminded me of Dr Kellogg. I even joked with my wife on the way out... "an enema and some fresh evergreens, that's all you need!" They proceeded to tell us how awful modern medicine is and it's all about the money. Doctors are trained prescription dispensers. They know better. It's all about natural medicine. We decided it wasn't for us at that point, though we got stuck with a 5k freaking bill!
BuffaloBill Posted May 5, 2009 Posted May 5, 2009 Yeah, you laugh at that... The first time we were there it was very much a respectable place. Kind of a holistic approach, which makes sense for things like migraines as it addresses issues like diet sensitivities and whatnot. The second time? It reminded me of Dr Kellogg. I even joked with my wife on the way out... "an enema and some fresh evergreens, that's all you need!" They proceeded to tell us how awful modern medicine is and it's all about the money. Doctors are trained prescription dispensers. They know better. It's all about natural medicine. We decided it wasn't for us at that point, though we got stuck with a 5k freaking bill! McJeff - good luck but you should review anything that you or your wife signed. My guess is that you have signed something that obigates you to make the payment if your insurance company does not. You should find out what your insurance company would pay for the services for an approved provider. My guess is that it is far less than $5k. Settle for that amount and put this bad episode behind you.
mcjeff215 Posted May 5, 2009 Author Posted May 5, 2009 McJeff - good luck but you should review anything that you or your wife signed. My guess is that you have signed something that obigates you to make the payment if your insurance company does not. You should find out what your insurance company would pay for the services for an approved provider. My guess is that it is far less than $5k. Settle for that amount and put this bad episode behind you. Yeah, I asked my wife to see if she has copies of any agreements she's signed. I'm sure you're probably right. Under most circumstances, I'd be ok with that . It's just in this instance, they "went over" what was covered and what wasn't and told me exactly how it would work out. It was only after understanding the charges that we agreed to try it out. The whole thing seems intentionally misleading and shady. Regardless, that's probably the course of action. I'll find out what this would normally be and attempt to settle it for a reduced percentage under the pretext of that misleading advice they've given. Who knows, maybe they'll actually get money out of my insurance provider and none of this will matter.
stuckincincy Posted May 5, 2009 Posted May 5, 2009 Fez, like i said, i know the insurance companies share a lot of the blame, but when it comes to billing, doctors and hospitals deserve their share of the blame and it's good that some people recognize that.... A Doctor's group and a hospital here in Cincinnati are under a Federal indictment. They cooked up a sweetheart quid pro quo - the hospital provided free office space, and the Doctors steered their patients to the hospital's testing facilities - the whole gamut...radiology, cardiology, blood work, and so on.
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