Jump to content

feetsdr

Questions about a 1 1/2 year old medical bill I'm not paying

Recommended Posts

I have a 1 1/2 year old bill from a hospital for about $600. After 2 different collection agencies, this one is finally talking about 'intending to sent this to an attorney for small claims court'. While I'd love my day in court, I haven't found anyone that can / can't say I have a chance based on my arguments.

So some questions

1)  has anyone had experience negotiating on a hospital bill thats 1 1/2 years old and with a 2nd CA? What % would they take?

2) What's the likelyhood they actually go to court for this? Can I just ignore it?

Some background - in the most recent letters, the CA talks of making the check out to the hospital, so the hospital (not a government / charity run hospital) still owns the debt?

But the CA will get a cut if I was to pay, right? Any idea what the CA's cut would be?

As for the reason I am not paying, I'd love to hear if you feel I am justified / you are or were in a similar situation and how you handled it, etc.:

I went to a new cardiologist.  Dr. had me download a bunch of the new patient forms days ahead of time for initial visit. During initial visit, we talk of my ADD and drugs I take related to that.  He said he wanted me to come back to his office for a stress test (run on treadmill) and fasting blood draw.  I tried making an AM appointment but all they had was in the afternoon.

Dr. has pages on their website about prep for stress test (run on a treadmill, the test at issue) - wear loose clothes, no powders that would hinder the adhesive pads they put on, etc.

My insurance covers 100% of diagnostic tests performed in a dr. office. This was a dr. office in a building with a wide range of other types of businesses (not a medical practices building, etc.). There's minimal stuff on the dr. website related to the hospital - we have admitting privileges at the hospital. and nothing about the hospital in the office. So as with other doctors offices I've been to before, I expected this stress test performed in his office would be an in dr. office diagnostic test.

Showing up for the tests, I'm fasting since the night before. Some handle fasting better than others. I like to eat... get there 10 min before the test and they hand me some forms. 1 has a short paragraph about about the risks of the stress test / how you could die. Me with my ADD focus on that and how they'd have me do it in a hospital if dr. thought that was at all possible - not good for a patient to die in the dr. office. Ha Ha. Then another form with LOADS of text, highlighted with where to sign at the bottom. I was hungry, focusing on the joke in my head I just made, have ADD, so I'm not going to be able to read a full page of even a menu. I signed where highilighted and put down the time - 7 minutes before the test. Lets get this over, I'm starving.

That paper with a page of text basically said 'the treadmill is owned by the hospital and this will be coded as an outpatient procedure'.

That is paid 80 / 20 after my deductible which I hadn;t reached. Previously doing this test / calling other cardiologists aferwards to see if they do this same 'game', the in network negotiated cost through insurance is about $400 for the test done in a dr. office, which insurance had paid 100%.

Because it's outpatient, the insurance allows them to charge almost double! And because it's outpatient, I am on the hook.

Had I had more time to understand how it would be treated, I wouldn't have done the test there. but they popped it on me at the last minute and I wasn't in the mood for reading / understanding a page of legalese. Shame on me you'd say.

OK, and I'd say they are sleazy. NO forms on the dr. website about stress tests / nuclear stress tests, etc. said anything about out it would be billed. Only at that last 10 minutes did I find out.

I climbed the ladder at insurance and they said they treat the costs as they are billed - outpatient, 1 way. In dr. office, another way. And they likely like this outpatient way better since they don't have to pay... but understandably, it's out of their hands.

and dr. had the nerve, after the test and I step off treadmill (the outpatient facility), back into his office to tell me 'everything looks fine, like we talked in 1st visit, lay off the carbs / soft pretzels'. That was an office visit charge!! Insurance did fight that - only paying out after he submitted claim a 3rd time. And I got hit with the office visit copay.

So I got another letter today from collection firm. they say to make check payable to hospital. So the hospital still owns it? They are paying about 50c a letter. And I call them on their 800 number from a payphone so they get hit with a payphone fee : ) 

It IS a nuisance, but I'm trying to have a little fun at the same time.

Since this, I've not gone to that hospital or cardiologist or any facility related to that hospital.  I've had a fair amount of tests / couple day hospital stay since then. None of it having anything to do with that hospital - my wife's saying (because i was anemic / winded going DOWN a flight of stairs) that she's taking me to the ER... I pushed her to not take me to this hospital. We are about equadistant to 3 different hospitals from our house. Not going to that hospital again if I am conscious. They are penny wise / pound foolish in my eyes.

This has helped me in that I am frugal... OK cheap and would not be as vigilant with medical treatment to save some $$ (hence the anemia... I had black stools but kinda ignored it / was going to wait to see what happened). But now!? It's a game of 'lets see if we can hit our max out of pocket for the year... and do it without any going to that hospital!  I've had a MUGA and other tests...all not at that hospital or their doctors / facilities.

Share this post


Link to post
Share on other sites

OK, skip the reason you didn't realize that you would be liable for ?? co-pay?? deductible??? What does your EOMB ( explanation of benefit) from your insurance say?? What was charged, what was allowed, what was paid and how much was left as patient responsibility.??

Follow the guide:

https://whychat.me/GUIDEBOOK.html

You do not have to delete old addresses, but you DO have to opt out and make sure you have your REAL credit reports.

If your EOMB shows that the HC provider never submitted the bill to your insurance then send the HC provider, NOT THE CA this:

https://whychat.me/hipltr.html

insert "b"

Share this post


Link to post
Share on other sites

Thanks!  What does the eob say?  It says that the insurance brought the cost down to their negotiated rate for outpatient version of this procedure - about $800 since hospital is in network, then since it was an outpatient procedure, they applied my policy rules which says that I have a 2500 deducible and they pay 80/20 after that.  This didn't go over the deductible, so I would be on the hook for all of it.

 

IF the dr. /hospital coded it as in dr. office, insurnace wouol bering it down tio the in dr. office procedure rate of $400 and apply my policy;'s rules of insurance paying for 100% of in dr. office diagnostic procedures, the hospital would pay the $400 and I would pay zero.

 

The dr / hospital stand by it being an outpatient procedure - the hospital owns the treadmill in the dr. office and I signed a full page of legalese where it was highlighted  that said the procedure would be outpatient.  They gave me that 10 minutes before the test in the afternoon, after dfasting since the day before and I have ADD.  I stand by the argument they did not give me sufficient notice that thuis wuold be out patient vs. in dr. office.

 

 

Share this post


Link to post
Share on other sites

OK,

You have a high deductible that apparently was not used up to the time of this procedure.

You signed an agreement stating it was outpatient.

 

You now wish to have it re-coded as a dr.'s office.

 

The fact that you were not fully "aware" of the consequence of signing yourself in as an outpatient would not IMO carry any weight in challenging the charges.

 

Your best best is to pay it to the Dr with the HIPAA letter insert "a" to prevent it from being reported as a paid collection.

 

https://whychat.me/hipltr.html

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Today's Birthdays

    1. Bobbilane
      Bobbilane
      Age: 56
  • Member Statistics

    • Total Members
      175,290
    • Most Online
      1,528

    Newest Member
    Speedbird747
    Joined

About Us

Since 2003, creditboards.com has helped thousands of people repair their credit, force abusive collection agents to follow the law, ensure proper reporting by credit reporting agencies, and provided financial education to help avoid the pitfalls that can lead to negative tradelines.
×

Important Information

Guidelines