Beware Charleston area healthcare billing (Summerville, Buffalo: lease, health insurance, condo)

[geraldz]

Be careful when you seek medical services in the Charleston area. My wife went to several medical service providers in the last 6 months and the bills continue to trickle in.

We have pretty good health insurance (United Healthcare), however, under our plan visits to the hospital are paid at a reduced rate (I think they only cover half). It appears that a lot of doctors, laboratories, etc. are all affiliated with MUSC (The Medical University of South Carolina) which is a hospital. This means that you will be paying dearly for these services.

Even if you don't actually go to the hospital, you will still be billed as if you went to the hospital since your doctor may very well be affiliated with this arrangement.

In Maryland we alway received very clear "Explanation of Benefit" statements from United Healthcare which we could easily match up with the bills from health care providers. No so in Charleston. Trying to make sense of the various bills, dates of service, etc. is a nightmare! Furthermore, my wife has had collectors from the hospital calling her about payment for bills that we have never received!

I recently leased a condo in Mt. Pleasant and noted that several of the applicants had "collections" on their credit reports for unpaid medical services. Now I understand why.

In one case my wife specifically asked a health care provider if they participated in the United Healthcare plan. Although they said yes, when we got the various bills, some of the pieces and parts were not a part of the network.

My advice to you: Avoid hospital charges at all costs. Ask you healthcare provider if they are in your healthplan network. Ask them if you will be billed by their hospital. Ask what other services you will be billed for (labwork, imaging, etc.). Ask if these other services are in your healthplan network. It might even be a good idea to follow up with a confirmation letter as follows:

Dear Dr. XXXX:

I understand that you participate in "Your Healthcare Network".

I also understand that any other services that you may order on my behalf are covered under the "Your Healthcare Network." Furthermore, your services and other services that you may order on my behalf will not be billed by any hospital.

Sincerely,

Cautious Healthcare Consumer

[emilybh]

Originally Posted by geraldz

Be careful when you seek medical services in the Charleston area. My wife went to several medical service providers in the last 6 months and the bills continue to trickle in.

We have pretty good health insurance (United Healthcare), however, under our plan visits to the hospital are paid at a reduced rate (I think they only cover half). It appears that a lot of doctors, laboratories, etc. are all affiliated with MUSC (The Medical University of South Carolina) which is a hospital. This means that you will be paying dearly for these services.

Even if you don't actually go to the hospital, you will still be billed as if you went to the hospital since your doctor may very well be affiliated with this arrangement.

In Maryland we alway received very clear "Explanation of Benefit" statements from United Healthcare which we could easily match up with the bills from health care providers. No so in Charleston. Trying to make sense of the various bills, dates of service, etc. is a nightmare! Furthermore, my wife has had collectors from the hospital calling her about payment for bills that we have never received!

I recently leased a condo in Mt. Pleasant and noted that several of the applicants had "collections" on their credit reports for unpaid medical services. Now I understand why.

In one case my wife specifically asked a health care provider if they participated in the United Healthcare plan. Although they said yes, when we got the various bills, some of the pieces and parts were not a part of the network.

My advice to you: Avoid hospital charges at all costs. Ask you healthcare provider if they are in your healthplan network. Ask them if you will be billed by their hospital. Ask what other services you will be billed for (labwork, imaging, etc.). Ask if these other services are in your healthplan network. It might even be a good idea to follow up with a confirmation letter as follows:

Dear Dr. XXXX:

I understand that you participate in "Your Healthcare Network".

I also understand that any other services that you may order on my behalf are covered under the "Your Healthcare Network." Furthermore, your services and other services that you may order on my behalf will not be billed by any hospital.

Sincerely,

Cautious Healthcare Consumer

As a licensed independent insurance agent who has concentrated mostly in health insurance for nearly two decades and who uses United Healthcare among other carriers, the problem may be that the type of UHC plan you have is not a PPO plan that gives you access to the entire UHC national network.

Many agents sell their HMO products which have much smaller networks associated with them (which I have always thought was a disservice to the client because the last thing you need is an insurance plan that doesn't allow you to go to ANY DOCTOR OR HOSPITAL ANYWHERE IN THE COUNTRY if you should get really sick and need to go beyond your local area for care) . The better PPO plans will have a national network associated with them and for the few doctors who aren't part of the network they still cover you out of network for an additional out of pocket cost.

You need to find out from UHC what type of plan you have and exactly which of their networks you can use (where if you use those providers they will accept the UHC reimbursment as payment in full). Another situation that might apply here is that the services you are receiving are subject to a deductible or coinsurance which you may not have satisfied yet.
In any event, if you still have a UHC plan you still should be receiving an Explanation of Benefits and it should show every claim that was submitted and the reason it was rejected.

Perhaps its time you upgraded your plan to a decent PPO plan so you won't have to deal with this.

Lastly, make SURE UHC knows about these claims and DO NOT PAY THE BILLS UNTIL AFTER YOU HAVE SENT THEM INTO UHC CLAIMS FOR REVIEW and they have confirmed they are legitimate.
Sometimes doctors will double bill or just bill you because they often get their money faster because so many people are intimidated by the medical establishment and think if they don't pay the bills right away, they'll be turned into a collection agency and their credit will be damaged. First of all, often you can negotiate a lower rate. Medical providers often charge consumers the highest rates they can get away with. Only the ones who put up with the abuse pay those rates.

Considering the genereally mediocre level of care we get in this country, nationally when you look at the statistics, we should be paying a lot less and getting a lot more for our money the way people in other countries do. Not only do they pay less but they are a lot healthier than we are. FYI (Interesting stats)Le Magazine, March 2004 - As We See It: Death By Medicine
The above appeared in "Life Extension" magazine and was compiled by doctors and statistics taken from medical journals, government records etc.All the resources are listed.

[wordzgirl]

My family is covered under the state health plan, and I've got to say I'm less than thrilled. I recently had to take my daughter to the ER and paid $125 for the copay. Then we received a bill for $150 for services that weren't covered. Then we received another $25 bill for X-rays. Luckily, she just had a sprained (not broken) ankle.

Our dental plan is state as well, and I called 10 dentists around town to find one who would take our insurance. All of them said they didn't accept our plan, but they would take off the charges that our dental plan covered and bill us the remainder, which would have been about $300 for my family of four to have our teeth cleaned.

I called BC/BS and they told me that there aren't any dentists in our network, that we can go to anyone. I looked around on their web site and found a list of five dentists in Summerville, called one of the, and this dentist charges exactly what our plan will cover. It would have helped if someone in charge at BC/BS would have explained this to me. I'm just thankful that I won't have to pay a fortune to have our teeth cleaned.

[emilybh]

There are very few people that dental insurance will benefit. In fact the only people who always benefit are employees whose employers pay for 90 percent to 100% of the cost of the insurance.

If you have reasonably good teeth it is MUCH LESS EXPENSIVE to just pay the dentist for the entire thing and ask for a discount for cash since he is getting his money right away and doesn't have to deal with an insurance company. Think about it. Two cleanings for a year may cost about $60 each or $120. It makes little sense to pay $30/mo, $50/mo. $70/mo or more which adds up to $360, $600 and $840 and then you have to pay deductibles and coinsurance on TOP when just paying for the dental work is less expensive.

If you have your medical insurance through the state high risk health insurance pool, you or someone in your family has a health issue that was rejected by private insurers. What I would do in that case is begin to think outside the box as to how to get rid of that problem and get the person's robust health back. If it is a Chronic or degenerative conditions, the best kind of doctor to go to is a Naturopathic Doctor as opposed to a Medical Doctor.
Naturopathic doctors have years of training in medical school to discover underlying causes of disease and know how to help the patient strengthn their immune systems to get rid of the disease altogether. This includes the so-called incurable diseases which are incurable by conventional western medicine but NOT by doctors of Natural Medicine.

You probably will have a hard time finding a Naturopath with experience in Charleston but I moved here knowing that I could continue to be helped by my naturopath via telephone appointments. If you want to know who mine is, send me a private message and I'll send you the contact info. Otherwise, I would at least find a good Acupuncturist who is experienced in Chinese Medicine. They would have an excellent understanding of herbs and diet and would probably be the next best thing to a Naturopath.

[wordzgirl]

We don't have an option as far as dental plan. It's part of our benefit package, so the money automatically comes out of my paycheck. Our plan pays for $30 per adult to have their teeth cleaned; $27 for children; $19 for exams for all, and full pan X-rays $42.10. Several of the dentists I called charge $80 or so for adult cleanings, and X-rays are way above $100, so they'd take off the $30 my insurance pays and I'd be responsible for the rest.

However, I found, as I said, a few dentists in my area who charge the exact same rate as what my insurance will cover. So if we're simply having our teeth cleaned, why would I pay someone more for that service when I found someone who will charge me exactly what my insurance will cover?

[geraldz]

Emilybh - thank you for your comments.

We do have a good nationwide UHC plan through my employer (over 100,000 employees) but it seems that every year we pay a little more and get a little less. It is the copay type arrangement whereby we typically pay a $35 copay (as opposed to paying a percentage of the cost).

As I mentioned, we have not had any problems in Maryland. But, for some reason, almost everything is billed through the MUSC hospital system and we pay a bigger chunk. UHC obviously wants it's policy holders to avoid hospitals because they are expensive - but its hard to do in Charleston because MUSC has a monopoly.

[Shannon2027]

Originally Posted by geraldz

Be careful when you seek medical services in the Charleston area. My wife went to several medical service providers in the last 6 months and the bills continue to trickle in.

We have pretty good health insurance (United Healthcare), however, under our plan visits to the hospital are paid at a reduced rate (I think they only cover half). It appears that a lot of doctors, laboratories, etc. are all affiliated with MUSC (The Medical University of South Carolina) which is a hospital. This means that you will be paying dearly for these services.

Even if you don't actually go to the hospital, you will still be billed as if you went to the hospital since your doctor may very well be affiliated with this arrangement.

In Maryland we alway received very clear "Explanation of Benefit" statements from United Healthcare which we could easily match up with the bills from health care providers. No so in Charleston. Trying to make sense of the various bills, dates of service, etc. is a nightmare! Furthermore, my wife has had collectors from the hospital calling her about payment for bills that we have never received!

I recently leased a condo in Mt. Pleasant and noted that several of the applicants had "collections" on their credit reports for unpaid medical services. Now I understand why.

In one case my wife specifically asked a health care provider if they participated in the United Healthcare plan. Although they said yes, when we got the various bills, some of the pieces and parts were not a part of the network.

My advice to you: Avoid hospital charges at all costs. Ask you healthcare provider if they are in your healthplan network. Ask them if you will be billed by their hospital. Ask what other services you will be billed for (labwork, imaging, etc.). Ask if these other services are in your healthplan network. It might even be a good idea to follow up with a confirmation letter as follows:

Dear Dr. XXXX:

I understand that you participate in "Your Healthcare Network".

I also understand that any other services that you may order on my behalf are covered under the "Your Healthcare Network." Furthermore, your services and other services that you may order on my behalf will not be billed by any hospital.

Sincerely,

Cautious Healthcare Consumer

geraldz-
I actually work for UnitedHealthcare. I am a customer service rep in Buffalo, NY. Believe me when I tell you that I TOTALLY understand how confusing this insurance is!!!
Just as a warning, Dr's and Hospitals also understand how confusing this plan is and very often try to take advantage of this. I spend 8 hours a day getting yelled at by frustrated UHC members!!!
Most Dr's and hospitals do not like UHC due to the discounts that are given when they are on contract with us. Mind you, it was their choice to sign the contract with us, but I guess they didn't read it and get upset about the discounts.
I am constantly taking calls from members that are being billed by a provider and don't know why. Most of the time (unless they have that wonderful deductible) they are being billed in error. Espically the people that are on one of the plans with a copay. Dr's don't like the fact that they are getting paid $50 for a $500 service at times (yet they signed the contract for that ammount). They know how confusing this plan is and they will balance bill or they will bill before they receive the EOB from the insurance. People get a bill from the Dr and they pay it. Then the provider ends up getting paid twice without the member knowing. And I am sure you can imagine that getting a reimbursment from a Dr or hospital is pretty difficult!!
My advice to you is to use the myuhc.com website. Sometimes that isn't really clear, so if it isn't call customer service. I know this is going to sound like a pain in the butt, but ask the rep if they are in Buffalo. If not, hang up and call back until you get someone who is. I know it sounds like I am tooting my own horn, but the call center that I work at is the best. We are the only call center that specifically handles corporations like Delta Airlines, Target, Raytheon, Textron and others. . .all by the requests of the corps. They refuse to be handled by anyone else.
Sorry for the length of the reply!! If you have any questions, please fell free to ask!!
~Shannon

[emilybh]

Originally Posted by Shannon2027

geraldz-
I actually work for UnitedHealthcare. I am a customer service rep in Buffalo, NY. Believe me when I tell you that I TOTALLY understand how confusing this insurance is!!!
Just as a warning, Dr's and Hospitals also understand how confusing this plan is and very often try to take advantage of this. I spend 8 hours a day getting yelled at by frustrated UHC members!!!
Most Dr's and hospitals do not like UHC due to the discounts that are given when they are on contract with us. Mind you, it was their choice to sign the contract with us, but I guess they didn't read it and get upset about the discounts.
I am constantly taking calls from members that are being billed by a provider and don't know why. Most of the time (unless they have that wonderful deductible) they are being billed in error. Espically the people that are on one of the plans with a copay. Dr's don't like the fact that they are getting paid $50 for a $500 service at times (yet they signed the contract for that ammount). They know how confusing this plan is and they will balance bill or they will bill before they receive the EOB from the insurance. People get a bill from the Dr and they pay it. Then the provider ends up getting paid twice without the member knowing. And I am sure you can imagine that getting a reimbursment from a Dr or hospital is pretty difficult!!
My advice to you is to use the myuhc.com website. Sometimes that isn't really clear, so if it isn't call customer service. I know this is going to sound like a pain in the butt, but ask the rep if they are in Buffalo. If not, hang up and call back until you get someone who is. I know it sounds like I am tooting my own horn, but the call center that I work at is the best. We are the only call center that specifically handles corporations like Delta Airlines, Target, Raytheon, Textron and others. . .all by the requests of the corps. They refuse to be handled by anyone else.
Sorry for the length of the reply!! If you have any questions, please fell free to ask!!
~Shannon

Shannon is right. If you have confirmed ahead of time that the provider is part of your plans network (and again the type of plan you have dictates which providers of all the UHC networks are participating providers in your plans network), the doctor is bound to accept the UHC reimbursement rate and you do not have to pay a penny more than that. In fact you should report the provider if he or she is trying to bill over and above that. That is why it is ALWAYS a good safeguard to send in any bills you receive from providers to the insurance company to make sure they know about all the claims. I've had clients who have been asked by doctors to pay big money up front before a surgery. Then after the surgery the doctor proceeds to bill the insurance company for the entire amount and is paid the entire amount by the insurance company. Then after the fact, the client calls me and wonders if the amount he paid the doctor directly can somehow be applied to the deductible --which at this late stage --after the doctor has been paid IN FULL is a little bit late to think about submitting a claim for a service that has already been paid for. REMEMBER doctors are in business to make money first and foremost. Some are less than ethical. The only bills you should pay from in network providers are ones that already match up with your explanation of benefits statement.