Over-billing in the Medical World

[Mike from back east]

Suzanne, that is just flat outrageous. When I need an Rx for a new mask, all I do is give the info (item needed, and the fax number for my source of supply) to the person who answers the phone at my local doctor's group. My doctor then will write the Rx and fax it to CPAP Pro in TX and in a few days the item shows up in my mailbox. My docs would never insist on a sleep study for mere ordering of supplies.

Most health insurance (I've got Anthem BC/BS) will AUTOMATICALLY allow you every six months to go to your source of supply (many of the "home health care" firms like Apria, Praxair, CPAP Pro, even Walgreen's) and you get your replacement masks, filters, hoses, etc, with NO questions asked.

If I were you, I'd call my health insurance firm and clue them in that this doctor does not know what he/she is doing. Truth is, a lot of docs don't know much about apnea, including childhood apnea that often presents as bedwetting.

[SouthernBelleInUtah]

No, but the companies I have gotten my equipment from have been very quick to call me every 3 motnhs to tell me I can order new tubing, filters, mask, etc. It must be the way your doctor wrote the original order to the equipment company. Call the company and inquire about it. They make money off these continual refills so I can't imagine why they aren't calling you!

You do not need a new sleep study all the time, the doc orders an overnight oximitry test (which is done at home with a small computer and a finger probe) and only if it is abnormal is a full sleep study needed. My pulmonologist reduced my pressure setting on the basis of an overnight oximitry test (don't know what they caost but certainly not $1800).

[momof2dfw]

I'm fighting two overcharges right now.

First one I had a doctors visit w/ a specialist to look at a mass in my breast. It was thru the local hospital. Had many appointments that year and even a year and a half later at the same hospital had two minor surgeries. Checking in for both my balance was just what I owed for that procedure. Next month, 1 1/2 years since the first visit, I got a late notice bill from them and the next month they turned it into a collection agency before I even got an itemized statement Got the itemized statement and they billed me for an "operating room" It's going on almost a year now and STILL fighting that one. My dental hygeniest has more equipment in her room to do an operation than that small itty bitty doctors exam room.

Second one is from eariler this year from when my doc had a colonscopy done. Got the bill late from his office, what is up with that???? Called my insurance, BC/BS and they are trying to bill me for TWICE what is the acceptable amount I should pay. Still fighting that one.

On both of these they have already been paid by my insurance more than the bill should have been total from the ins and me. It's insane. The first one my insurance paid their portion of me being in an "operating room". They have no one overseeing them and they just charge what they want.

[resident14]

I was recently having severe stomach pain so I went to my local ER to see if they could do anything. I wanted to at least find out what was wrong. I spent about a total of 3 hours in the hospital, the whole time laying on a bed. All they did for me was take my blood and tell me that the results came back ok and that I should see a personal physician if I needed more treatment. That was it. And for just that I received two bills, one for $3,443 and another for $500. My health insurance was expired and I knew I would be charged but wtf why does it cost that much? makes no sense I laid on a bed for 3 hours and recieved basically no treatment so it costs 1,000 an hour just to lay there? We need to get rid of greed in our healthcare system. I just felt like ranting somewhere, does anyone else have a story to share about being charged thousands of dollars for no treatment?

[Mike from back east]

Resident, IMO the outrageous bills are to cover the cost of care to those who cannot pay the bills, so the hospitals and docs bill these outrageous sums to the insurance companies and Medicare.

My understanding is that insurance companies pay hospitals and docs about 44% on the dollar; hospitals and docs try to collect at least part of the balance from the patient. IIRC, Medicare pays about 25% on the dollar, which is why some docs won't accept Medicare patients.