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This all has to do with how the bill was "coded" for insurance. We use UHC, which is a major provider, so I assume it is not too different from others. But even just the plebotomy clinic at duke is out of network, so we either pay $50 for every single test they run (with one draw), or we go to a LabCorp facility, walk in, get drawn, walk out (no bill) and they send the results to Duke.
As for the part of mine you quoted, that is odd. Duke Doctors have always done this. I've even had a few say THEY hate it. I pay my copay to see them (usually $50, for a specialist), but the one's I have seen are all on Duke main campus. Each person that talks to us has their own code so that is it's own deductable or copay. If you run a lab (example: Breathing tests for our Pulmonary patient), they charge you the deductable for that "in patient service". No getting around it. I had the same experience seeing an endochrinologist there. One bill from him, another from the clinic. One was a copay, the other was a deductable. Cost me hundreds of dollars.
Not blaming Duke, just giving the OP things to consider, and watch out for. Better to know (and check) up front.
I'm baffled if you can go to a clinic, see multiple professionals (Doctor, PT, etc...), and get out for $50. Baffled.
Duke's plebotomy clinic is out of network and not part of Duke? Seems strange for something so integral to basic care.
Great advice. And yes, large healthcare systems are complex and bureaucratic, to say the least, and they are usually good at the urgent care/emergency stuff.
I'm concerned that you've gotten collection calls from bills not due! Some insurance payers (including Medicare) can take a while to pay and then with a supplement that pays the difference between Medicare and the cost, they have to wait for Medicare to pay first. So, it's not the patient's fault that the payers are taking a while to pay the bill. Collections needs to understand the reality of the billing world.
Question: is the collections operation part of Duke or is it a 3rd party contractor?
Always internal when the bill was not due yet. And to their credit, they have always responded when I told them it was not due, or even if I told them (as I have many times) "I ignore the first bill in order to give insurance time to sort it out, and then I pay on the second bill, after I get my EOB".
So yes, it's annoying, but they are not turning me over to collections. (I think once, many years ago, they did something third party. I probably pushed it too far, I usually pay my bills like clockwork, but we've had some pretty major medical stuff, and I likely waited too long to sort it all out. )
Short answer, they are annoying, but not predatory or anything. My bigger concern is just "make sure you always have a knowledgeable and non-timid advocate". The people there are dedicated professionals. The Bureaucracy is the problem, and it's not the staff's fault.
Just had someone at duke who was the lucky winner of a post op infection, which per the surgeon was likely contracted during the surgery at Duke. There were numerous miscommunications throughout the stay and I complained to patient relations. I had a discussion with the surgeon who I really like and would use again but the bottom line is that someone needs to be advocating for the patient and questioning decisions that are made. Don't just blindly agree to things. A good physician is discussing things with you not dictating. If their ego is too big for that than move on.
Definitely great advice!
RE: hospital-acquired infections.....here's a statistic: Over 200,000 people die per year from medical errors and complications from infections acquired in the hospital. Unfortunately, it's impossible to get a breakdown of the number of errors causing death for any specific hospital, anywhere, a very opaque system.
Duke's plebotomy clinic is out of network and not part of Duke? Seems strange for something so integral to basic care.
Thanks for posting. Great info!
The people who draw blood at Duke are not in my INSURANCE network. I have to go to LabCorp or pay with an arm or a leg.
But to your point, Duke is in Network, but some of their doctors may not be. This is an insurance issue, I don't think it is at all unique to Duke, but you have to check every facility, every procedure, and every doctor to make sure they are in (insurance) network. Just because Duke is, does not mean the doctor you are seeing, or the procedure you are having is covered.
Always internal when the bill was not due yet. And to their credit, they have always responded when I told them it was not due, or even if I told them (as I have many times) "I ignore the first bill in order to give insurance time to sort it out, and then I pay on the second bill, after I get my EOB".
So yes, it's annoying, but they are not turning me over to collections. (I think once, many years ago, they did something third party. I probably pushed it too far, I usually pay my bills like clockwork, but we've had some pretty major medical stuff, and I likely waited too long to sort it all out. )
Short answer, they are annoying, but not predatory or anything. My bigger concern is just "make sure you always have a knowledgeable and non-timid advocate". The people there are dedicated professionals. The Bureaucracy is the problem, and it's not the staff's fault.
Good to know. Glad they haven't turned anything over to collections.
Some big healthcare systems have outsourced their billing and it's a disaster. 3rd party billers are not well versed in all the ins and outs of the healthcare systems they contract with, to say the least. And forget about asking questions. Disaster.
Yup, I agree totally with the bureaucracy being the problem. These healthcare systems are huge and getting bigger with mergers all over the place. At least Duke is still a non-profit, university-based health system, which is much better than these for-profit operations. I'll take the residents asking me the same questions over and over, instead of "financial" people hounding patients in the ER about how they intend to pay their bill before they've even seen a doctor! I've read about stuff like that in some for-profit hospitals.
The people who draw blood at Duke are not in my INSURANCE network. I have to go to LabCorp or pay with an arm or a leg.
But to your point, Duke is in Network, but some of their doctors may not be. This is an insurance issue, I don't think it is at all unique to Duke, but you have to check every facility, every procedure, and every doctor to make sure they are in (insurance) network. Just because Duke is, does not mean the doctor you are seeing, or the procedure you are having is covered.
Excellent point. Even with Medicare, when I called Duke and asked about ER docs in particular, since many places contract them out, I was told that Duke also uses contracted ER docs, but they can't refuse to see someone based on the fact that they have Medicare and that they can't play by different rules than docs who are employees of Duke.
Some other hospitals who use contracted ER docs can refuse Medicare patients, which is ridiculous, since an ER patient doesn't choose which doc to see in that situation. Some states have put laws in place to protect ER patients from these "surprise" bills, but not all states have those protections, and the laws might not cover any service other than the ER.
But your advice is well-taken, even for Medicare, since specialists or labs, for example, might not accept Medicare, and checking first is very important. And you're right. None of this is unique to Duke.
RE: hospital-acquired infections.....here's a statistic: Over 200,000 people die per year from medical errors and complications from infections acquired in the hospital. Unfortunately, it's impossible to get a breakdown of the number of errors causing death for any specific hospital, anywhere, a very opaque system.
I had a conversation with the surgeon and his rate is very low and the hospitals rate for the procedure is lower than the nation average so this this person was the unlucky 1%. However, as I said to the surgeon I still want to know what will be done to prevent from happening again. Surgeons should be open with you about their infection rate.
We had communication issues, not with the surgeon, but different departments were not communicating with each other. I complained to patient relations they called every department involved and they then called me to apologize and work to fix the issues. I respect that approach. Things do go wrong at times, what matters is how you respond and fix it!
I will say the nursing staff on the units were lovely! They were super helpful and responsive. Loved the physical therapist we had on the ortho unit and even requested her on the next admission.
If you see a Duke doctor in the main building, they will bill a facilities fee. Luckily for me, most of my specialists have now moved to Brier Creek, Page Road and now Southpoint.
I have been happy with Duke overall. My PCP in non-Duke, and I won't leave him! He's looked after me for 20 years!
I see Rheumatology, Endocrinology, Gastroenterologist, Orthopedic and Ophthalmology. (I'm a mess!) The best thing is having all providers having access to everything. I've had two hip arthoscopies - one at Duke Regional and the other at the Ambulatory Center near the main hospital. Dr. Stephen Olson is the go-to guy for hip preservation surgery!
I haven't had any problems with billing, but that's not to say someone else won't. It's a big place! Your mileage may vary!
I don't like that they book return visits for 15 minutes. I had an ocular migraine (at least I hope that's what it was) that caused a very strange visual disturbance and partial vision loss briefly - I told them that when I made the eye center appointment for tomorrow, and just checked and it says my appointment is 15 minutes.
If I'd had a longer temp vision loss, maybe they'd see me for 1/2 hour?
The people who draw blood at Duke are not in my INSURANCE network. I have to go to LabCorp or pay with an arm or a leg.
But to your point, Duke is in Network, but some of their doctors may not be. This is an insurance issue, I don't think it is at all unique to Duke, but you have to check every facility, every procedure, and every doctor to make sure they are in (insurance) network. Just because Duke is, does not mean the doctor you are seeing, or the procedure you are having is covered.
Duke Primary Care Brier Creek have an in-house lab, I checked to be sure that part was in-network
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