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Old 10-22-2014, 11:19 AM
 
Location: SW Florida
9,759 posts, read 7,038,572 times
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Quote:
Originally Posted by BucFan View Post
So what does one do? Ask the doc "are you in my network"....."you're not, okay, sorry, bring me another doctor in the department who is." ?? I'm curious what your insurance company recommends you do in this situation - nice to know information before you get sick.
Unfortunately, you're between a rock and a hard place in that situation- you're hurt, unconscious, or otherwise incapacitated and most often the last thing in the world you think of is whether or not the doc who's providing those services in your network hospital is in the network himself. Hospitals know this, doctors know this, and insurance companies tend to fall back on their own policies for out-of-network providers for payment of these providers, so the patient's usually stuck holding the bag for the rest of the charges.

It's hospitals that choose who they contract with to provide services, and IMO it's the hospitals who should be taken to task for putting "in-network" patients in this position. I'm happy to see the article in the Tampa newspaper about this practice, it makes people aware that this practice occurs not infrequently, and when they mention the hospitals by name, it often embarrasses the hospital- hospitals HATE any kind of adverse publicity.

There were a series of articles in the Miami Herald some years ago about this very topic- in this case they cited folks who had taken their child to an urgent care center for an ankle injury. Seems the hospital who owned the urgent care center hired "weekenders"- docs who worked at the Veteran's Hospitals, or who were otherwise out of network, and the doc who briefly looked at this kid's ankle, ordered an x-ray, looked at the X-ray, declared the ankle not broken, had a nurse wrap the ankle with an ACE bandage, and sent him home with some crutches. Apparently the doc, who was an out of network provider, charged $6000 for his services, and the father's insurance covered little if any of it. There were also stories abounding of out of network "hospitalists" who take care of patients in hospitals- with no consent on the part of any patient for the hospitalist to do so, and these patients have ended up with enormous bills for this care (such as it is) not covered by their insurance. Then there are the anesthesiologists, pathology services, which may also not be covered.

I known my husband used to write a little note on any admission or other papers he signed for hospital services, stating that he did not want, nor would he be responsible for paying "out of network costs" for any provider who was not in network. The clerks always discouraged him from doing so, telling him that it didn't matter what he wrote on his papers, but in a dispute he had over bills he got from two hospitalists who very briefly visited during an overnight stay (one was actually a supervisor just checking on the other one, but they both billed my husband), the hospital administration noted that he had included his wishes in writing on his forms, and they came to some sort of an agreement with him over those bills.

The same hospital ( whose name appeared prominently in the Miami Herald articles), agreed that it wasn't fair to saddle patients with out-of network costs, and agreed to look at their practices of hiring so many out-of-network providers. I don't know if they ever did anything about it, I think maybe they just handled complaints about this on a case-by-case basis.

I don't know that this practice is prevalent these days either, but I recall when my daughter had an emergency appendectomy a number of years ago when she was in school in Tampa, she went to one of the HCA hospitals- in Brandon if I recall. The surgeon was not in her insurance network either, but he accepted the network payment and co-payment as payment in full, although it was a fraction of what he had billed for the surgery. He also sent a bill for the remainder,( the amount made me almost pass out), but it was obvious the way the bill was written that they really didn't expect payment. I spoke to their billing department and also to the hospital billing department, and they informed me that the hospital had an agreement with its contracted providers (including out of network) for them to accept payment as in-network providers for the patients they took care of there. I could have sworn the hospital also told me that all of the hospitals in Tampa had the same agreements with their out-of-network providers, but from these stories, and that article linked in the original post, I guess that's not the case.

As to what to do about it- seems to me there's a lawsuit waiting to happen- breach of contract by the hospital who contracts with out-of-network providers? I don't know, built perhaps a start is to indicate on the financial responsibility papers one signs for any medical services-the papers that have one agreeing to pay any charges in case the insurance doesn't pay, or for non-covered charges, that one will be responsible for the applicable deductible, or co-pays of charges incurred only by in-network providers.

 
Old 10-22-2014, 11:25 AM
 
Location: SW Florida
9,759 posts, read 7,038,572 times
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Quote:
Originally Posted by jambo101 View Post
I guess they are coming over for the adventure
USATODAY.com - Medical errors still claiming many lives

Quite amazing that if one goes to an emergency room the parameters of your insurance coverage needs to be addressed to see if the Doctor or the hospital accepts your healthcare plan. For a hundred bucks or two it may not be a big deal but some of these costs could escalate to 10s of thousands of dollars in a real hurry.
Unfortunately I've never ever seen an ER bill- no matter how minor the event was that sent you there- that was less than $1600.
 
Old 10-22-2014, 11:34 AM
 
Location: Tampa, FL
27,798 posts, read 26,217,684 times
Reputation: 14611
One good outcome from this problem might be lowing of "E.R. Abuse" where patients use the E.R. when they don't have a genuine emergency - getting charged one time for a ER doc's care for a strep throat, ear infection, sprained ankle will likely reinforce to the patient that ERs are for true emergencies, not acute illnesses that can be seen in an clinic by a family physician.
 
Old 10-22-2014, 11:39 AM
 
Location: SW Florida
9,759 posts, read 7,038,572 times
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Quote:
Originally Posted by EngGirl View Post
How is this patient's problem???
As I stated above, Florida Hospital in Wesley Chapel physicians at ER do not accept any insurance! Their only way to get paid is by billing every single patient and their rates are insane! It's 10 times higher than my insurance is paying to in-network doctors!!!

I had an emergency and went to in-network hospital. I cannot control who is treating me. I cannot chose who will treat me. I do have insurance (1400 a months for a family, I thought it was 1200 but I was wrong, it's 1400 a months), I go to in-network hospital and then I have to deal with out-of network providers??? What is the point to have health insurance at all?
Well, without that insurance you'd get another enormously inflated bill from the hospital for using their ER services and facilities, in addition to the doctors' bill.

But I agree with your outrage at the out-of-network doctor's bills you received. I think the worst thing about this ( besides the unexpected sticker shock from an IMO unwarranted bill) is that patients who assume since they've come to an in-network hospital, all their providers there will also be in-network are taken advantage of since the hospitals and docs know they're most often not in a position to decide who provides that care, and patients don't even know it's happened till they get those bills.

IMO it's unconscionable that any hospital who signs a contract as an in network provider would staff an ER with doctors who take no insurance. And the fact that they don't even notify patients that their ER doc won't take theirs, or any insurance, prior to their care, is even worse. I'd think that they might rethink this situation if they stopped getting patients- patients who decided to take their emergencies elsewhere. I know this might not always be possible in a life-threatening situation and that were the nearest hospital, but often patients do have some time to go elsewhere.

I think I'll do a little homework on the Florida Hospitals in that area, and see what they claim about themselves.
 
Old 10-22-2014, 11:49 AM
 
Location: SW Florida
9,759 posts, read 7,038,572 times
Reputation: 14295
Quote:
Originally Posted by BucFan View Post
One good outcome from this problem might be lowing of "E.R. Abuse" where patients use the E.R. when they don't have a genuine emergency - getting charged one time for a ER doc's care for a strep throat, ear infection, sprained ankle will likely reinforce to the patient that ERs are for true emergencies, not acute illnesses that can be seen in an clinic by a family physician.
Well, THAT is certainly true. That's what the urgent care centers, and even the clinics in some of the drugstores are good for.

I think the problem with some of the folks who go to ERs for their routine care is that they expect not to have to pay anything for their medical care ( I don't mean the folks on this thread who've gone to in-network ERs and been taken care of and billed by out-of-network providers). Many urgent care providers, and all the drugstore clinics, post the costs for their services and while they may accept many insurances, if someone has no insurance or it doesn't cover these visits these facilities expect payment at the time of service.

I don't know about the family physician being available all the time- it used to be much easier to get in to see a primary physician than it is currently. When you call a docs office, the first message you hear is if you have a emergency, ( and folks have differences of perspective on what constitutes an emergency), to hang up and call 911. Or to go to the nearest ER.
 
Old 10-22-2014, 11:55 AM
 
Location: SW Florida
9,759 posts, read 7,038,572 times
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Quote:
Originally Posted by Stewabby View Post
Well this is scaring me. I just had a baby at Florida Hospital Wesley Chapel who then was switched to another Florida Hospital for a few days in the NICU. I ended up in the ER for a complication about a week later. We have an Aetna PPO. I'm looking through our claims right now and I'm not seeing anything jump out at me, but I guess we will see when the bills stop coming in.
You may find that many of the providers who took care of you and your baby are in the network for your insurance. I hope so!

We've found that there are very few providers not in our insurance either. It seems to me that there are generally more providers in PPO type insurance plans than there are in HMO's- at least that's been my observation over the years.

I hope all is well with you and your baby!
 
Old 10-22-2014, 12:03 PM
 
Location: SW Florida
9,759 posts, read 7,038,572 times
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Quote:
Originally Posted by bentlebee View Post
Did anyone ever hear of this prior to Obamacare?

I never heard of this and assume it can be related...
Yes, it's been going on for years. I might speculate that because of, or in the anticipation of decreased reimbursements by insurance companies to providers due to large increases in out-of-pocket expenses ( large copays, deductibles, and maximum out-of pocket expenses where the patients may be reluctant or unable to pay these), and other changes in reimbursement hidden in Obamacare laws, providers may be resorting to more aggressive means, directly to the patients, to collect their fees.

So if there's an increase in this practice, it could, IMO, be in response to what providers anticipate coming down the road with Obamacare.
 
Old 10-22-2014, 12:13 PM
 
Location: SW Florida
9,759 posts, read 7,038,572 times
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Quote:
Originally Posted by Pragmaticus View Post
This is the responsibility of the hospital, period. These ER doctors won't get your business if it were not for the hospital. If a subcontractor is out-of network, the hospital should be considered out-of-network otherwise. You can't have it both ways.

Having said that, who is the insurance provider? I checked mine (HMO Blue Florida) and my Co-pay remains at $50 whether in- or out-of-network for emergency room visits. The last thing I would want to worry about in an emergency is whether the ER doctors are acceptable to my insurance. I think, hospitals and insurance providers should need to figure this out. There is no way a subcontractor is not covered under the same policy, somebody need to eat the "extra" cost.
It really depends on the terms of the contract between the insurance company and the provider, and the terms of your insurance. If according to the terms of your HMO, you pay the copay/deductible to any provider, in or out of network, and no more, then an out of network provider can bill you any extra till the cows come home, and you're not required to pay those bills. It'll say that on your explanation of benefits for any services ( ie, "what you owe") and if that were a bone of contention with an out-of network provider who wants you to pay extra I think the insurance company would be happy to explain it to the provider.

We had a Blue/Cross Blue Shield PPO for years ( still have it as a secondary for our Medicare), and there was a clause in our contract stating that we owed any amount over and above billed by an out-of- network provider once they had been paid the customary reimbursement by the insurance company, copays and deductibles. We never ran into a problem with physicians in that regard, but over the years we did encounter it with ambulance services.
 
Old 10-22-2014, 12:31 PM
 
Location: SW Florida
9,759 posts, read 7,038,572 times
Reputation: 14295
Quote:
Originally Posted by CravingMountains View Post
Wow. I thought only the hospitals in Naples did this. I am dealing with a similar struggle Because of an ER visit of my own.

This is a very bad thing what the ER docs are doing. It's not going to get them more money. It's going to get them stiffed. And the state of Florida is already onto them with regulating out of network billing. You guys mention that HMOs are the only ones that have protections against balance billing but my POS plan with Humana quoted me the Florida statute that says this balance billing is not legal (which is probably why the docs billing company is located out of state!).

Don't give in and pay OP. Even if this debt gets sold to a collector they can't touch your paycheck because of medical debt without a judges rulling. I could never see a judge rule that you would have to pay the full amount. Not even close.
Generally the Florida laws governing patient care, other patient issues is applicable to those who provide care to patients in Florida, so a billing company being out of state most likely won't get them off the hook. IMO the companies count on patients not knowing this, and just the luck of the draw that whatever they bill, there will always be a certain number of people who will just pay those bills rather than go to any trouble to investigate whether the bills are valid or not.
 
Old 10-22-2014, 12:35 PM
 
Location: SW Florida
9,759 posts, read 7,038,572 times
Reputation: 14295
Quote:
Originally Posted by bentlebee View Post
Strange that hardly anyone heard about this as it seems by reading this thread and why hasn't there been a legal case or has there been one since it seems there are people suing daily and this seems to me a huge issue for many people if this is something that you claim has been around for decades....
I can assure you, the practice HAS been around for years, but you might understand that hospitals don't advertise the practice, and most people won't know about it unless they get directly involved (mired) in it.
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