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Old 10-22-2014, 12:37 PM
 
Location: Freakville
503 posts, read 386,979 times
Reputation: 528

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Quote:
Originally Posted by EngGirl View Post
It's a little different with ER visits. Of course they ask you to sign many papers, but you can refuse to sign and they cannot refuse to see and help you.

If doctor/hospital has no signature, and contacted you with the bill/ sold your debts to collection agency, just send them a debt validation letter using certified mail and you will never hear from them again. They also will not be able to report your debts anywhere.
And even if you signed, and doctor/hospital sold your debts, there is a chance they lost your file, so debt validation letter would also work.
LOL...yea...try that and let us know how it goes.
If you don't sign consents...you're not going to get anything unless you have an Emergency Medical Condition (see EMTALA). BTW...an EMC is determined by a Licensed Independent Practitioner (as opposed to you) with appropriate clinical training (MD, DO, NP, PA or even an RN with the appropriate training/supervision) and is basically defined as an immediate threat to life, limb or organ.
If you have that...you're covered under EMTALA and treatment must be provided regardless of your ability to pay (doesn't mean you won't be billed...you will).
If none of the above is present (as determined by a Medical Screening Exam performed by an LIP)...the hospital can deny treatment all day long.
Not all hospitals do this...but they can. You'll see more and more doing it in states that don't expand medicaid (as the expansion requirement portion of the ACA was overturned leaving the decision to the states).

Anyway...good luck with your quest.

 
Old 10-22-2014, 07:26 PM
 
3,313 posts, read 4,289,700 times
Reputation: 1835
Quote:
Originally Posted by Travelassie View Post
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.
I agree with this policy because it's for people who chose to use out-of-network providers, so they have to pay the difference. With ER visits you cannot chose who will treat you, the only option you have is to go to in-network hospital. So it's unfair to have this "owed any amount over billed by an out-of-network provider" rule for ER visits.
 
Old 10-22-2014, 07:45 PM
 
Location: SW Florida
9,661 posts, read 6,959,908 times
Reputation: 13967
Quote:
Originally Posted by EngGirl View Post
I agree with this policy because it's for people who chose to use out-of-network providers, so they have to pay the difference. With ER visits you cannot chose who will treat you, the only option you have is to go to in-network hospital. So it's unfair to have this "owed any amount over billed by an out-of-network provider" rule for ER visits.
Unless, of course, it's written into your contract with the insurance carrier. Apparently with an HMO it's not, and Florida law does not allow for balance billing by a health care provider not in the HMO network for care provided to an HMO subscriber. I'd guess that should protect you from your excessive bills from the ER physicians.

Actually, while PPO subscribers have the option of going out of network for their providers, they know this will result in higher out of pocket expenses, but if they choose to see an out of network provider, it's their choice and their responsibility to pay the extra costs. Most subscribers I know ( including ourselves) would rather remain in network and not have to incur those extra charges. And when they go into an in-network hospital ER, as you did, not realizing, and not being informed that the physicians treating them are not in their PPO network, they're in exactly the same boat you were. Only unless they address the problem successfully, they'll be liable for those extra charges.

We have very seldom run into providers who were not a part of our PPO network- I think perhaps the network is much wider for at least some PPO's than they are for many HMO's.
 
Old 10-22-2014, 07:46 PM
 
3,313 posts, read 4,289,700 times
Reputation: 1835
Quote:
Originally Posted by Flem125 View Post
LOL...yea...try that and let us know how it goes.
If you don't sign consents...you're not going to get anything unless you have an Emergency Medical Condition (see EMTALA). BTW...an EMC is determined by a Licensed Independent Practitioner (as opposed to you) with appropriate clinical training (MD, DO, NP, PA or even an RN with the appropriate training/supervision) and is basically defined as an immediate threat to life, limb or organ.
If you have that...you're covered under EMTALA and treatment must be provided regardless of your ability to pay (doesn't mean you won't be billed...you will).
If none of the above is present (as determined by a Medical Screening Exam performed by an LIP)...the hospital can deny treatment all day long.
Not all hospitals do this...but they can. You'll see more and more doing it in states that don't expand medicaid (as the expansion requirement portion of the ACA was overturned leaving the decision to the states).

Anyway...good luck with your quest.
We did this couple years back actually (not for myself directly, I was there as a translator and later as negotiater). It was a real emergency though. Nothing really unique, but something req. immediate assistance. That person had no insurance, but agreed to pay copay ($250) at the hospital. And that person refused to sign because he didn't like all terms. Hospital employees was trying to push even me to sign... Didn't happen. The total bill was close to $40K by the way and came in in 10 different bills - few from labs, one from hospital, few from radiology, and like 5 from different doctors including 3 who did consultation over the phone (!!!) and billed $2000 per hour... I consulted an attorney (who told me about debt validation letter in the first place and told me it's a known practice for hospitals to use all resources with uninsured patients in hope to get $$ from them).
I helped to settle all but these 3 bills - doctors refused to provide any discounts or payment plans, and let medical collection agency manage these debts. Debt validation letters were mailed to each after harrasment calls from collections, and after they received it that person never heard from these doctors again.

I am not into going to ER when there is no real emergency. That explains why we were in urgent care 99% times and this last time (1% lol) we ended up in ER...
 
Old 10-22-2014, 07:57 PM
 
3,313 posts, read 4,289,700 times
Reputation: 1835
Quote:
Originally Posted by Travelassie View Post
Unless, of course, it's written into your contract with the insurance carrier. Apparently with an HMO it's not, and Florida law does not allow for balance billing by a health care provider not in the HMO network for care provided to an HMO subscriber. I'd guess that should protect you from your excessive bills from the ER physicians.

Actually, while PPO subscribers have the option of going out of network for their providers, they know this will result in higher out of pocket expenses, but if they choose to see an out of network provider, it's their choice and their responsibility to pay the extra costs. Most subscribers I know ( including ourselves) would rather remain in network and not have to incur those extra charges. And when they go into an in-network hospital ER, as you did, not realizing, and not being informed that the physicians treating them are not in their PPO network, they're in exactly the same boat you were. Only unless they address the problem successfully, they'll be liable for those extra charges.

We have very seldom run into providers who were not a part of our PPO network- I think perhaps the network is much wider for at least some PPO's than they are for many HMO's.
I agree with you and I still think that people with PPO should also be covered or at least rates need to be limited to real numbers. Otherwise all this mess doesn't make any sense.

My fight is not over yet, so I hope we will end up without a payment from our pocket.

As for HMO coverage, I heard HMO includes less doctors, but for the last 10 years we are on HMO we never had a problem to find a doctor. All recommended to us doctors were accepting our insurance so far.
But it might change as soon as this coming January when insurance cost remains the same, but less doctors will participate in HMO.
 
Old 10-23-2014, 07:49 AM
 
3,923 posts, read 10,290,333 times
Reputation: 5212
I mentioned this to a friend at lunch recently. He said a similar thing happened to him. He told the hospital that he showed his insurance card on admission and it was their responsibility to assign a doctor that accepted his plan. He ultimately got an attorney to dispute the charges but said he didn't pay the hospital for the doctor bill. I had no idea these things went on so thanks for letting us know. Good luck with your bill.
 
Old 10-23-2014, 10:50 AM
 
Location: SW Florida
9,661 posts, read 6,959,908 times
Reputation: 13967
Quote:
Originally Posted by EngGirl View Post
I agree with you and I still think that people with PPO should also be covered or at least rates need to be limited to real numbers. Otherwise all this mess doesn't make any sense.

My fight is not over yet, so I hope we will end up without a payment from our pocket.

As for HMO coverage, I heard HMO includes less doctors, but for the last 10 years we are on HMO we never had a problem to find a doctor. All recommended to us doctors were accepting our insurance so far.
But it might change as soon as this coming January when insurance cost remains the same, but less doctors will participate in HMO.
I'd hope that Florida law regarding balance billing would protect you as an HMO member, and I'd also hope maybe your insurance carrier would also go to bat for you, but you might have to lean on them a little to get them to do it.

I know some of the HMO's provide a wider network of providers than others- I've always stayed away from those but we've been lucky enough to have great employer-based coverage that nearly everyone likes and accepts. I've looked at some of the HMO's to see about coverage for some family members who needed insurance, and it seemed as though the BlueCross/BlueShield HMO's in Florida, as well as Aetna, weren't too bad. There are a lot of reasons, from both the insurance carriers and providers, as to why only certain providers are included in their networks. Of course there is the matter of reimbursements, if providers feel these are too low, making it difficult even to keep up with their overhead, they'll bail out. Or if an insurance company believes a doctor is costing them too much money by ordering what they consider too many tests, or procedures on too many patients- they'll drop him/her. On the other side of that coin is that the doc believes the restrictions placed on him/her regarding the care of patients by the HMO or insurance carrier prevents him/her from practicing medicine according to the standards of care. Or there's a huge hassle with getting insurance claims paid in a timely manner, or too many denied, and docs will drop out because of that. And so it goes.

That said, most people I've known who were in HMOs have said they were generally satisfied with the care they got, their medical conditions and needs taken care of pretty well.

I don't know how the HMO's compare with the Medicare Advantage plans (these plans are paid by Medicare funds to take care of senior citizens who subscribe to these programs), but I'm assuming it's pretty much one and the same as far as the care ( except that the care of senior citizens is subject to Medicare laws). I know the loss of providers from the United Health Care Medicare Advantage plan in this area has been an ongoing problem in many areas, and I haven't seen any real explanation on the part of UHC as to why that's happening. I can only hope that the same thing doesn't happen with the other HMO's, but as you say, we'll see.

Anyway, good luck with your battle over those bills! Just doesn't seem to me as though you really owe that money.
 
Old 10-23-2014, 03:13 PM
 
Location: SW Florida
9,661 posts, read 6,959,908 times
Reputation: 13967
Quote:
Originally Posted by TampaKaren View Post
I mentioned this to a friend at lunch recently. He said a similar thing happened to him. He told the hospital that he showed his insurance card on admission and it was their responsibility to assign a doctor that accepted his plan. He ultimately got an attorney to dispute the charges but said he didn't pay the hospital for the doctor bill. I had no idea these things went on so thanks for letting us know. Good luck with your bill.
Those doctors bill patients directly for their services, so the hospital doesn't get involved with those charges. Hospitals contracting for the services of doctors who aren't in the insurance "in-network" of many of their patients' (even though the hospital is in the network) has been going on for a number of years, but most people don't know about it till it affects them. So IMO public awareness of this issue is a good thing.
 
Old 10-27-2014, 09:53 PM
 
Location: Way up high
14,115 posts, read 20,816,661 times
Reputation: 14390
Speaking of hospital bills: I just got the bill. I spent 1.5 hours in the Denver ER about two weeks ago as I had strained my neck pretty bad. All I got was 6 X-rays, a Flexerill and a Vicodin. Let's take a guess on how much it cost?? This could be fun. I don't have insurance btw.
 
Old 10-27-2014, 10:56 PM
 
3,313 posts, read 4,289,700 times
Reputation: 1835
Quote:
Originally Posted by himain View Post
Speaking of hospital bills: I just got the bill. I spent 1.5 hours in the Denver ER about two weeks ago as I had strained my neck pretty bad. All I got was 6 X-rays, a Flexerill and a Vicodin. Let's take a guess on how much it cost?? This could be fun. I don't have insurance btw.
Was this bill for hospital ER itself? Was it for x-rays? According to my experience you should at least receive 4 separate bills (ER/hospital, physician, radiology, radiology tech/doctor)
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