Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
I wonder if my medical insurance United Healthcare would pay much of the bill for out of state?
After heart surgery, a couple gets a $30,000 cardiologist’s invoice. Can others avoid the same fate?
When Susan Rosalsky was hired as an English instructor at SUNY Orange last year, she was elated. After several years of unemployment, she and her husband, Michael Trost, had been eating through their savings and 401Ks. Better yet, the job came with good health insurance through New York’s Empire Plan and United Healthcare. Rosalsky signed herself, Trost, and their daughter up for the plan.
Good ol' United Healthcare, playing dumb, once again - until someone called them on it. They knew very well the NY law applied to them.
They settled with the doc for about $15-$18k, I'll bet, instead of the $33k he wanted. My sister had a similar surgery about 10 years ago - doc in-network fee was $12k - worth every penny. He put in his own invention - some type of o-ring device. So far, she's fine.
Link in that article on state guidelines on balance billing doesn't work. This is the one which does:
They have an HMO, the surgery was not an emergency procedure, they needed to make sure the providers were in network, which obviously the surgeon was not. End of story, know your plan and how it works. If you don't understand your plan, ask someone.....yet again, another "evil insurance company" story when it was user error....
This patient needed heart surgery - it was an emergency. They asked if the hospital was in plan but 'foolishly' didn't think to ask the radiologist, the laboratory technicians, the surgeon, the operating room nurses, the pathologist, etc. if they were all in-network.
The problem is doctors and laboratories have unbundled from hospitals so they can make more money (a worthy goal that I share) but with no easy way for patients to know who and what is in-network. Often a patient doesn't even know the laboratory reading their blood test is not in-network until they get the bill.
States are right to enact laws against this. The insurance companies are not at-fault but the medical community sure is.
Never had a problem with all the years with UHC, but also never hospitalized out of state. Things I am sure have changed in the years since being with them but in 2006 I had a spinal fusion done which required therapy prior to any surgery done. When that didnt work testing done,surgery required,back brace made. After almost eight hour surgery with a five day hospital stay my grand total for everthing was well into 45,000 and my out of pocket under 500. Have been on medicare for years and never had any problems there either but never had any major stuff going on either.
Never had a problem with all the years with UHC, but also never hospitalized out of state. Things I am sure have changed in the years since being with them but in 2006 I had a spinal fusion done which required therapy prior to any surgery done. When that didnt work testing done,surgery required,back brace made. After almost eight hour surgery with a five day hospital stay my grand total for everthing was well into 45,000 and my out of pocket under 500. Have been on medicare for years and never had any problems there either but never had any major stuff going on either.
You may have had employer coverage with UHC while working. In that instance, expect them to be very well-behaved. You may now have a UHC Medigap F - again you will absolutely no problems with UHC on its Medigap. If, on the other hand, now that you're on Medicare you have a UHC Advantage, good luck to you.
They have an HMO, the surgery was not an emergency procedure, they needed to make sure the providers were in network, which obviously the surgeon was not. End of story, know your plan and how it works. If you don't understand your plan, ask someone.....yet again, another "evil insurance company" story when it was user error....
Not at all applicable in this situation.
The article clearly states (did you read it?) the issue was not that the patient did not have in-network doc (called in from the outside by the hospital, btw, to do the surgery), it was United Healthcare citing ignorance of a NY law which REQUIRED UHC to pay for an out-of-network doc in an in-network facility.
The usual UHC games. Thank heaven that patient was so aggressive.
This patient needed heart surgery - it was an emergency. They asked if the hospital was in plan but 'foolishly' didn't think to ask the radiologist, the laboratory technicians, the surgeon, the operating room nurses, the pathologist, etc. if they were all in-network.
The problem is doctors and laboratories have unbundled from hospitals so they can make more money (a worthy goal that I share) but with no easy way for patients to know who and what is in-network. Often a patient doesn't even know the laboratory reading their blood test is not in-network until they get the bill.
States are right to enact laws against this. The insurance companies are not at-fault but the medical community sure is.
An emergency is immediate care, not several days later. The patient went to the hospital in March and did not have surgery until April.
An emergency is immediate care, not several days later. The patient went to the hospital in March and did not have surgery until April.
Actually, we can't assume either scenario b/c the specific March date is not mentioned, although it appears surgery was only a day, at most two, later. Once admitted, patient never left hospital(s) until after surgery:
Quote:
And they were—until this past March. One morning the couple was out walking their dog when Trost began feeling short of breath. “Just take me to the ER,” Rosalsky recalls him saying.
She opted for Bon Secours Community Hospital in Port Jervis, New York—the state where the couple’s insurance plan was based. When they arrived, the couple says they were told their insurance would indeed be accepted.
Bon Secours admitted Trost, and, after performing an echocardiogram, deduced that he had a failed mitral valve and would require surgery.
He was taken by ambulance to a different hospital, Good Samaritan in Suffern, New York. Rosalsky says Trost asked there, too, whether his insurance would be accepted and was told it would.
On April 1, Trost’s heart was operated on by Arthur Ng, a cardiac surgeon with an independent surgery group based in Hackensack, New Jersey. Trost was in the hospital for a week before going home to recover.
Sounds like patient never went home -
March 30/31 - Bon Secours which transferred him by ambulance to
March 30/31 - Good Samaritan
April 1 - Surgery at Good Samaritan
When my sister went into valve failure she couldn't breathe - was literally flailing for breath - they had to trach her. Admitted to the ER at midnight, surgery next morning. I doubt there was more than a day's interval between the ER admission and the surgery for patient Trost - and, for sure, this guy never went home until after the surgery.
Actually, we can't assume either scenario b/c the specific March date is not mentioned, although it appears surgery was only a day, at most two, later. Once admitted, patient never left hospital(s) until after surgery:
Sounds like patient never went home -
March 30/31 - Bon Secours which transferred him by ambulance to
March 30/31 - Good Samaritan
April 1 - Surgery at Good Samaritan
When my sister went into valve failure she couldn't breathe - was literally flailing for breath - they had to trach her. Admitted to the ER at midnight, surgery next morning. I doubt there was more than a day's interval between the ER admission and the surgery for patient Trost - and, for sure, this guy never went home until after the surgery.
Even 2 days is not emergency care, period. Know your policy.
Please register to post and access all features of our very popular forum. It is free and quick. Over $68,000 in prizes has already been given out to active posters on our forum. Additional giveaways are planned.
Detailed information about all U.S. cities, counties, and zip codes on our site: City-data.com.
Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
