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Old 09-15-2011, 06:12 AM
 
Location: Lafayette, Louisiana
701 posts, read 553,096 times
Reputation: 786

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Surgery was performed at this outpatient facility on July 14, 2011. Prior to the surgery I was quoted a price of $1,200 which I paid in full pre-op. This cost was merely for the usage of the facility for my surgery. The actual surgeon performing the operation is not affiliated with that outpatient facility and billed me ~$5,000 for his services. Today, September 15, I received a bill from this outpatient center for an additional $7,859 ($9,059 total). The bill list the two surgeries that were performed as being the reason for the balance owed. Why would they be charging me for surgeries done by a surgeon not associated with them and who already billed me seperately, in addition why $4,000 more than the actual surgeon charged?

I received paperwork informing me that they attempted to bill my insurance however were unsuccessful. My belief is that my insurance also became suspicious of the excessive amount and rejected the claim for this reason.

What are the options for a patient suspecting medical overcharging?
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Old 09-15-2011, 10:13 AM
 
Location: Mostly in my head
19,865 posts, read 57,913,059 times
Reputation: 19182
Ask for a meeting with a patient rep. They will have billed you for supplies used during the surgery and for the anesthesiologist's charges, unless that doctor also bills seperately. Both of those categories cannot be known ahead of time.
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Old 09-15-2011, 10:13 AM
 
Location: Georgia, USA
25,193 posts, read 30,059,309 times
Reputation: 31326
The reason you were billed the additional amount was because the insurance did not pay. The amount you paid in advance was based on your share of the charge after insurance.

If you jumped through all of the preauthorization hoops for the insurance company and the procedure is covered by your policy, the insurance should pay. Most surgery centers and hospitals are careful to make sure the insurance will cover the procedure before it is done.

Did you get an "Explanation of Benefits" from the insurance company? It should give the reason for denying the claim.

The amount the insurance actually pays will be heavily discounted and nowhere near what you were billed.

I recently had a lab charge that was billed to me because the insurance did not pay. The lab had billed the wrong insurance company, one I had previous coverage with.

I would contact the billing office and make sure they filed with the right insurance info and find out the reason for the denial.

Then you will need to take it up with the insurance company.
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Old 09-15-2011, 10:18 AM
 
Location: in your dreams
11,734 posts, read 14,099,736 times
Reputation: 16327
Sometimes they do make mistakes.

I had surgery 4yrs ago and when the lady in the billing dept was looking over my papers, she said they had charged me twice!
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Old 09-15-2011, 11:11 AM
 
Location: Georgia, USA
25,193 posts, read 30,059,309 times
Reputation: 31326
Quote:
Originally Posted by SouthernBelleInUtah View Post
Ask for a meeting with a patient rep. They will have billed you for supplies used during the surgery and for the anesthesiologist's charges, unless that doctor also bills seperately. Both of those categories cannot be known ahead of time.
The anesthesiologist almost always bills separately.

The supplies are almost always bundled into the facility charge. And the insurance should cover them anyway.
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Old 09-21-2011, 11:59 PM
 
Location: Lafayette, Louisiana
701 posts, read 553,096 times
Reputation: 786
Thanks for the responses. They have definitely been helpful. I have further information.

A. I was wrong about the insurance. Contacted Aetna and apparently a decision is still pending.
B. Today I received another bill from this place for $753.75 for anesthesia services.
C. I have located two forms. The first one provides a price of $3,100 and states that the price quoted is for O.R. & anesthesia only. Lab, EKG, and/or pathology will be additional fees if ordered. The $7,859 bill I received mentions only the surgeries performed and doesn't specify anything concerning lab work, etc... I highly doubt that would cost $8,000 anyway. The next form I found is dated after the $3,100 quote and list a price of $1,200 for O.R. and anesthesia. The price drop is due to the discount I received for having Aetna as insurance and for paying in cash. I have a receipt for my $1,200 payment.
D. Contacted the surgery center and was told that it would be preferential if we discussed this after my insurance makes their decision. This has raised my suspicion even more. It's as if they were hoping that my insurance would just pay the bill, and in doing so, I'd be relieved and not pursue it further.
E. I contacted the state A.G. They actually have a special department that handles this and allows you to fill out a form online. I did so but haven't heard back from them yet.
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Old 09-26-2011, 12:07 AM
 
Location: Georgia, USA
25,193 posts, read 30,059,309 times
Reputation: 31326
Quote:
Originally Posted by 5trillion View Post
Thanks for the responses. They have definitely been helpful. I have further information.

A. I was wrong about the insurance. Contacted Aetna and apparently a decision is still pending.
B. Today I received another bill from this place for $753.75 for anesthesia services.
C. I have located two forms. The first one provides a price of $3,100 and states that the price quoted is for O.R. & anesthesia only. Lab, EKG, and/or pathology will be additional fees if ordered. The $7,859 bill I received mentions only the surgeries performed and doesn't specify anything concerning lab work, etc... I highly doubt that would cost $8,000 anyway. The next form I found is dated after the $3,100 quote and list a price of $1,200 for O.R. and anesthesia. The price drop is due to the discount I received for having Aetna as insurance and for paying in cash. I have a receipt for my $1,200 payment.
D. Contacted the surgery center and was told that it would be preferential if we discussed this after my insurance makes their decision. This has raised my suspicion even more. It's as if they were hoping that my insurance would just pay the bill, and in doing so, I'd be relieved and not pursue it further.
E. I contacted the state A.G. They actually have a special department that handles this and allows you to fill out a form online. I did so but haven't heard back from them yet.
Why did you do "E" before the insurance has paid? I highly doubt that the surgery center is trying to do anything underhanded.

The surgery center sends a bill to the insurance company. The insurance company pays the amount that it has contracted to pay to the surgery center. The surgery center writes off the rest. You are responsible for any deductibles and coinsurance that your contract with the insurance company requires you to pay.

If you got a bill from the anesthesiologist and the surgery center stated that anesthesia was included in the original quote they gave you, then that is something the surgery center needs to explain to you. It again may be due to the failure of Aetna to pay promptly.

It has been over three months since the surgery. Aetna should have paid by now. You deserve to know why they have not. The ball is in Aetna's court. The surgery center cannot tell you anything until the insurance company pays. It is really, really, really premature to be filing complaints with the A. G. about this. I expect someone will contact you and explain the same scenario that I just did.

You need to contact Aetna again and find out what the delay is about. If the surgery was straight forward and covered by your policy, there is no reason for it to take over 12 weeks to pay the claim.
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