4 replies to this topic

[ralph perrello]

From January to march 2008 I had prostate cancer treated at the Mayo Clinic in Phoenix, AZ. ( Good to go so far.)
I have medicare and Blue Cross.I keep all paperwork that comes to me during and after treatments. Until all has been paid.
The bills go to medicare. When they are done with the bills they are automatically forewarded to B/C. I thought I put out a lot of money during this period.
I sat down and sorted the paperwork. Mayo Clinic, Medicare, Blue Cross. I sorted each by date of treatment. I made a chart.
I found that Blue Cross held back about $7500.00. I paid Mayo Clinic but was never reimbursed.
I called B/C and they said they never got the paperwork. Yeah right. I had Mayo Clinic send it to them again. I called B/C two weeks later and again they said they never received the bills.
I went through the same routine again. The third time they never received them. I was on the east coast and let it sit until I arrived in Phoenix again.
I went to the Mayo Clinic and again they gave me the paper work This time I hand carried the bills to B/C and got a receipt.
Three weeks later I received my check. It was only 1.5 years late! How many times do these Insurance Companys do this and get away with it. Often I am sure but not with me.
Watch them like a hawk and get what is rightfully yours.

Edited by ralph perrello, 07 April 2011 - 07:32 PM.

[Randy retired]

Good catch. We had the same problem with United Health Care and more. I argued with them for more than 18 months about our bills. It first started with a bill for $18,000 for my part of a surgery. After 18 months of back and forth phone calls they finally reduced my part to $4,000. I gave up after that but I still think they owe me another $2,000. The Mayo Clinic is out of network for me so UHC kept saying things like customary and reasonable charges and other misnamed criteria. It turns out that customary and reasonable charges are actually the cheapest that anyone can get the procedure done in the area even if it is cousin Jim's hack shop. They even said they don't set the amounts as this is done by a separate company. They made it sound as if they didn't have any input but it turns out this other company is a subsidiary of UHC! This was all further complicated by the fact that since Mayo doesn't have a contract with UHC they charged me the highest rate as if I was uninsured. During this time my DW was also having treatment at the Mayo Clinic. She has Medicare and UHC. I had a hard time trying to determine if UHC was paying the correct amount. When I questioned them they said they checked and all was correct. Finally I noticed that for 3 consecutive months my DW saw the same doctor for the same reason but UHC paid 3 different amounts. Mayo charge the same amount for the same code but UHC paid 3 different amounts. This time I became a little more forceful and finally got them to review her bills. Turned out there was problems and UHC owed us more but they needed to have a special committee review the review before they could reimburse us. A couple months later they paid us. Sorry for the rant but I hate insurance companies. I also found some billing errors with Mayo and Medicare and if I knew more I bet there were more but it is so complicated.

[ralph perrello]

During my last marriage my wife had some female surgery. I got the customary and resonable BS. I went to 5 other OBGYN doctors and got their charges for the same thing.
I then wrote a letter to the insurance company and quoted the prices, which were all the same, and the names and addresses of the doctors.
They were backed into a corner and had to pay accordingly.

[marnindale]

For anyone concerned about hospital billing, there are companies that will review your hospital bill for billing errors and that will assist you like an advocate.

A little off subject: Just found out that the Florida Hospital System will bill a self pay patient only 25% of what the "normal" charge would be. I was told that they used to bill 50% but that too many people couldn't pay their bill so they decided to try it this way.

Perhaps other hospitals have this policy in place as well.

[Dersequim]

Several years ago my wife broke her little tow, on her right foot, she stubbed it on the leg of the bed. Office Call $32.50, Blue Boot $6.00.
Two nights later her Mother, on Medicare, did the SAME identical thing, good for a few laughs. Same Doc! Office Call $48.00, Blue Boot $18.00!

I sent copies of both bills to Medicare!

Nancy was admmitted to Desert Center hosp in Palm Springs in 04'. While there the Patient's Advocate, DUE to some EXTREME mishandling and MISS DIAGONIS of her INJURIES by EMT's and Emergency Room Staff, She was ASSIGNED an Advocate by the LEGAL Department to monitor her care. They even called in a Surgeon form Eisenhower to handle her case.

The Advo and i were having coffee one afternoon and talking about Billing procedures. Suddenly she led forward and whispered, "Did you know that in California, if a Resident dies in the Hospital; the State PAYS all their BILLS that Insurance doesn't cover, BUT the Hospitals STILL BILL the Families!"