Medical Billing Error - a success story!

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dm200
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Medical Billing Error - a success story!

Post by dm200 » Wed Jun 15, 2016 12:49 pm

I believe this post is "actionable" and thus within the rules, as well as being focused on "billing" and not on medical matters.

I am on Kaiser Medicare and recently received a $40 bill (same amount as specialist copay) citing the date and name of a specialist. I knew I had paid the copay - so I was puzzled. I called and the rep told me this was the fee for an ECHOcardiogram (I had one a few days later). As I was about to mail the $40 check, I went online and reviewed my visit/procedure history. I still thought it very odd that the date of the ECHOcardiogram was not the visit/procedure date on the bill. I called again, got a different rep and we reviewed the whole situation.

Bottom line: after about 20 minutes of out time on the line, her checking with others, and my narrative of the entire situation - the bill turned out to be for an ELECTROcardiogram done at the specialist visit. Under MY plan, I should not have been billed for this ELECTROcardiogram. It sounds like part of the confusion that led to the billing error was due to the very similar names (and perhaps abbreviations) of the two (very different in my non-medical opinion) tests/procedures. My conversation with the billing rep was very, very cooperative and congenial. :happy

Correction of this billing error was facilitated by my attention to detail, my exact recollection of the full sequence of events and (I think) my firm, but 100% cooperative approach on the second call. It is my additional opinion that these kinds of mixups due to similar sounding things can also result in actual medical errors.

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BolderBoy
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Re: Medical Billing Error - a success story!

Post by BolderBoy » Wed Jun 15, 2016 1:45 pm

Well done. These sorts of errors happen all the time. Important to remember (as you saw) that the folks you talk with when calling in, have zero personal stake in collecting money from you. But both parties have a great stake in doing the right thing.

(know of a tragic outcome when an over-the-phone order for ePHEDrine was misunderstood as ePINEPHrine with a resulting stroke in a laboring patient)
"Never underestimate one's capacity to overestimate one's abilities" - The Dunning-Kruger Effect

sawhorse
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Re: Medical Billing Error - a success story!

Post by sawhorse » Wed Jun 15, 2016 4:40 pm

Great to hear! The number of medical billing errors is outrageous. I can't imagine any other industry being allowed to get away with so many billing errors.

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dm200
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Re: Medical Billing Error - a success story!

Post by dm200 » Wed Jun 15, 2016 6:17 pm

BolderBoy wrote:Well done. These sorts of errors happen all the time. Important to remember (as you saw) that the folks you talk with when calling in, have zero personal stake in collecting money from you. But both parties have a great stake in doing the right thing.
(know of a tragic outcome when an over-the-phone order for ePHEDrine was misunderstood as ePINEPHrine with a resulting stroke in a laboring patient)
Speaking of medical "mistakes", I had a recent ultrasound - and this department had initiated a somewhat elaborate process for those getting procedures in the Radiology department. They prepared and gave be an ID (name, date of birth) wristband and the technician had me initial a form "certifying" by name, date of birth and the specific test/procedure. I had no problem with any of this - but in chatting with the technician expressed a bit of puzzlement for such an elaborate "process" for what was being done. She told me that they went to this "process" because it had become more frequent that when they would call a patient's name from the waiting room, the wrong person would get up and come back -- only to have them find out it was not the right person. Yikes!

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BolderBoy
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Re: Medical Billing Error - a success story!

Post by BolderBoy » Thu Jun 16, 2016 1:29 pm

dm200 wrote:Speaking of medical "mistakes", I had a recent ultrasound - and this department had initiated a somewhat elaborate process for those getting procedures in the Radiology department. They prepared and gave be an ID (name, date of birth) wristband and the technician had me initial a form "certifying" by name, date of birth and the specific test/procedure. I had no problem with any of this - but in chatting with the technician expressed a bit of puzzlement for such an elaborate "process" for what was being done. She told me that they went to this "process" because it had become more frequent that when they would call a patient's name from the waiting room, the wrong person would get up and come back -- only to have them find out it was not the right person. Yikes!
If you haven't seen the movie, "The Hospital" (from the early 1970s) it can amuse you. The patients were dying of "vestigial identity".
"Never underestimate one's capacity to overestimate one's abilities" - The Dunning-Kruger Effect

amarone
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Re: Medical Billing Error - a success story!

Post by amarone » Thu Jun 16, 2016 8:16 pm

sawhorse wrote:Great to hear! The number of medical billing errors is outrageous. I can't imagine any other industry being allowed to get away with so many billing errors.
Calling them "errors" is charitable in many instances. We are handling the finances of my sister-in-law, who had a stroke last September. I have a file of bills that we have not paid because they are wrong - all too high, of course. A favorite tactic is for the provider to bill the insurance company an outrageous amount, the insurance company knocks it down to something more reasonable, and the provider then tries to get some or all of the difference from the patient.

toofache32
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Re: Medical Billing Error - a success story!

Post by toofache32 » Thu Jun 16, 2016 10:50 pm

amarone wrote:
sawhorse wrote:Great to hear! The number of medical billing errors is outrageous. I can't imagine any other industry being allowed to get away with so many billing errors.
Calling them "errors" is charitable in many instances. We are handling the finances of my sister-in-law, who had a stroke last September. I have a file of bills that we have not paid because they are wrong - all too high, of course. A favorite tactic is for the provider to bill the insurance company an outrageous amount, the insurance company knocks it down to something more reasonable, and the provider then tries to get some or all of the difference from the patient.
This is called out-of-network. The paltry fees paid by the insurance company are irrelevant.

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Re: Medical Billing Error - a success story!

Post by Dead Man Walking » Thu Jun 16, 2016 11:52 pm

After my insurance paid for a major surgery, I was charged an extra forty-three thousand dollars ($43,000) by one of the best hospitals in the USA. The hospital is an in network provider and a major research and teaching hospital. Since I have a myriad of medical problems, the hospital had residents specializing in every condition I suffer from interview me daily. Other than diabetes, none of my other conditions affected my post op recovery. I learned later that one of their protocols actually aggravated one of my conditions. My insurance company went to bat for me and I paid nothing.
Insurance companies get a lot of bad reviews, but in my case they really came through.

DMW

amarone
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Re: Medical Billing Error - a success story!

Post by amarone » Fri Jun 17, 2016 5:31 am

toofache32 wrote:
amarone wrote:
sawhorse wrote:Great to hear! The number of medical billing errors is outrageous. I can't imagine any other industry being allowed to get away with so many billing errors.
Calling them "errors" is charitable in many instances. We are handling the finances of my sister-in-law, who had a stroke last September. I have a file of bills that we have not paid because they are wrong - all too high, of course. A favorite tactic is for the provider to bill the insurance company an outrageous amount, the insurance company knocks it down to something more reasonable, and the provider then tries to get some or all of the difference from the patient.
This is called out-of-network. The paltry fees paid by the insurance company are irrelevant.
They were not out of network.

toofache32
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Re: Medical Billing Error - a success story!

Post by toofache32 » Fri Jun 17, 2016 7:58 am

amarone wrote:
toofache32 wrote:
amarone wrote:
sawhorse wrote:Great to hear! The number of medical billing errors is outrageous. I can't imagine any other industry being allowed to get away with so many billing errors.
Calling them "errors" is charitable in many instances. We are handling the finances of my sister-in-law, who had a stroke last September. I have a file of bills that we have not paid because they are wrong - all too high, of course. A favorite tactic is for the provider to bill the insurance company an outrageous amount, the insurance company knocks it down to something more reasonable, and the provider then tries to get some or all of the difference from the patient.
This is called out-of-network. The paltry fees paid by the insurance company are irrelevant.
They were not out of network.
Then was it applied to a deductible or coinsurance?

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Re: Medical Billing Error - a success story!

Post by Userdc » Fri Jun 17, 2016 11:11 am

I am also convinced that many of these "errors" are fraudulent attempts by doctors and hospitals to get overpaid by forgetful or busy patients who don't check their math. And I bet their success rate is pretty high.

We recently went through this on an HSA plan, where we received a flood of bills in a short period of time. At least two of them did not make any attempt to run through our insurance to get the negotiated rate or the insurance portion of coverage (we blew through our deductible pretty handily).

In one of those cases, a hospital sent us three separate bills for different services all of which were run through our insurance company and matched the EOBs. But they also sent us a fourth bill for the same patient on the same day that was nowhere to be found on our insurance account. A quick call and - "oops, sorry about that sir, we will send you a new bill". given that we are in the 80/20 reimbursement portion of our plan, and the negotiated rate is usually half of the billed rate, I expect that the new bill will be 90% lower! How is that not criminal fraud?

Can you imagine the fines that a bank or mortgage company or consumer lender would pay if they had practices like this?

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Re: Medical Billing Error - a success story!

Post by dm200 » Fri Jun 17, 2016 11:33 am

I am also convinced that many of these "errors" are fraudulent attempts by doctors and hospitals to get overpaid by forgetful or busy patients who don't check their math. And I bet their success rate is pretty high
.

Yes - that could be true.

Based on the details and my conversations with the billing reps, I am convinced my case was just an inadvertant error. To be fair, i realize that the EXACT test/procedure I was wrongly billed for - under many of their plans, the charge would be legitimate under those plans.

I don't know how common another type of "error" that my wife encountered a few years ago might be. Here PCP ordered (and had performed) a certain test on a machine that practice had recently purchased/installed. The insurance company rejected the claim. We went round and round - bill resumbitted, insurance company rejected, etc. Turned out that this test, while applicable to a small number of conditions, was not appropriate for my wife. The doctor dropped the charge. Part of my "research" (internet searches) turned up advertising/promotion by the sellers of this equipment to doctors' offices that doctors can make their practices more "profitable" by purchase of that machine, recommending/prescribing more tests and billing those patients for the test/procedure. I will not get into any of the detailed medical information, which is beyond the scope of these discussions. The key "actionable" matter here is that patients should be wary of some things being prescribed to be done (billed and paid for) in Physicians' offices.

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Re: Medical Billing Error - a success story!

Post by amarone » Fri Jun 17, 2016 6:29 pm

toofache32 wrote:
amarone wrote:
toofache32 wrote:
amarone wrote:
sawhorse wrote:Great to hear! The number of medical billing errors is outrageous. I can't imagine any other industry being allowed to get away with so many billing errors.
Calling them "errors" is charitable in many instances. We are handling the finances of my sister-in-law, who had a stroke last September. I have a file of bills that we have not paid because they are wrong - all too high, of course. A favorite tactic is for the provider to bill the insurance company an outrageous amount, the insurance company knocks it down to something more reasonable, and the provider then tries to get some or all of the difference from the patient.
This is called out-of-network. The paltry fees paid by the insurance company are irrelevant.
They were not out of network.
Then was it applied to a deductible or coinsurance?
Nope. She had reached her annual out of pocket maximum under her ACA policy and therefore had neither further deductible or coinsurance to pay. As the "mistakes" were always in the health provider's favor, I am not inclined to believe that they were always genuine mistakes.

Mind you, there is one out-of-network situation. the biggest bill was after the local hospital said that they did not accept her insurance but they would do a contract with her insurance provider. They got paid the usual 30 - 35% of their bill and only six months later did they say it was out of network and demand the rest - after previously sending a bill showing a zero balance after the insurance paid. They are now demanding $27,000. If they push this, my sister-in-law will go bankrupt despite having insurance coverage. I cannot begin to say how I feel about this and the whole "healthcare system" without seriously breaching forum policies.

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Re: Medical Billing Error - a success story!

Post by toofache32 » Fri Jun 17, 2016 6:37 pm

amarone wrote:Nope. She had reached her annual out of pocket maximum under her ACA policy and therefore had neither further deductible or coinsurance to pay. As the "mistakes" were always in the health provider's favor, I am not inclined to believe that they were always genuine mistakes.

Mind you, there is one out-of-network situation. the biggest bill was after the local hospital said that they did not accept her insurance but they would do a contract with her insurance provider. They got paid the usual 30 - 35% of their bill and only six months later did they say it was out of network and demand the rest - after previously sending a bill showing a zero balance after the insurance paid. They are now demanding $27,000. If they push this, my sister-in-law will go bankrupt despite having insurance coverage. I cannot begin to say how I feel about this and the whole "healthcare system" without seriously breaching forum policies.
I'm sorry to hear about this. The last thing I can think of to make sure it's not in your control, is are the premiums for her ACA plan paid up to date? One of the biggest "gotchas" and hidden features of the ACA was that a patient can stop paying their premiums for 3 months before the insurance company will tell the providers that the patient no longer has an active policy. This actually retro-actively cancels the policy and all the money paid to providers from the last 3 months is demanded back by the insurer. If they don't pay it back, then insurance just deducts it from future payments and now the provider becomes the bill collector towards the patient.

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Re: Medical Billing Error - a success story!

Post by littlebird » Fri Jun 17, 2016 6:46 pm

toofache32 wrote:
amarone wrote:
sawhorse wrote:Great to hear! The number of medical billing errors is outrageous. I can't imagine any other industry being allowed to get away with so many billing errors.
Calling them "errors" is charitable in many instances. We are handling the finances of my sister-in-law, who had a stroke last September. I have a file of bills that we have not paid because they are wrong - all too high, of course. A favorite tactic is for the provider to bill the insurance company an outrageous amount, the insurance company knocks it down to something more reasonable, and the provider then tries to get some or all of the difference from the patient.
This is called out-of-network. The paltry fees paid by the insurance company are irrelevant.
This is also how it works under "regular" Medicare if you have a high deductible secondary plan. Typical EOB: "Doctor charged $602; Medicare paid $80: you owe $16."

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Re: Medical Billing Error - a success story!

Post by amarone » Sat Jun 18, 2016 4:24 am

toofache32 wrote:
amarone wrote:Nope. She had reached her annual out of pocket maximum under her ACA policy and therefore had neither further deductible or coinsurance to pay. As the "mistakes" were always in the health provider's favor, I am not inclined to believe that they were always genuine mistakes.

Mind you, there is one out-of-network situation. the biggest bill was after the local hospital said that they did not accept her insurance but they would do a contract with her insurance provider. They got paid the usual 30 - 35% of their bill and only six months later did they say it was out of network and demand the rest - after previously sending a bill showing a zero balance after the insurance paid. They are now demanding $27,000. If they push this, my sister-in-law will go bankrupt despite having insurance coverage. I cannot begin to say how I feel about this and the whole "healthcare system" without seriously breaching forum policies.
I'm sorry to hear about this. The last thing I can think of to make sure it's not in your control, is are the premiums for her ACA plan paid up to date?
Thanks for the suggestion, but yes, they are. Since her medical incident, we handle all her finances and make sure her premiums are paid.

amarone
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Re: Medical Billing Error - a success story!

Post by amarone » Sat Jun 18, 2016 4:26 am

littlebird wrote:
toofache32 wrote:
amarone wrote:
sawhorse wrote:Great to hear! The number of medical billing errors is outrageous. I can't imagine any other industry being allowed to get away with so many billing errors.
Calling them "errors" is charitable in many instances. We are handling the finances of my sister-in-law, who had a stroke last September. I have a file of bills that we have not paid because they are wrong - all too high, of course. A favorite tactic is for the provider to bill the insurance company an outrageous amount, the insurance company knocks it down to something more reasonable, and the provider then tries to get some or all of the difference from the patient.
This is called out-of-network. The paltry fees paid by the insurance company are irrelevant.
This is also how it works under "regular" Medicare if you have a high deductible secondary plan. Typical EOB: "Doctor charged $602; Medicare paid $80: you owe $16."
ACA plans are similar but if you are getting a subsidy, there is an out of pocket maximum. Once that has been reached, ACA would pay the full $96 in your example. That is one of the issues we are having. The provider is now being paid the full $96 by BC/BS, yet still billing us for the $16.

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