Questionable ethics of "Health Care Providers" ?

Question

I have recently had confrontations with several hospitals and medical labs which all subcontract their billing.

The subcontractors "block out" their caller IDs (e.g. 'Out of Area', with no tel. number given), misrepresent themselves (e.g. as as "Patient Services"), do not allow direct calls back to the person that you last spoke to, send out "Reminders", before an invoice is actually mailed, do not itemize their bills (e.g. six times on one bill "Hospital Services", no codes, no additional information given).

Note, I pay all invoices on time.

One Hospital's "Enforcer" started with daily harassing calls on Monday when the invoice had arrived only on Saturday (i.e. with still 2 weeks to pay). They next called at 2am on Tuesday. The hospital's administrative offices refused to even look into the issue of an incorrectly issued invoice. The harassing calls stopped only after I threatened to submit my file to the State's "Dept of Health and Senior Services".

Had similar experiences?

Answer 1

I've had all sorts of problems with "health insurance" and especially hospitals over the years.

I've had things clearly covered in the policy, which were PRE-AUTHORIZED with a pre-auth number on the initial consult form, etc. "denied" because it "was not covered." A lot of people don't "appeal," I did and pointed out the facts: no leg to stand on: it's in the policy, it was pre-authorized, nothing more was done during the visit. They had to pay their responsibility, but not after harassing me.

I had another more recent example where I had an injury while covered and went to see my regular doc. His office had no med staff that day and I was told to go to urgent care in the building. I did and the first thing I said was: "Do you take this policy?" Yes. I told the doc: "Do the minimum to do right." He did. Then he said I MUST see an orthopedist within 48 hours. I called the insurance to see if I had to. They said yes and it would be covered. I got the doc list FROM THEM and then picked one. I called and gave the diagnosis from the urgent care MD. I was told, "For that you have to go to this ER." I said, "No, please let me come in and IF you need me to go to the ER then let's do it." Gal claims she talked to the doc and he said no, ER required. I checked the insurance: they covered that ER. I was driven to the ER. Went to ER admissions. Before I signed anything, first question, "Do you take this policy?" Yes.
Turns out orthopod would not come (now mid-afternoon on Fri) so ER PA played around for awhile and I told her to do the least possibly for right treatment. On way out, I stopped at Cashiering (that's the design). Heard what the policy was and the gal said, "Oh you don't even have a co-pay!"
Got home, sent in the required claim form before I'd even been billed (totally acceptable).
Got an ER bill--ignored it--came too soon.
Week later got an EOB (Explanation of Benefits)--they had paid the ER. My responsibilty: $0.

I got another ER bill--sent a copy of the claim form and said YOU fax it in case something got missed, but it's being processed. They took that--never heard a peep.
So all was good, right?
Nope, got another bill from ER--claiming I owed what the insurance wrote-off.
I called, stated I had an EOB that said differently. They then came up with this BS: "Oh we don't have a contract with them anymore so you owe." I said I had asked EVERYONE you could: the insurance, the admissions, the cashier AND they had been paid by insurance, so NO, that was NOT an acceptable response.
For months they harassed me. They started tacking on interest and other BS. I refused to pay and contacted the AG's office. Idiots told me to hire an attorney!
It was a pure scam on the part of the hospital--not a leg to stand on and I'm supposed to fork over for an attorney? It's probably on my credit report, but I say contract law is on MY side and I have that EOB and they can stick it. IF I had been told before treatment: We don't take your insurance, I would have gone home. I was LIED to and I had gone above and beyond all reasonable efforts to ensure it was covered--and as the insurance PAID--it WAS covered.
Rational people would have said, "Our mistake" and left me alone. Greedy SOBs wouldn't.

Oh, and here's a new wrinkle:
http://www.businessweek.com/bwdaily/dnflash/content/nov2007/db20071120_397008.htm

Answer 2

1

Answer 3

yeah, I had to resort to a lawyer, before they would stop harrassing me...and they started the day I got home from the hospital, before they had even sent out an invoice!! And then when I demanded an itemized invoice, they refused, until I said my lawyer would report them to the attorney general's office, in this state it is a law to provide an itemized bill on request. So, yeah, I can fully identify with what has happened to you, welcome to the american health care system.

Answer 4

Two suggestions, one- record all conversations with any person regarding this matter and second, change your answering machine to say " all unsolicited incoming commerical calls are recorded and will be prosecuted to the fullest extent of the law" You can file complaints with the phone co, Fed Trade Comm. and your local DA.