HomeFairfax General ForumArrest/Ticket SearchWiki newPictures/VideosChatArticlesLinksAbout
Insurance Fraud? You tell me
Posted by: yellow mellow ()
Date: August 30, 2010 04:23PM

cliff notes:

Broke a toe
Went to ER for xray (i thought it was 2 toes)
Paid my copay which was about 130 or 120 at the hospital
Thought that was it.


Receive a bill from the hospital for 100 (another copay)

The hospital submitted my visit as 2 claims.
1) Emergency Service 130.
2) Surgery-Bone/Muscle 100

I called the place that sent me the bill ; they said this bill is for the doctor. The other bill was for the visit..

Is this normal?


I will pay it regardless I just don't want it on my credit report

Re: Insurance Fraud? You tell me
Posted by: More Complete ()
Date: August 30, 2010 04:26PM

You tell me?

Re: Insurance Fraud? You tell me
Posted by: Johnny Walker ()
Date: August 30, 2010 04:28PM

I believe this is pretty normal. The hospital doesn't always do the collection for the doctor that is working there. They are their own thing.

Re: Insurance Fraud? You tell me
Date: August 30, 2010 04:29PM

yellow mellow Wrote:
-------------------------------------------------------

>
> Is this normal?
>
>
> I will pay it regardless I just don't want it on
> my credit report


Yes. Emergency Service and Surgery are usually under two difference categories in Insurance Policies. I usually get two or three different bills from different entities when I have a visit (a lab or radiology will send their own bills, for instance, separate from the hospital). It's not fraud. Just an inefficient, fucked up system that is the pride of the "free market."

---------------------------------------------------------------------------------
http://bible.cc/1_corinthians/13-11.htm

Re: Obama + Goldman Sachs > Bush + ENRON - Where's the Outrage?
Posted by: WingNut ()
Date: August 30, 2010 04:56PM

Re: Obama + Goldman Sachs > Bush + ENRON - Where's the Outrage?


idontlikebeingrightaboutshitlikethisbutiam



Edited 21 time(s). Last edit at 5/31/1967 05:57AM by WingNut.

Last edit at 11/30/2015 01:37PM Last edit at 5/14/2015 03:52PM Last edit at 1/28/2014 05:57AM Last edit at 11/29/2015 01:10PM Last edit at 3/14/2011 11:52PM Last edit at 7/20/2012 04:07AM
Last edit at 6/29/2013 11:18PM Last edit at 3/19/2011 01:02PM Last edit at 3/26/2012 09:07PM



Edited 1 time(s). Last edit at 12/18/2015 07:56PM by WingNut.


Re: Insurance Fraud? You tell me
Date: August 30, 2010 05:02PM

WingNut Wrote:
-------------------------------------------------------
> It's a waste of money going to the doctor for
> broken toes, all they'll do is the same thing you
> can easily do yourself. Tape them together and
> don't do any jumping jacks for a week or so. That
> copay you wasted could have bought a lot of tacos.


I guess it depends on the break. I broke a toe once and got by with a tight-fitting pair of shoes for about a month. There was some discomfort for about six months, but it is fine now.

---------------------------------------------------------------------------------
http://bible.cc/1_corinthians/13-11.htm

Re: Insurance Fraud? You tell me
Posted by: It's normal ()
Date: August 30, 2010 05:08PM

> Receive a bill from the hospital for 100 (another
> copay)
>
> The hospital submitted my visit as 2 claims.
> 1) Emergency Service 130.
> 2) Surgery-Bone/Muscle 100
>
> I called the place that sent me the bill ; they
> said this bill is for the doctor. The other bill
> was for the visit..
>
> Is this normal?
>
>
> I will pay it regardless I just don't want it on
> my credit report

It is normal for two separate bills and often 3. If the bill is for the ER Doc your can expect a third bill from the radiologist (xray reader). Don't panic and just pay. Take a few minutes to verify that they have all been presented to your insurance company first.

Re: Obama + Goldman Sachs > Bush + ENRON - Where's the Outrage?
Posted by: WingNut ()
Date: August 30, 2010 05:08PM

Re: Obama + Goldman Sachs > Bush + ENRON - Where's the Outrage?


idontlikebeingrightaboutshitlikethisbutiam



Edited 21 time(s). Last edit at 5/31/1967 05:57AM by WingNut.

Last edit at 11/30/2015 01:37PM Last edit at 5/14/2015 03:52PM Last edit at 1/28/2014 05:57AM Last edit at 11/29/2015 01:10PM Last edit at 3/14/2011 11:52PM Last edit at 7/20/2012 04:07AM
Last edit at 6/29/2013 11:18PM Last edit at 3/19/2011 01:02PM Last edit at 3/26/2012 09:07PM



Edited 1 time(s). Last edit at 12/18/2015 07:57PM by WingNut.


Re: Insurance Fraud? You tell me
Posted by: Warhawk ()
Date: August 30, 2010 05:13PM

Just one more reason that I'd better be on death's door before I'll go to an ER. I may be having a heart attack or a bone sticking out of my arm, but I don't need to add financial rape to my problems.

__________________________________
That's not a ladybug, that's a cannapiller.

Re: Insurance Fraud? You tell me
Posted by: It's normal ()
Date: August 30, 2010 05:48PM

WashingTone-Locian Wrote:
------------------------------------------------------->
> Just an inefficient, fucked up system that is the pride of the "free market."


Au contraire, Mon frère. I couldn’t agree more that it is an inefficient system. However, the manor in which the current health care system functions, and has for my 40 plus years, is exactly like a government program. No other service or industry is even close. Meaning those of us who are fortunate enough to be covered by a health plan have NEVER asked a doctor what he charges, what an operation will cost, what a med cost etc. Why? Because we are only aware of our co pay and the total cost doesn’t matter. We’re not paying for it. I haven’t met anyone yet (who had insurance) who shopped a doctor because of cost. It all depends on if you “like†him or her. I’ve heard plenty of griping over the years of “What the insurance didn’t pay†but always after the fact. Expect the cost to continue to rise for the very same reason. It is not an example of the free market system.

Re: Insurance Fraud? You tell me
Posted by: itchy ()
Date: August 30, 2010 05:50PM

hospitals are a joke and a financial nightmare even with insurance. The last time I went to an emergency room was for a broken shoulder. I waited for 3 hours just to be seen by hospital staff; 8 hours of my time were wasted there that day. I won't go anymore unless it's condition critical or I know I need antibiotics for an infection. I smashed and broke my pinky whitewater kayaking last year and splinted it myself. I have suture kits for deep cuts. If I can't reach it to stich it, I'll find someone who can.

Re: Insurance Fraud? You tell me
Posted by: dika-dika ()
Date: August 30, 2010 06:02PM

Next time go to a Black Market Doctor (unlicensed/illegal). One bill for everything. Quite a few serving this area.

-------------------------------------------------------------------------------------

Re: Insurance Fraud? You tell me
Posted by: Troll@AOL ()
Date: August 30, 2010 06:58PM

1 candle + 1 Jack-O-Lantern - Entire House = Insurance Fraud

==================================================================================
"Why don't you LOSERS just pack your flower print DOUCHE BAGS
and get your stoopid @$$#$ THE FUCK OFF MY INTERNETZ!"

- 'philscamms' (the YT Watchdog) ; internet & YouTube® extraordinaire.

Re: Insurance Fraud? You tell me
Posted by: justsayin ()
Date: August 30, 2010 07:05PM

That's one of the jokes of health insurance, especially with NoVA hospitals. Insurance reps will say you are "covered" at area hospitals, but that only covers employees of the hospitals. Years ago INOVA hospitals outsourced their emergency rooms, and those companies often don't bother negotiating rates with insurance companies. The end result is often the emergency room is out-of-network.

You can see what your insurance company is willing to pay and ask those doctors if that will be acceptable. If not, I'm afraid you'll have to take the pittance the insurance will give you and bend over for the balance-billing. Welcome to the joke of our health-insurance based system.



Edited 1 time(s). Last edit at 08/30/2010 07:06PM by justsayin.

Re: Insurance Fraud? You tell me
Posted by: Britdrnva~ ()
Date: August 30, 2010 07:26PM

I deal with this a lot - it isn't insurance fraud but as a consumer I can easily see how you view this.

I would check with your insurance company if you have any questions they can likely explain it far better than anyone here. Based on what you're saying it appears your insurance - you pay a copay for getting into the ER then it's set up so that additional services could be charged as extra (SCANS, radiology, XRAY, specialists, etc.) once you've met the minimum acceptable payments insurance will kick in.

It's a convoluted process, highly inefficient and honestly doctors hate insurance probably more than the average consumer.

I would say doctors are 50/50 split between no insurance system whatsoever (i.e. no middleman and consumers paying fairly standard fees - like you would to get an oil change for example) vs nationalized health. Ask any doc if they like insurance and 9.9/10 the answer is an unequivocal no.

Re: Insurance Fraud? You tell me
Posted by: Whobe ()
Date: August 30, 2010 07:33PM

I think I've been billed from 4-5 different sources on my last surgery. A procedure that should have cost less than $10k was somehow inflated to a $30K procedure by the doctor/surgery center (that he is a part owner of) all for about 1 1/2 hours surgery tops and 4-5 hours of me actually being present.

And my out of pocket has been at least double what the pre-operative estimates were quoted as.

Re: Insurance Fraud? You tell me
Posted by: Curious One ()
Date: August 30, 2010 07:46PM

Whobe Wrote:
-------------------------------------------------------
> I think I've been billed from 4-5 different
> sources on my last surgery. A procedure that
> should have cost less than $10k was somehow
> inflated to a $30K procedure by the doctor/surgery
> center (that he is a part owner of) all for about
> 1 1/2 hours surgery tops and 4-5 hours of me
> actually being present.
>
> And my out of pocket has been at least double what
> the pre-operative estimates were quoted as.

Typically your out of pocket are capped. Were you insured? Did you pay over the cap?

Re: Insurance Fraud? You tell me
Posted by: Whobe ()
Date: August 30, 2010 09:08PM

Not the greatest but I do have insurance, had unicare at the time. Kind of high deductible.

Re: Insurance Fraud? You tell me
Posted by: Curious One ()
Date: August 30, 2010 09:16PM

Whobe Wrote:
-------------------------------------------------------
> Not the greatest but I do have insurance, had
> unicare at the time. Kind of high deductible.

Got that. Most of the plans are high deductible now. To go from 10K to 30K is outrageous but I have no problem believing that's what happened.

Re: Insurance Fraud? You tell me
Posted by: Hugh Johnson ()
Date: August 30, 2010 09:25PM

Totally normal to get a separate bill from the ER doc AND hospital. Call your insurance company first before paying to verify, but yeah, normal.

Also, your insurance company might reimburse you later for some of the costs.

Re: Insurance Fraud? You tell me
Posted by: Teh King ()
Date: August 30, 2010 09:29PM

Lemme guess, you went to the Innova Emergency Care Center on Chain Bridge in Fairfax?

Re: Insurance Fraud? You tell me
Posted by: mark j ()
Date: August 30, 2010 09:29PM

Just because the hospital or dr bills a certain fee does not mean they
will get it from you or your ins. company. Once you are on an insurance panel, you will only get the contract rate no matter what your fee is...Surgery I had this past yr was billed at 20K...my insurance covered only $10k. Because this is the contracted rates for these services, the hospital had to write the rest off. I could not be billed for the difference (after my copays, of course.)

This crazy system will only get worse as Obamacare kicks in...God help us all.
Hopefully, after the Nov elections, let's hope Obamacare will be repealed piece by piece

Re: Insurance Fraud? You tell me
Posted by: overklok ()
Date: August 30, 2010 09:37PM

This method of billing is standard for the medical industry. Look at your bill from the doctor, I bet it is a bunch of codes that you will never be able to decipher. You will get a bill from the doctor and the facility. Doctor and hospital billing is a scam. What other industry do you pay for services rendered without knowing the cost beforehand. I got 7 stitches to seal a cut 1 month ago, the total bill was 1200.00. What a ripoff, I was there for total of one hour, doctor worked on me for 15 minutes.

Re: Insurance Fraud? You tell me
Posted by: all the same ()
Date: August 30, 2010 10:06PM

Teh King Wrote:
-------------------------------------------------------
> Lemme guess, you went to the Innova Emergency Care
> Center on Chain Bridge in Fairfax?

They all operate the same, Inova, Arlington, Alexandria etc.

Re: Insurance Fraud? You tell me
Posted by: momma ()
Date: August 31, 2010 11:41AM

file a complaint and make sure it is reviewed

Re: Insurance Fraud? You tell me
Posted by: TOE be or Not to be ()
Date: August 31, 2010 11:44AM

How did you break your toe anyway??

Re: Insurance Fraud? You tell me
Posted by: momma? ()
Date: August 31, 2010 11:46AM

momma Wrote:
-------------------------------------------------------
> file a complaint and make sure it is reviewed

Momma...read the thread

With who? For What?

Re: Insurance Fraud? You tell me
Posted by: yellow mellow ()
Date: August 31, 2010 11:58AM

it was a inova hospital

Re: Insurance Fraud? You tell me
Posted by: int ()
Date: August 31, 2010 12:16PM

a little interesting snippet from businesssweek:

"After Dr.Mark Logsdon tore a ligament in his knee skiing at Lake Tahoe in March, he returned home to Sacramento and had an MRI scan at Sutter Davis Hospital. Sutter's price for the knee scan was $1,271, payable by Logsdon and his insurer. The same MRI at a local office owned by Radiological Associates of Sacramento would have cost $696, or 45 percent less.

Logsdone didn't know something his insurer does: Sutter Health, the non-profit that owns Sutter Davis, charges 40 percent to 70 percent more than its rivals for a typical procedure, and it requires insureres to keep its rates secret."

Re: Insurance Fraud? You tell me
Posted by: momma ()
Date: August 31, 2010 12:46PM

unless you know the exact in and outs of your ins. policy, i'd file a dispute w the provider to have it reviewed. or file a complaint w the county. this happened to me before (i have bcbs) after a ER visit and i was billed separately by the dr and a hosp specialist (beyond the copay). doctors will bill you and take the risk that you or your ins company can't figure out what exactly you're responsible for. i called bcbs to dispute the bills from the dr and hosp specialist and they told me i was responsible. it took me filing a formal complaint for the ins. co to realize that my policy did include all ER needs.

Re: Insurance Fraud? You tell me
Posted by: momma? ()
Date: August 31, 2010 12:58PM

momma Wrote:
-------------------------------------------------------
> unless you know the exact in and outs of your ins.
> policy, i'd file a dispute w the provider to have
> it reviewed. or file a complaint w the county.
> this happened to me before (i have bcbs) after a
> ER visit and i was billed separately by the dr and
> a hosp specialist (beyond the copay). doctors will
> bill you and take the risk that you or your ins
> company can't figure out what exactly you're
> responsible for. i called bcbs to dispute the
> bills from the dr and hosp specialist and they
> told me i was responsible. it took me filing a
> formal complaint for the ins. co to realize that
> my policy did include all ER needs.

Thanks for elaborating. Helpful explanation and useful.

This forum powered by Phorum.