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Let me tell you my story about being in the hospital for a few days. This is going to be a long one folks, but I’d like your thoughts about what to do to resolve the situation. Here goes! For my birthday, my thoughtful brother who is turning 50 this year, decided to get health conscious. For my birthday, he sent me a pedometer and a neat electronic blood pressure monitor. Well, I tried it out and got a reading of 248/149. With a reading like this, I figured it must be broken! To make an even longer story shorter, I found out it was not broken! I told one of my friends about it and she screamed at me and took me to the Emergency Room. When the nurses took my BP it read 239/146 and their eyes nearly bugged out. I ended up staying in the hospital for a few days until it came down. As I was admitted, I asked whether the hospital accepted BCBS and was told “Yes” by the admitting office. Here’s where the problem starts. I later got a statement from BCBS saying that the emergency room doctor was not “in the network” and that I now owed him several hundred bucks. Why was I not informed of this fact? I spent maybe 10 minutes with him and perhaps he spent another 10 minutes looking at my CAT scan. So this guy was earning about $40 a minute for the time he spent on my case. The problem nowadays is that hospital personnel don’t resemble the days of Dr Kildare with the doctors having there white garb with a name tag indicating that they actually are doctors. Everyone is dressed in multicolor outfits and you can’t tell the doctors from the physician assistants or the nurse practitioners or the nurses. Everyone is "Charlie" or "Sue" or "Nancy". If I had known this guy was not “in network” I would have refused to deal with him. He didn’t tell me anything I didn’t already know!
This whole situation rankles me to no end! I’m glad I was not in a situation where I needed extensive emergency surgery and ended up with a bill where BCBS pays $25,000 and because the operating doctor was not “in network”, I now owed him $35,000! This is the new “surprise” that now befalls everyone who thinks they are covered by their health insurance. The funny thing is, that had I gone to the hospital two weeks before, I would have been covered for this. It seems that CMC changed their “Doctor Group” that operates (no pun intended) out of the hospital. This is the dirty little secret that catches a lot of patients. Doctors and other specialists don’t work for the hospital. They work for a group that operates out of the hospital. So while your hospital bill minus any co-pays is taken care of, the doctor bills you accrue in the hospital may not be. This is especially true for emergency room visits. At least if you’re having elective procedures you can do more extensive research on this issue. Patient Beware!
My situation is thus: Should I pay the entire bill from him? BCBS sent me a check for what they pay for this “out of network” scenario. I wish they had sent it directly to him instead. The amount seemed to be in line, percentage-wise, of what they would pay to an “in-network doctor”. My friend who took me to the hospital thinks that I should send him a check for the amount of what BCBS sent to me and to forget about the rest of the amount. I’m tending to agree with this. Have you had this happen to you? What did you do?
Here’s a link to an article that deals with this increasingly common situation. It's interesting to note that California and New Jersey have "outlawed" emergency room balance billing. I'm figuring that the NC legislature will get to this right after 485 is completed! BTW, I must say that the care I got there was excellent! The Charlotte area should be justly proud of the great hospitals we have here!
Let me tell you my story about being in the hospital for a few days. This is going to be a long one folks, but I’d like your thoughts about what to do to resolve the situation. Here goes! For my birthday, my thoughtful brother who is turning 50 this year, decided to get health conscious. For my birthday, he sent me a pedometer and a neat electronic blood pressure monitor. Well, I tried it out and got a reading of 248/149. With a reading like this, I figured it must be broken! To make an even longer story shorter, I found out it was not broken! I told one of my friends about it and she screamed at me and took me to the Emergency Room. When the nurses took my BP it read 239/146 and their eyes nearly bugged out. I ended up staying in the hospital for a few days until it came down. As I was admitted, I asked whether the hospital accepted BCBS and was told “Yes” by the admitting office. Here’s where the problem starts. I later got a statement from BCBS saying that the emergency room doctor was not “in the network” and that I now owed him several hundred bucks. Why was I not informed of this fact? I spent maybe 10 minutes with him and perhaps he spent another 10 minutes looking at my CAT scan. So this guy was earning about $40 a minute for the time he spent on my case. The problem nowadays is that hospital personnel don’t resemble the days of Dr Kildare with the doctors having there white garb with a name tag indicating that they actually are doctors. Everyone is dressed in multicolor outfits and you can’t tell the doctors from the physician assistants or the nurse practitioners or the nurses. Everyone is "Charlie" or "Sue" or "Nancy". If I had known this guy was not “in network” I would have refused to deal with him. He didn’t tell me anything I didn’t already know!
This whole situation rankles me to no end! I’m glad I was not in a situation where I needed extensive emergency surgery and ended up with a bill where BCBS pays $25,000 and because the operating doctor was not “in network”, I now owed him $35,000! This is the new “surprise” that now befalls everyone who thinks they are covered by their health insurance. The funny thing is, that had I gone to the hospital two weeks before, I would have been covered for this. It seems that CMC changed their “Doctor Group” that operates (no pun intended) out of the hospital. This is the dirty little secret that catches a lot of patients. Doctors and other specialists don’t work for the hospital. They work for a group that operates out of the hospital. So while your hospital bill minus any co-pays is taken care of, the doctor bills you accrue in the hospital may not be. This is especially true for emergency room visits. At least if you’re having elective procedures you can do more extensive research on this issue. Patient Beware!
My situation is thus: Should I pay the entire bill from him? BCBS sent me a check for what they pay for this “out of network” scenario. I wish they had sent it directly to him instead. The amount seemed to be in line, percentage-wise, of what they would pay to an “in-network doctor”. My friend who took me to the hospital thinks that I should send him a check for the amount of what BCBS sent to me and to forget about the rest of the amount. I’m tending to agree with this. Have you had this happen to you? What did you do?
Here’s a link to an article that deals with this increasingly common situation. It's interesting to note that California and New Jersey have "outlawed" emergency room balance billing. I'm figuring that the NC legislature will get to this right after 485 is completed! BTW, I must say that the care I got there was excellent! The Charlotte area should be justly proud of the great hospitals we have here!
Oh Em, how awful that you had this health scare and now the aggravation following! Hope you are all better now and keeping that blood pressure under control.
I'm sure Ani will have a lot more to say than I can, but until she shows up I'll give you my 2 cents. I would call the doctors office manager. Explain the situation to her and work a deal to send them the exact amount BCBS sent you. If you don't try to work this out with them they may try to turn you over to a credit agency and hurt your credit scores.
It is just ridiculous that the hospital didn't warn you this doc was not in network for you. Shouldn't all ER docs be available to all people? I know if you call in a specialist you have to be careful to call one in network, but your ER doctor, in the middle of a crisis???
You should not have to pay that doc one penny more than whatever the contracted price is for in network doctors. Call his office and say that and tell them you will await a corrected statement showing the contract price has been adjusted.
Oh Em, how awful that you had this health scare and now the aggravation following! Hope you are all better now and keeping that blood pressure under control.
I'm sure Ani will have a lot more to say than I can, but until she shows up I'll give you my 2 cents. I would call the doctors office manager. Explain the situation to her and work a deal to send them the exact amount BCBS sent you. If you don't try to work this out with them they may try to turn you over to a credit agency and hurt your credit scores.
It is just ridiculous that the hospital didn't warn you this doc was not in network for you. Shouldn't all ER docs be available to all people? I know if you call in a specialist you have to be careful to call one in network, but your ER doctor, in the middle of a crisis???
Thanks for the kind words loves! That's the sad situation for many people who end up in the emergency room. I thought I had all my "bases" covered. I'm so peeved about this. I strongly suspect that even if I call them, they're going to want the full amount. Everyone wants their money these days. I went through a similar situation with my mother after she died of breast cancer. The doctor she went to, was "in network" and padded his bills anyway. BCBS told me to ignore his requests as they were "illegal" in NJ. He turned the unpaid amount over to a collection agency who constantly called me threatening to ruin "my" credit. I told her I wasn't the patient (my mother had died several months before) and that she didn't even know my name anyway. She persisted and I started getting to the point of using "lanugage" that would melt C-D's server! LOL. Eventually, I ended up changing my phone number and it went away. I used to write "Deceased-Return to Sender on the bills. They went away after a while too! Can you tell I'm "itching" for a fight?
ani - This was not the actual ER physician that intially treated me. This was a guy who showed up on the second day, who told me about my CAT scan results. I thought he was a PA. Now, I'm advising all my friends not to use CMC and to check out Presbyterian as they don't seem to have this problem - yet, as far as I can determine!
Thanks for the kind words loves! That's the sad situation for many people who end up in the emergency room. I thought I had all my "bases" covered. I'm so peeved about this. I strongly suspect that even if I call them, they're going to want the full amount. Everyone wants their money these days. I went through a similar situation with my mother after she died of breast cancer. The doctor she went to was "in network" and padded his bills anyway. BCBS told me to ignore his requests as they were "illegal" in NJ. He turned the unpaid amount over to a collection agency who constantly called me threatening to ruin "my" credit. I told her I wasn't the patient (my mother had died several months before) and that she didn't even know my name anyway. She persisted and I started getting to the point of using "lanugage" that would melt C-D's server! LOL. Eventually, I ended up changing my phone number and it went away. I used to write "Deceased-Return to Sender on the bills. They went away after a while too! Can you tell I'm "itching" for a fight?
NO NO - there is legislation - albeit fine points of the law - backing up your request to ask for the contract in network rate. Plus, the fact that you are retired . . . there are many nuances to the law that should get a very polite and immediate agreement to lower that bill to reflect what you would have been charged for an in network doc.
Call them right now. If you have problems, you let me know and I will tell you what to do next, but you should not get even a SHADE of huffiness about your request.
ani - This was not the actual ER physician that intially treated me. This was a guy who showed up on the second day, who told me about my CAT scan results. I thought he was a PA. Now, I'm advising all my friends not to use CMC and to check out Presbyterian as they don't seem to have this problem - yet, as far as I can determine!
That is why I was asking if he were a hospitalist. Many hospitals are using hospitalists now - very common - but if he is subcontracted, not your fault - so there should be no question about billing. Honestly.
ani - This was not the actual ER physician that intially treated me. This was a guy who showed up on the second day, who told me about my CAT scan results. I thought he was a PA. Now, I'm advising all my friends not to use CMC and to check out Presbyterian as they don't seem to have this problem - yet, as far as I can determine!
I do have to say, last year when I went in to Presby-Main for appendicitis, the ER was very helpful in giving me a list of who my options were for surgeons on call. In the past you just seemed to take whatever surgeon was in the hospital, but now you have to be sure to get one in your network. We called the one I liked best off the list the ER gave me and he came right over and took me to surgery. So, yes, Presbyterian seems to have a better handle on this for sure.
That is why I was asking if he were a hospitalist. Many hospitals are using hospitalists now - very common - but if he is subcontracted, not your fault - so there should be no question about billing. Honestly.
I promise you - we can fix this.
Presby has a great hospitalist
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I told one of my friends about it and she screamed at me and took me to the Emergency Room. When the nurses took my BP it read 239/146 and their eyes nearly bugged out. I ended up staying in the hospital for a few days until it came down. As I was admitted, I asked whether the hospital accepted BCBS and was told “Yes” by the admitting office. Here’s where the problem starts. I later got a statement from BCBS saying that the emergency room doctor was not “in the network” and that I now owed him several hundred bucks. Why was I not informed of this fact? I spent maybe 10 minutes with him and perhaps he spent another 10 minutes looking at my CAT scan. So this guy was earning about $40 a minute
