How do you handle the pushback from billing department that they have to honor the contracted insurance rates and the only other options are needs based discount or a payment plan?
Hi MG! Thank you for the question. I reject the idea that it’s ok for the insurance companies and hospitals to agree to make us overpay. I don’t care if they have a contract, they do not have a right to ignore the patient, who is also a party to the agreement. So I reject their premise on this one and insist that the patient be considered and treated fairly.
Marshall, of course some billers think it’s their claim. It’s not. As I’m sure you’re aware, it’s always the patient’s claim. The payment may be assigned to the provider but that’s about it. The provider’s contract with the health plan cannot interfere with the patient’s rights under the plan. Interestingly, the ACA integrated some ERISA principles into the plan, such as appeal rights. Timely filing is another big area.
This is great if the hospital/health center decides to back down. Would you have any suggestions that I can share with our local small claims court judges on how to judicate besides the Federal Open Price Term? Our local small claims court judge stated he did not know how to judicate this type of situation by telling a health system on what they can or cannot charge, but is willing to be educated. It would be great if you have any suggestions particularly for unnecessary procedures/protocols and upcoding. Although the judge saw I had valid arguments with evidence, he dismissed my case and kept it open to be readdressed if I choose to. He felt the only way to proceed is to wait for them to sue me and for me to defend my case or wait for them to send me to collections and have the debt collector sue me for unpaid bills....which both scenarios I was hoping to prevent. I appreciate that the judges are willing to be educated if I had information to share on how to proceed in such case.
Thank you for your platform and invaluable information. I appreciate if you do have any input you may have in this type of case to share.
How do you handle the pushback from billing department that they have to honor the contracted insurance rates and the only other options are needs based discount or a payment plan?
Hi MG! Thank you for the question. I reject the idea that it’s ok for the insurance companies and hospitals to agree to make us overpay. I don’t care if they have a contract, they do not have a right to ignore the patient, who is also a party to the agreement. So I reject their premise on this one and insist that the patient be considered and treated fairly.
Marshall, of course some billers think it’s their claim. It’s not. As I’m sure you’re aware, it’s always the patient’s claim. The payment may be assigned to the provider but that’s about it. The provider’s contract with the health plan cannot interfere with the patient’s rights under the plan. Interestingly, the ACA integrated some ERISA principles into the plan, such as appeal rights. Timely filing is another big area.
This is great if the hospital/health center decides to back down. Would you have any suggestions that I can share with our local small claims court judges on how to judicate besides the Federal Open Price Term? Our local small claims court judge stated he did not know how to judicate this type of situation by telling a health system on what they can or cannot charge, but is willing to be educated. It would be great if you have any suggestions particularly for unnecessary procedures/protocols and upcoding. Although the judge saw I had valid arguments with evidence, he dismissed my case and kept it open to be readdressed if I choose to. He felt the only way to proceed is to wait for them to sue me and for me to defend my case or wait for them to send me to collections and have the debt collector sue me for unpaid bills....which both scenarios I was hoping to prevent. I appreciate that the judges are willing to be educated if I had information to share on how to proceed in such case.
Thank you for your platform and invaluable information. I appreciate if you do have any input you may have in this type of case to share.