Insured patients are showing up for medical appointments and being told to pay the ENTIRE BILL up front or they won’t get treatment. What should they do?
I actually have a question it is along these lines. I read "Got a Bogus bill Sue Them". My husband went to the doctor, they took knee x-rays and gave him a shot in the knee. We received a $5,874.00 they included an adjustment of $2349.60. For a total of $3524.40 amount due. I did not pay it. I wrote them a letter asking for a reasonable and customary bill. They sent me past due bill for being late of $4324.80. That is $800.40 extra. They never returned any of my calls, I also sent a certified letter to them, they kept it for a month, before they sent another bill, $4324.80. Today I just received a final notice. My question is should I start my small claims today or do something else?
Very interesting. I'm a member of a health care sharing ministry and have experienced this myself. In 2022 I was found to have a tumor that needed to be removed and biopsied. The day before the procedure was to occur, I get a call from the hospital demanding I pay $28K. I didn't have it and I refused. I've worked in the health care industry for 13 years at that point, first at a medical bill negotiation firm, and now as a sales consultant for a health plan company. I knew how to push back, and we used every resource we had, which included a fabulous surgeon who had been kind enough to give his cell phone number to us (he gives it to all his patients; he also doesn't entrust his patients to hospitalists; very old-school, and very amazing). He actually worked on my behalf speaking to the CEO of the hospital, while I asked politely to speak to the supervisor of the young guy who had called demanding $28K.
After about an hour and a half of waiting for a return call, I phoned the original guy who called me and, detailing how unethical it was when I was facing possible cancer to be held hostage by their demands for up front payment in full. They knew I was a member of Samaritan (they had been paid in a timely manner the year prior when I had a ruptured appendix), so they knew I was good for the charges. I proceeded to be very direct and firm and told the young guy in the billing office that he was going to take my credit card number, and take $5K and I was going to have the procedure. Sure enough...he took it. I had the procedure and the second day as I was recovering I had the hospital CEO show up in my room to apologize.
I knew what to do, and it wasn't easy to do. I had a credit card (don't tell Dave Ramsey!)...but had I been able to walk away and keep a trusted surgeon (who is amazing at working for his patients), I would have.
That said, I cannot reiterate what you said in what you said in number 1 in Before the Appointment. I speak with thousands of people each year looking for quality health plans and far too many have the perspective that having insurance is like having someone else's credit card. It isn't. If the insurer declines to pay for the service, whatever it may be, the patient is the final guarantor of a service once rendered. If it wasn't that way, everyone in the US would love their insurance, and trust me: they don't.
I would add, especially for those who have employer sponsored plans...don't stop with HR. Ask to speak to the insurance agent rep that works with the employer. They may be able to up the ante a bit. They really don't want to lose a client for something a medical provider is doing.
I actually have a question it is along these lines. I read "Got a Bogus bill Sue Them". My husband went to the doctor, they took knee x-rays and gave him a shot in the knee. We received a $5,874.00 they included an adjustment of $2349.60. For a total of $3524.40 amount due. I did not pay it. I wrote them a letter asking for a reasonable and customary bill. They sent me past due bill for being late of $4324.80. That is $800.40 extra. They never returned any of my calls, I also sent a certified letter to them, they kept it for a month, before they sent another bill, $4324.80. Today I just received a final notice. My question is should I start my small claims today or do something else?
Thanks again Marshall. A sad truth. It's not getting better. It does require Deb Aut and AIMM to be the champion. Well done.
This is great info to know and be prepared for. Incredible how low the ethics of the medical industry has dropped!
In the end, this will produce more regulations and laws to constrain this behavior.
Very interesting. I'm a member of a health care sharing ministry and have experienced this myself. In 2022 I was found to have a tumor that needed to be removed and biopsied. The day before the procedure was to occur, I get a call from the hospital demanding I pay $28K. I didn't have it and I refused. I've worked in the health care industry for 13 years at that point, first at a medical bill negotiation firm, and now as a sales consultant for a health plan company. I knew how to push back, and we used every resource we had, which included a fabulous surgeon who had been kind enough to give his cell phone number to us (he gives it to all his patients; he also doesn't entrust his patients to hospitalists; very old-school, and very amazing). He actually worked on my behalf speaking to the CEO of the hospital, while I asked politely to speak to the supervisor of the young guy who had called demanding $28K.
After about an hour and a half of waiting for a return call, I phoned the original guy who called me and, detailing how unethical it was when I was facing possible cancer to be held hostage by their demands for up front payment in full. They knew I was a member of Samaritan (they had been paid in a timely manner the year prior when I had a ruptured appendix), so they knew I was good for the charges. I proceeded to be very direct and firm and told the young guy in the billing office that he was going to take my credit card number, and take $5K and I was going to have the procedure. Sure enough...he took it. I had the procedure and the second day as I was recovering I had the hospital CEO show up in my room to apologize.
I knew what to do, and it wasn't easy to do. I had a credit card (don't tell Dave Ramsey!)...but had I been able to walk away and keep a trusted surgeon (who is amazing at working for his patients), I would have.
That said, I cannot reiterate what you said in what you said in number 1 in Before the Appointment. I speak with thousands of people each year looking for quality health plans and far too many have the perspective that having insurance is like having someone else's credit card. It isn't. If the insurer declines to pay for the service, whatever it may be, the patient is the final guarantor of a service once rendered. If it wasn't that way, everyone in the US would love their insurance, and trust me: they don't.
I would add, especially for those who have employer sponsored plans...don't stop with HR. Ask to speak to the insurance agent rep that works with the employer. They may be able to up the ante a bit. They really don't want to lose a client for something a medical provider is doing.
Really appreciate all you do!