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Patti - what a nightmare hospital billing can be!!!! When you visit the ER, you will always receive seperate billing statements; 1. from the hospital itself 2. from the ER physician's billing group (which is separate from the hospital) 3. possible separate bill from an outside lab/xray Medicare is getting notorious for denying everything in the hope that people don't know what to do!!! Every single billing agency has the ability to review charges and make adjustments based on the patients' ability to pay. However, many people don't know how to access this or whom to talk to. For a hospital, always ask for the patient advocate. For a physician, lab or xray billing, ask to speak to a billing supervisor. Unforunately, unless you are unemployed and uninsured with other monthly bills that far exceed any income, many are not going to work with you. I hope you get this resolved. It is ridiculous for an medicare approved facility to use physicians are who are medicare providers, knowing they bill separately!!!! |
Patti, I have been reviewing my Mom's plan all day after reading about your ordeal. I don't know the circumstances of your emergency visit & if your husband was admitted to the hospital or not. My Mother has United Advantage HMO, not PPO. (I'm not sure if you have actually have an Advantage plan PPO or if you have the Original Medicare with Medigap/supplement policy) Her policy regarding emergency room visits state a $50 co-pay and if non-network providers treated the emergency her insurance will work with providers to have network providers take over after the emergency is over, but she is entitled to care ANYWHERE in the case of emergencies. I really think your insurance & hospital dropped the ball because they should have realized the Dr. was not an in-network provider. |
Patti, I am so glad you were able to get it resolved. It was the last thing you needed to worry about. Prayers for your continued strength. |
I work in a call center that takes calls for the er dr bills. It sounds like the hosp outsources thier er services. The company I work for supplies drs to ers across the country. When a non par dr treats someone at a participating hosp we adv to call the ins and appeal it. Tell them you had no choice of what drs to see and that the hosp is participating. Many times they will go back and pay the participating rate. Most times the dr themselves do not know whether or not they are par as they do not do their own billing. Our company takes care of all of that. It is not a matter of coding. We list the dr that signs the records. This may or may not be the person you actually saw. It would be the dr in charge while you were there. For some reason that med grp decided not to be par with medicare, it could be they could not come to an agreement with them over the contract. I deal with this every day just on the physcian's (medical) side. |
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