I received an envelope in the mail this week from a doctor I never met from a medical facility I never heard of. Inside was an invoice for $57.90. This wasn’t the first “your invoice is in the mail” experience I’ve had in the last several months. Others have appeared from the two hospitals where my husband, David, was treated last August and September for a neurological condition.
Thankfully, David is back to normal. But these surprise charges have given me headaches and palpitations. Most of them contain EOBs (explanation of benefits) with charges for assorted doctors and services we never heard of.
Here’s what we’ve learned and you should know if you are hospitalized:
You may be in a hospital that participates in your health insurance network but not the doctors who actually treat you. A New England Journal of Medicine report noted that 22% of the time patients are treated at a hospital facility covered by their insurance, they will still receive a bill from a doctor who treated them who is not in their insurance coverage network. You may be stuck with out-of-network charges. Read this article During a recent TV interview I watched, the guest, an author, likened the situation to “buying an airplane ticket and then getting a separate bill from the pilot and co pilot.”
You may never see the doctor, but what you will see is the bill. You’re unconscious in the hospital and maybe alone. How can you possibly know if the doctors coming in to examine you are in -network or out of network? An unconscious or dazed and confused patient can’t just sit up in the hospital gurney and say, “Wait! I need to check your insurance to make sure you are in network before you touch me!”
It’s worse if you have a medical emergency and need to visit the ER. The same New England Journal of Medicine reported that “One in five patients who seek care at in-network emergency departments may learn later that they owe thousands of dollars for a treating physician who isn’t in their plan’s network.” Read this article.
Sticking out your tongue at the doctor may result in medical sticker shock If a therapist asks you to “stick out your tongue” or “touch your finger to your nose” you may be charged hundreds of dollars without receiving any actual therapy. This happened to us.
That friendly 5 minute visit by your Primary Care Physician (PCP) to say “Hello! How are you doing?” may be billable to you. Some doctors’ groups are being pressured to bill more of their time and find sneaky ways to do so. David’s PCP stopped by the hospital unscheduled for a few minutes in the mornings to say “Hello” and do nothing more. David thought she was being friendly. She billed us for every visit even though he was being treated by specialists at the hospital. We told her “Goodbye”
Beware the friendly call from the health insurance company “advocate.” You may be tripped us on your coverage if you tell them you are “feeling much better.” We were warned by a nurse practitioner that insurance companies may be fishing around for ways to document your recovery and limit your coverage for additional medical services. This also happened to us, and David was denied extended treatment.
It’s a shame that this type of financial labyrinth happens at all. It’s especially upsetting because it usually occurs when an individual is at his/her most vulnerable point and unable to focus clearly on checking everyone’s references and insurance plans.
Why does does the health care system “stick it” to the patients? Image courtesy of jscreationzs at FreeDigitalPhotos.net
What you can do even, if they are all tricky:
Make sure you have a patient care advocate from the hospital to help you or a health care proxy to make decisions on your behalf. The latter is not always immediate since the ailing, dazed and confused patient has to sign an agreement to allow someone to serve as a proxy. When David was in the hospital those first few days he could barely focus or move his left side much less sign his name. Be prepared. Have a signed and notarized document designating a health care proxy filed with your health insurance papers somewhere easy to find and take with you to the hospital.
Be on call when the doctors are on call. This is tricky since most doctors appear unannounced. David’s doctors tended to show up unannounced between 6 and 7AM or late at night when I was asleep in bed. Its hard on the caregiver or spouse to be “on call” in the hospital room for 24 hours waiting for doctors to show up.
Have a sign in the room saying: If you do not participate in XYZ health insurance plan, do not touch this patient. I was like policewoman in the hospital. Every time a doctor came in I asked for proof that he/she was in network.
Fight for your rights. Asked for a more detailed EOB breaking down charges. Ask for a detail on what has/has not been submitted and paid by your insurance. Do not agree to pay anything, even if threatened with a bad credit report, until you are 100% clear on why you are receiving a bill, what the charges are for, and have they been coded correctly. Ask about the medical coding for charges you question since it can impact the bill. Errors in medical coding are common.
Don’t pay that first invoice until you know whether your health insurance has already paid the doctor. Sometimes an “estimated charge” will be more than the “actual charge.” I never pay the first bill since there is usually an adjustment after health insurance pays the hospital or medical provider.
Keep every bill and record of payment. There will be glitches. I am still arguing over an excessive $5000 ER charge because I fainted from stress in David’s hospital room. My insurance company had a computer glitch and had marked me as “canceled for non payment” even though I have documentation that the insurance bill was paid and I was covered.
Stay healthy. This is also tricky. You can eat well, exercise regularly, watch your stress and still get sick or have an accident. But, it pays to do what you can to keep strong and healthy because your body will rebound and heal better if something happens.
Bottom Line. Be choosy about your doctors and smart about asking questions, getting second opinions and being your best health advocate. Know your rights as a patient. And good luck!
Want to take your health care rights back? Read this book.
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