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Medical CA - How to prove hospital overcharging


yiddster
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I have a few medical baddies left on my reports that Im trying to get taken car of - all were for visits to the ER while I had no insurance.

I know that the hospital cannot charge you more than what is reasonable for services and treatment and i know that "reasonable" is equated to the rate that the hospital would bill medicare for the same treatment and services.

In order to prove this I need to find out where or how to view the medicare fee schedule for items listed on my medical bills from the emergency room.

Does anyone have any experience with this at all?? Any tips would be most appreciated!!

Thanks,

Kim

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how do you know that Medicare is the standard? Why wouldn't it be Medicaid, which covers the population in general? I would not rely on either of these, but it is a good argument.

If that's what you want to pay and can do so, write the Hospital CEO, tell your sad song, ask him to take the MM amount in lieu of the standard charges as a matter of good will, and ask him to please remve the item from your CR. It might work.

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I have to agree with recovering attorney on this as I have dealt with medical collections for some time, and have never heard of this before. True, most of what I've done involves insurance companies, but, you would think that somewhere along the line this would arise.

Therefore, my advice to you is to check out that adivsed site. What I read looks like the answer to your questions. I am keeping that site available to me.

Thanks for the reference, Asleep!

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I have emailed and called the hospitalvictims.org and have gotten absolutely NO response, which is quite disappointing. I called the OC to request the UB-90 and they refuse to send that exact form, as it is against their policy due to the coding that appears on that form....it is only for the medical facilities and doctors to see. Those were there exact words.

My next step is to send a letter in hopes of getting that same refusal in writing. I have no idea how to find out what the Medicare or MediCal fee schedules are for the services I received without the codes from the UB-90. Its too bad that hospitalvictims.org wont reply. I will also try contacting Bud Hibbs to let him know of their nonresponse to see if he has any suggestion.

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That is beyond ridiculous. Mind you, I'm all for the HIPAA law, but, way too many providers are taking it to the extreme. The worst part is that they now wonder WHY they don't get paid.

Call the Insurance Commissioner for your state. They may be able to guide you in this matter, or, maybe refer you to someone who can.

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I have a few medical baddies left on my reports that Im trying to get taken car of - all were for visits to the ER while I had no insurance.

I know that the hospital cannot charge you more than what is reasonable for services and treatment and i know that "reasonable" is equated to the rate that the hospital would bill medicare for the same treatment and services.

In order to prove this I need to find out where or how to view the medicare fee schedule for items listed on my medical bills from the emergency room.

Does anyone have any experience with this at all?? Any tips would be most appreciated!!

Thanks,

Kim

I thought that a CA could not report a medical account to a CRA in California?

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I have emailed and called the hospitalvictims.org and have gotten absolutely NO response, which is quite disappointing. I called the OC to request the UB-90 and they refuse to send that exact form, as it is against their policy due to the coding that appears on that form....it is only for the medical facilities and doctors to see. Those were there exact words.

QUOTE]

Don't be to quick to condem them. They recieve hundreds of inquiries a day it takes time to respond to all of them.

Edited to add. Did you look up the hospital on thier site to see what they have to say about them?

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I do medical billing for dialysis patients here in California and two things confuse me here.

First if you have no insurance why is there a UB-92 form in the first place? The UB-92 is the particular form that we bill Medicare, Medi-Cal, HMO's etc. If you have no insurance to bill why would one even exist that can or cannot be released to you?

Secondly, patients in California are entitled to their medical records which include billing information. It is ridiculous to have the attitude that these codes are some kind of big secret. HIPAA does not apply here either as the medical provider is not releasing this information to any third party. If they get even more ridiculous about that tell them you will be happy to sign a release allowing them to release your medical information to yourself. HIPAA is designed to prevent medical information from being released to third parties to whom the patient has not given consent. There is no danger of violating HIPAA laws or any state privacy laws here. UGH. Good luck to you.

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  • 1 year later...

If this is so, where can I find this information? It would be of much help.

To update on the case, I received the information from the hospital (UB-92) after sending the letter to the hospital CEO that I found on hospitalvictims.org. They were able to tell me that the fair share for me to pay is MediCare rate plus 25%. That is the amount that I will be sending to the hospital and from there I will use the HIPPA process to acheive deletion.

This hospital (Hemet Valley Medical Center) is on their list of hospitals that are known for overcharging. They charged me $1300 for a splint that consisted of the underside of a cast that was wrapped on with an ace bandage.

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Hospitals typically overcharge the uninsured quite a bit more than they would medi-cal or the insured. Actually, prior to treatment in a Cali hospital it is a requirement that the uninsured are to receive a list of the 25 most common procedures with the costs of these.... Here is a resource for you below. Also, don't know your financial situation but there are businesses that will audit your bill and negociate a fair price. Good luck.

http://www.oshpd.cahwnet.gov/

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You have a fantastic question! You really do. I think so many people will learn from your question and these replies you get. I will try to look in to this and if I find any thing I will let you know.

The Basics

10 ways to avoid outrageous hospital overcharges http://moneycentral.msn.com/content/Insurance/Insureyourhealth/P74840.asp

http://www.fraudguides.com/medical-hospital-billing-errors.asp

If you find errors, contact your provider's billing office and your insurer. If they are of no help and the discrepancies are significant, you may want to turn to trained professionals who will help you analyze the bill and negotiate for you.

You can also get help from the consumer protection office of your state's attorney general.

"These professionals have sprung up because there are so many errors," says Bill Mahon of the National Health Care Anti-Fraud Association. "They are saving people money, and sometimes it's a lot of money."

Medical Billing Advocates of America is one of them. Based in Salem, Va., it operates in 18 states and the District of Columbia. These firms frequently work on a contingency basis, meaning they get paid a percentage of the amount they save you. But that percentage often runs as high as 50 percent, so make sure you understand their charges before you put them to work.

You can find others if you do an Internet search under "hospital bill review."

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I find this thread very interesting. Valid questions with good references from those who share. I commend all of you for your efforts here.

As I've said before, my "adventures" included insurance so had no real knowledge of how the billing works for those who do not have insurance, except for those who fall into the "indigent" level. But, there, so much is involved in being considered as such.

I'm one who has said for years as to how the medical providers overprice themselves on some things. True, they must do so to survive as now, with these ripoff HMO's and PPO's, how else can they stay in operation. If one sits down and really takes the time to pore over all that has occured since this type of health care insurance came into being, may not be too happy with what they see. I know I'm not.

An example of an overcharge I had to endure was when I had my Heart Attack in 1997. The Doctor told my wife I may not survive, but, they have a shot they could give me which may help. My wife responded as to why they had not given it yet, and she was told the shot was very expensive. She said "so what, give it to him". They did and I'm still here. Yes, had to have open heart surgery, also. They gave me two doses of this shot, and, the price of those two shots on the Hospital bill is $9034.21. Remember, 1997. I still have the bill as many do not believe me. Plus, I still am in shock even today. I wonder what it is in today's money? What the shots do is seek and devour blood clots.

As to the original poster here, I would do as the others have advised and see what can be done. Communicating with a creditor can be beneficial at times. I would just lay out my situation and see what happens. If they threaten to assign to collections, let them know their effort would not get them paid any sooner, and, is why you are in contact as your desire is to come to a reasonable and amicable solution.

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If you ever find yourself in a dire situation with no health insurance or no way to pay. Most hospitals (even small ones) have patient assitance programs. They are not-for-profit hardship funds. They have and application process and approval board. These are a Godsend! When my son was 18 he had a severe eye injury and had to have immediate surgery. We had no insurance at the time....he was still in high school and had no job. Because he was 18 he was able to apply for this charity and was approved for 100%. I did have to pay for his prescriptions and doctor visits but the entire hospital bill was paid.

Many people are not aware of such services. You usually have to ask about it as it is something they do not openly advertise.

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