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Medical Collections from "CA EMER PHYS MED GRP"


bluelife
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long story short... got in car accident with old civic that had only liability, which i thought included medical...

 

however I hit some property fencing that the insurance is taking care of and because of airbags deploying, the police took me to ER at nearby hospital to have me checked out

 

that was early january...

 

now i received a letter from "CA EMER PHYS MED GRP" asking for money because "your insurance company has denied payment on this claim. Contact them for reason for denial. the balance due is your responsibility."

 

It says to contact my insurance group, which i will do tomorrow, anyone else in this situation before?

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Guest usctrojanalum

I'm pretty sure that's just the doctor who treated you sending you a bill for the services rendered.  The doctor most likely belongs to that group and the company is requesting payment.

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The ER doctors are probably contracted to provide physician services to the hospital and bill separately from the facility fees.  If the group is not a "preferred provider" then the insurance would deny payment because of it. 

 

I would call your health insurance carrier and appeal.  The patient has no choice as to who the ER doctor is and if they are a preferred provider in an emergency situation.  Most insurance companies will pay it as "in network" under those circumstances.  You just have to jump through a hoop or two.

 

If you did not have health insurance and assumed your auto policy had medical under liability (it doesn't) then the denial is based on NO coverage.  In that case you call the hospital and negotiate a cash price lump sum payment.  

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  • 2 weeks later...

Go see an attorney....insurance companies will keep you in the dark as long as they can... Have an attorney send them a letter saying he/she represents you and then watch the insurance try to work things out.

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Go see an attorney....insurance companies will keep you in the dark as long as they can... Have an attorney send them a letter saying he/she represents you and then watch the insurance try to work things out.

 

$350 and hour to a lawyer over a bill that is probably less than $200?  Not exactly smart math.  Most attorneys will not send a letter like that unless they are representing a client and a retainer fee of a couple grand for that is more money poorly spent.  

 

So far it appears to be merely a communication issue that is easily sorted out.  Sometimes the ER physicians have the wrong insurance information and once billed correctly the problem is solved.  Until what caused the denial is actually determined threatening with a lawyer is over kill and unnecessary.  

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First find out what's going on, and then if thing go hot, probably yes, but an attorney right off the bat is not a smart way to go, unless you know for sure the guys are complete jerks and violate every single law they can.

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I got approx a little under $400 on the doctors bill and a little over $1400 on the ER charges for no more than 7-8 minutes of "checking on me"

 

Because i have only liability on that vehicle it does not cover the ER, scary thought

 

I guess i will always have some kind of full coverage from now on on auto policies

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unfortunately no.... I didnt realize the hospital bills were so damn expensive here in America, No wonder people talk about going to other countries to get their procedures done AND have enough to spend and enjoy themselves...

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unfortunately no.... I didnt realize the hospital bills were so damn expensive here in America, No wonder people talk about going to other countries to get their procedures done AND have enough to spend and enjoy themselves...

@bluelife - where are you from?

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call the hospital and anyone else that billed you and see what they tell you. Many hospitals got a financial aid office, find that out if they do, go to their office and speak with a Financial Counselor there, they normally will help you and make a payment plan or will drop the bill to 0 depending on your situation.

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In Northern California, Sacramento to be more exact.

 

I may have to apply for some aid, Im willing to work out some plan as long as they are.

From the way you were talking, I assumed that you were from elsewhere.  But I feel the same way.  

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From the way you were talking, I assumed that you were from elsewhere.  But I feel the same way.  

Oh I see, yeah I just never had any reason to be in the hospital before now... I've heard horror stories, but now that its firsthand, and I went again into the ER last week from a bike accident, Im not looking forward to that bill...

 

But all else is well so things are looking well except for the bills

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In Northern California, Sacramento to be more exact.

 

I may have to apply for some aid, Im willing to work out some plan as long as they are.

 

If it is the hospital billing you most non-profit hospitals have some sort of charity care program that you can apply for.  You have to present proof of income, assets, etc. and they determine an amount if any you are eligible for.  

 

If it is the treating doctor as a separate practice who is under contract to provide physician services to the ER then the chances they have any sort of charity program is slim. 

 

However, most if not all medical providers will take a reasonable monthly payment and as long as you make it they won't turn it over to collections or sue.  All you have to do is ask for a payment plan.

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If it is the hospital billing you most non-profit hospitals have some sort of charity care program that you can apply for.  You have to present proof of income, assets, etc. and they determine an amount if any you are eligible for.  

 

If it is the treating doctor as a separate practice who is under contract to provide physician services to the ER then the chances they have any sort of charity program is slim. 

 

However, most if not all medical providers will take a reasonable monthly payment and as long as you make it they won't turn it over to collections or sue.  All you have to do is ask for a payment plan.

 

The time to negotiate on medical bills is before service, unfortunately.  I know how difficult this can be when you're in an emergency, though.  

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you will get separate bills from the Dr. the ER, the radiology, and the lab.  I think it should be all inclusive, but it's not. You can try to negotiate, insurance companies do all the time, try 50%-60% of the bill which is what they allow them.  You would need to talk to someone other than the person in billing, our hospital has a patient rep, I would try there.  Explain the situation, he/she may be able to negotiate for you.

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The time to negotiate on medical bills is before service, unfortunately.  I know how difficult this can be when you're in an emergency, though.  

 

Curious, not expecting a next time, but nobody ever expects an ER visit i guess.

 

How is this done? are there special people or procedures to follow? What search term would provide results as negotiation pops up with everything

 

you will get separate bills from the Dr. the ER, the radiology, and the lab.  I think it should be all inclusive, but it's not. You can try to negotiate, insurance companies do all the time, try 50%-60% of the bill which is what they allow them.  You would need to talk to someone other than the person in billing, our hospital has a patient rep, I would try there.  Explain the situation, he/she may be able to negotiate for you.

 

Thank you, I will give this a try. So to clarify, when i call the billing department, and i ask for "patient rep" they will know what i am talking about?

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no, call the hospital and ask the operator if they have a patient rep.  Some hospitals may call it something different.  If they don't then you could call the billing dept. and ask to speak to one of the supervisors over billing.  A patient rep might have a little more pull than if you called the billing dept. directly.

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The time to negotiate on medical bills is before service, unfortunately.  I know how difficult this can be when you're in an emergency, though.  

 

That is true for elective care but not emergency.  It is still possible to negotiate a lower amount after the services are rendered.  However, it is most effective when done BEFORE an account goes to collections.

 

I second the idea of contacting a patient representative.  They often can connect with the person with the authority to negotiate a lower amount, make arrangements for charity care, and payment plans.  

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OH MY... My recent stay to the ER came in at Almost $20K

 

I literally do not know how it got this much for a 5 hour stay and definitely does not needs to be this much. this is absolutely ridiculous, I will have to start another thread, but honestly do not know how I will be able to pay this back

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