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Medical Bill from February where I never received a billing statement


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Hi All,

 

I have not been as active on here the last 6 months or so. I went through multiple eye surgeries for a detached retina and glaucoma. My glaucoma doctor's office is fantastic. Before any service or procedure, they let me know exactly how much I will have to pay out of pocket for my co-pay and deductible. 

 

For surgery, they contract out their anesthesia services to a separate company. From Sept last year, the first surgery, I have not received anything from this anesthesiology group. I started getting a couple phone calls the last couple months, but the calls never stated the company they were calling from, all they stated was this call is made for a past due medical balance. 

 

I called my doctor's office to see who this medical group is and they gave me the phone number, which matched up with the number showing on my caller ID. I called to see what the balance was. It was for $70 from 2/18/2014. I told the person that I never have received any billing statements for any medical service provided. I am asking for an itemized bill showing what services were provided. She faxed me over the bill and all it showed on there was: Anesthesia Service for $840, then Insurance Reimbursement and Insurance rebate. Last, amount applied to co-pay of $70. 

 

I wrote and faxed a letter back stating that I requested an itemized bill showing how they came up to the $840. I will not remit payment until they show me what medical service or procedures they performed on 2/18. I know there is federal laws that mandate that a medical provider has to provide an itemized bill upon request, but I could not remember the name of the law. 

 

I wonder if they will ever provide me what I am requesting. They are not giving me the opportunity to dispute if something is wrong. If they  turn it over to a collection agency or try to report it on my CR, I know I have a lawsuit against them. 

 

I need to know what laws govern medical billing. Any ideas?

 

 

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The problem you have with this demand is that when it comes to anesthesia services they are billing for the physician's time.  The hospital billed for the room, equipment, and actual anesthetic drugs.  The physician has NO way to itemize their time.  You cannot receive a bill that says:  1) gave this drug, 2) insertion of breathing tube etc.  

 

They arrived at their bill based on the type of anesthesia you needed i.e. local, spinal, vs general anesthetic.  If you have multiple health problems requiring a more skilled anesthetist ups the amount billed.  The total amount of time they were there is also factored in.  

 

They billed insurance, the carrier paid the contracted amount, and you were left with your co-pay.  You can howl and protest all you want but you are contractually obligated to pay that co-pay.  It doesn't matter if they billed $1840 or $10,350 if the contracted amount is $350 and your co-pay is 20% you owe $70.  

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I know the anesthesiologist spent no more than 10-15 minutes with me. I was awake for the surgery. I will not pay unless they justify to me exactly how they came up to the $840. Further, I believe that i already met my maximum out of pocket for the year by that time. I am trying to figure out if they are balance billing me for the amount the insurance company did not reimburse them, 

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The anesthesiologist has absolutely NO legal requirement to meet that demand and quite frankly it is rude and obnoxious.  You certainly didn't mind what care you got when you received it of the job they did right up until they asked you to pay for their services.  While you may believe they only spent 10-15 minutes with you the reality is far different thanks to the sedative drugs they give to keep you comfortable during an awake procedure.  In fact monitoring someone who is awake during a surgical procedure while keeping them calm, pain free, and not moving around is much more difficult that general anesthesia.

 

If they sent you a statement showing the contracted amount and the copay you can do that math yourself and figure it out if it is balance billing.  You should also have your EOMB from your insurance company showing what your responsible amount is.  Your carrier is the one who knows whether or not you have met your out of pocket maximum not the anesthesiologist.  They go by what your carrier states you owe.  

 

The bottom line is this amount is so small it is ridiculous.  You are obligated by your contract with the carrier to pay that amount as a co-pay and no demand you make of them for an itemized statement is going to change that.  It is wasted energy fighting over it and you are risking hitting your credit for less than a Benjamin?  Says more about your integrity than theirs.

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@bmc100. It is good they may have only spent 10-15 minutes with you, makes the total bill less. They bill for their total time. That includes before you went into surgery, usually they meet with you prior to ask you about allergies, previous reactions to anesthesia, things of that nature. They review your chart. They check in with recovery, making sure there is no complications, etc. so what may seem like 15 minutes is more likely the entire time you spent in pre op, surgery, and post op.

850.00 in this day is a reasonable sum for a anesthesiologist to charge. :)

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I do have the right to ask for an itemized statement for it is deemed hospital care and the outpatient medical facility or contractors have to abide by the same rules and regulations as an actual hospital. They are licensed that way. I don't mind paying the $70, but I have never received a billing statement up to the point I called them. Under hospital care, if asked for a itemized bill, the medical provider has to provide one...it is the law. Since this surgery in February, I have also had an additional 4 surgeries with the same anesthesia group who has never sent me a billing statement for any of the other surgeries as well. I had another 3 surgeries in 2013 where this group never sent me a billing statement, even if I did not owe them anything.

 

If one knew the billing history and practices of this medical group, you would want to question their charges as well.

 

I find that to be odd. If I met my max out-of-pocket for the year prior to the surgery, their contract with the insurance company does not involve me. In fact, if they are balance billing me for the difference, it is illegal. The medical practice has to take that up with the insurance company, not ask me for more money.

 

I have gotten to know this anesthesiologist pretty well. My issue is not about the time he spent with me, the care or medical services he provided. It should not be insulting to a medical provider, especially when they contract out there billing services to another company for someone to ask for an itemized bill, when it is the law.

 

Given the amount of money I have already dished out to pay medical providers, I am to a point where I want to make sure no one is double charging for services or care. Everyone other provider has been paid in full, but they also sent me out itemized billing statements that I could compare to a benefits statement prior to paying. I do not want to give them any banking information knowing there are other billing issues out there with them and I am unsure if I might owe additional money. I don't want $70 turning out to be $700 and once they get my information they use it to pay anything I am unaware of. I do not feel like fighting that battle.

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I do have the right to ask for an itemized statement for it is deemed hospital care and the outpatient medical facility or contractors have to abide by the same rules and regulations as an actual hospital.

 

ONE MORE TIME:  YES you have the right to ASK for an itemized statement.  However, when it comes to anesthesia care there is NO ITEMIZED statement.  The hospital does not produce one and neither does the anesthesia group.  Your carrier does not require one and knows it does not exist.  The hospital knows it does not exist and so does the insurance commissioner.  I have been doing surgical cased for 30+ years including the billing and NEVER has an itemized statement for anesthesia care been developed, implemented, or used.  They are not going to invent one for your hissy fit.

 

I find that to be odd. If I met my max out-of-pocket for the year prior to the surgery, their contract with the insurance company does not involve me. In fact, if they are balance billing me for the difference, it is illegal. The medical practice has to take that up with the insurance company, not ask me for more money.

Meeting your maximum for the year prior does NOT carry over to the next year.  The out of pocket maximum zeros out at midnight on 12/31.

 

Given the amount of money I have already dished out to pay medical providers, I am to a point where I want to make sure no one is double charging for services or care. Everyone other provider has been paid in full, but they also sent me out itemized billing statements that I could compare to a benefits statement prior to paying. I do not want to give them any banking information knowing there are other billing issues out there with them and I am unsure if I might owe additional money. I don't want $70 turning out to be $700 and once they get my information they use it to pay anything I am unaware of. I do not feel like fighting that battle.

 

ONE MORE TIME:  you have their bill now and you can get a copy of your EOMB from the carrier.  If they are billing the same amount as what the EOMB says is your responsible portion then NO ONE is double billing or balance billing you. 

 

Feel free to die on this sword and tank your credit over $70 but I can tell you for a fact that you are dead wrong on this one and no complaint to any state board regarding not getting an itemized statement for care that cannot be itemized and is billed by the hour is going to get any attention. 

 

We are done.

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ONE MORE TIME:  YES you have the right to ASK for an itemized statement.  However, when it comes to anesthesia care there is NO ITEMIZED statement.  The hospital does not produce one and neither does the anesthesia group.  Your carrier does not require one and knows it does not exist.  The hospital knows it does not exist and so does the insurance commissioner.  I have been doing surgical cased for 30+ years including the billing and NEVER has an itemized statement for anesthesia care been developed, implemented, or used.  They are not going to invent one for your hissy fit.

 

Meeting your maximum for the year prior does NOT carry over to the next year.  The out of pocket maximum zeros out at midnight on 12/31.

 

 

ONE MORE TIME:  you have their bill now and you can get a copy of your EOMB from the carrier.  If they are billing the same amount as what the EOMB says is your responsible portion then NO ONE is double billing or balance billing you. 

 

Feel free to die on this sword and tank your credit over $70 but I can tell you for a fact that you are dead wrong on this one and no complaint to any state board regarding not getting an itemized statement for care that cannot be itemized and is billed by the hour is going to get any attention. 

 

We are done.

You misunderstood what I was saying. I reached my max out of pocket for 2013, then by February 2014, I reach this year's max out of pocket. 

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You misunderstood what I was saying. I reached my max out of pocket for 2013, then by February 2014, I reach this year's max out of pocket. 

 

You don't understand insurance.  Even if you have met your out of pocket maximum for the year that does not apply to CO-PAYS.  Co pays are exempt from the OOP max and always payable.  Out patient surgical procedures are ones that almost always have a copay for the ancillary services such as lab and anesthesia.  

 

You are arguing here when you could resolve this very easily by calling your insurance carrier and asking them if this is one of those situations.  They will be more than happy to explain it to you.

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Clydesmom, stop responding to me like I am stupid. I fully understand my insurance coverage. Further I have my undergrad and grad degrees in economics and finance. For all the times I wrote pleadings for posters on here, instructing them step-by-step how to do things only to win their lawsuits over and over again as a non-attorney shows my ability to learn and apply what I read. Last, I have multiple designations in the financial field and multiple licenses. Now I am studying for the CFA. Take the bar exam and multiply it by 3, it is 3x harder. 

 

All I asked for is what federal laws do health care providers have to abide by outside of HIPAA when it comes to medical billing. I am all too familiar with HIPAA. There is the law called the Fair Medical Billing Act and the best part to HIPAA outside of privacy is the Patient Bill of Rights. 

 

For a medical provider to never send a bill for any medical procedure or service rendered and then asks someone to pay an amount without knowing it is accurate boarders on fraud and extortion. The medical practice(s) you work with are most likely honest, but not every medical practice is like that. I find it odd that all of the other providers sent me timely billing statements even if I did not owe them anything. I do not make it easy for another person or company to screw me out of money. 

 

I would

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So far NOTHING you posted has indicated they billed you unfairly or illegally.  If this were thousands of dollars I could see fighting over it but there is NO way on this Earth I would trash my credit over $70.

 

Being able to practice law without a license is not something I would brag about.  It also has NOTHING to do with your situation.  While you spend time splitting hairs over what you want them to send you, what you believe they should send you, and what they are required to send you they have nailed your credit when you could have simply called your insurance company and got the EOMB and soothed your concern about billing by comparing the EOMB to the billing statement you now have.  

 

For a medical provider to never send a bill for any medical procedure or service rendered and then asks someone to pay an amount without knowing it is accurate boarders on fraud and extortion

 

Put the drama llama back in the paddock.  Just because you did not receive the bill doesn't mean they didn't send it.  Even if they did forget to mail it to you it does not mean fraud or extortion.  They are not threatening you with ANYTHING they cannot legally do by law if you don't pay.  You got care, they billed insurance, you have a balance and you refuse to pay.  That is your choice but it is also their choice to ding your credit.  

 

Again, feel free to die on the sword making a stand.  It is your credit to trash.  

 

FYI:  Billing by ancillary services is often fraught with difficulties.  I had surgery and I have no idea whose insurance the anesthesia group billed but it was not mine.  My first clue was a bill stating I owed them almost $1000.  When i called they said insurance didn't pay.  I called my carrier and they had no claim from the anesthesia group.  Another call revealed they billed a policy and carrier that was not mine.  Once they had the correct information they billed MY insurance and lo and behold my balance was $35 and I sent them a check.  Mistakes happen but it isn't worth ruining my credit to argue over a piddly amount or what they did or did not send me.

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@bmc100  I work in a hospital and recently had outpatient surgery. My insurance contract calls for surgery and anesthesia to be paid at 100% after I pay a $150 deductible per admission.  Your anesthesia costs sound about right, although their billing practices seem odd.   This link may provide some information about anesthesia charges.

http://www.groupanesthesia.com/billing.php

I recently commented that after my surgery, I had to battle with my own hospital because my employee health insurance did not fully pay for a ER stay I had following my surgery.  Fortunately, being a hospital employee, I was able to access the right people and  got the matter resolved.  My carrier eventually paid in full.  Had I not had that inside knowledge,  and refused to pay, it would have gone to Collections, and then I would have been involved in a legal morass.

There is not, to my knowledge, any specific federal law about medical billing, although I think such a bill has been introduced in Congress.

Notwithstanding@Clydesmom abrasive replies, I think you were probably treated fairly.  Nevertheless, if you seriously think something is amiss, then you should pursue it, but don't damage your credit over it.

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