Real Life Medical Bill Stories: Paying Before Receiving Care

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medical-advocacy_154183430I have been fortunate enough to be armed with vital knowledge through Medical Billing Advocates of America of how to protect myself from erroneous charges and unreasonable prices on my medical bills. Last week, I found myself in an increasingly common situation in which everyone in the U.S. should be aware of. This particular occurrence is happening more and more often across the country, and even in the small town in which our organization is located.

My doctor ordered a very common healthcare procedure: an ultrasound. Before going into the ultrasound room, I had to register with the radiology department. The registration employee took my driver’s license and health insurance card, tapped on her keyboard, then asked for $100. As a proactive patient, I informed her that I had already talked to my health insurance company and knew that this procedure would cost nothing out of my pocket, according to my plan. It was 100% covered.

The employee did not look as though she registered what I had stated and, again, asked for $100. I could see that this could go on and on, so I flatly stated that I would not be giving them any money today. She tapped on the keyboard and then informed me that according to my insurance, I would be responsible for 20% of my costs for my care that day. I was not in a mood to argue, but I asked if she was able to see my individual plan. She stated that she could. I asked if she was looking at my coverage for this exact procedure, but she replied that she was not. So I asked her how she knew it would only cover 80% of my costs for that day. She stammered an inaudible response, then said that it was fine if I didn’t pay the $100.

I worked in a hospital for 12 years, and I had friends who worked in ER registration. They told me about how they were instructed to ask for money up front from patients. Sometimes these patients would be suffering horrible ailments, such as heart attacks, strokes, broken limbs, and the registration employees were instructed to go to them with their hand out. I’m not talking about the copay that you might owe to the facility according to your individual health insurance plan. I’m referring to an amount of money that they ask for you to pay up front before receiving care, which the registration staff states will go toward the balance you owe.

But here’s where it gets interesting: The facility asks for this money up front, before care is given. How do they know what care you will receive? Does the registration employee know that you will receive an MRI and an injection of promethazine 12.5mg? Even if they knew the precise care you would receive, would they know the exact costs of that care and how much you would be billed? Are they certain that the patient’s health insurance will not pay for this care? No, they do not know this information. How then can they ask for a specific amount of money up front?

The occurrence of being asked for money up front in a healthcare facility is not new. It’s absolutely essential that we raise awareness with the public that you need to protect yourself from practices within the U.S. healthcare system that many would call immoral. There are many areas in our healthcare system that could fall under that heading, and these areas will be discussed in future posts.

A very large part of protecting yourself involves being proactive in certain practices when it comes to your healthcare. Keep this in the forefront of your mind when you are facing any type of medical service.

 

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2 responses to “Real Life Medical Bill Stories: Paying Before Receiving Care”

  1. Anonymous says:

    Do you know how occupational and physical therapy is billed in an acute cae hospital..?

    For example a thera py eval is equal to one billable unit..no matter how much time is spent with a patient yet an employer tells us to put in 4 unit charges for every eval we do..in the computet billing system.when I asked why they said don’t worry we just do that for productivity. .not buying it!! Do you know anyone who has expertise in cost hospital cost reports

    • Pat Palmer Pat Palmer says:

      The billing depends on the code being used. If you can provide the code, we will be happy to look into this further. Give us a call at 855-203-7058.

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