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AnxietyClown
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Post subject: anyone dealt with Medical Over Billing? Posted: Tue Mar 19, 2013 10:12 am |
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Joined: Mon Mar 13, 2006 3:24 pm Posts: 9265
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Hey gents, anyone ever gotten wildly over billed by a doctor and been able to deal with it? My wife ended up in the ER a month ago when she cut a nice slice into her finger chopping veggies. We paid all the ER and hospital bills and insurance paid the actual guy who stitched her up $2700 for the 5 stitches. Now the guy who stitched her has sent us a -- wait for it -- $23,000 bill for his services - money he wants on top of the $2700 he got from insurance. As ever, refusal to pay means he'll report it to our credit filing agencies.
Anyone have ideas for how to handle this. I'm thinking I might talk to some friends in news here in NY and do a story on him and overbilling in medicine (a good story, actually) but I need to deal with the bill itself somehow.
_________________ "A problem cannot be solved with the same level of awareness that created it" - Albert Einstein
http://www.thehandsondad.com
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nooobieee
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Post subject: Re: anyone dealt with Medical Over Billing? Posted: Tue Mar 19, 2013 11:31 am |
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Joined: Tue Mar 14, 2006 11:57 am Posts: 9799 Location: same as it ever was
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Wow. I've had cases where I was billed for stuff that didn't happen (they took it off the bill when I pointed it out). But never egregious over-billing like that. I'd talk with your insurance company for one and the hospital as well.
- Oh, and there is the new consumer protection bureau that may be able to help.
_________________ Knowledge isn't free, you have to pay attention.
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Jinxter
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Post subject: Re: anyone dealt with Medical Over Billing? Posted: Tue Mar 19, 2013 1:46 pm |
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Joined: Fri Mar 24, 2006 8:26 pm Posts: 6640 Location: Silverdale, WA
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Definitely do some more research...between what you payed at the hospital and what your insurance covered should have been well more than enough for 5 damn stitches. Hell, I could have done them for you for free. (Yes, was a medic for 10 years and trained to stitch by 2 general surgeons and 1 plastic surgeon. My work, when I did it, left very tiny scars...) I think this idiot is attempting to fleece you...
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chuuuw
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Post subject: Re: anyone dealt with Medical Over Billing? Posted: Tue Mar 19, 2013 2:14 pm |
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Joined: Sat Jun 19, 2010 12:08 am Posts: 33
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AnxietyClown
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Post subject: Re: anyone dealt with Medical Over Billing? Posted: Tue Mar 19, 2013 2:56 pm |
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Joined: Mon Mar 13, 2006 3:24 pm Posts: 9265
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Its happening in NYC. The research I've done tells me the average price should be about $1800. After getting $2700 from insurance I still would have PAID the guy $1800 had he billed me (he did nice work). But now it's 'a thing' I'll use the consumer protection department and a few other obvious things. My real hope is that between the investigative producer from 60 Minutes that I know and the girl at NBC NY that does 'consumer protection' stories, I can hand this guy his ass long before I pay to worry about the actual bill.
I'll keep you posted.
_________________ "A problem cannot be solved with the same level of awareness that created it" - Albert Einstein
http://www.thehandsondad.com
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MATRIX
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Post subject: Re: anyone dealt with Medical Over Billing? Posted: Tue Mar 19, 2013 6:11 pm |
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Joined: Sat Mar 18, 2006 7:36 am Posts: 1501 Location: Phoenix,Az
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contact your insurance company to find out what the Hospital sent over, and let them know about it as they should be able to follow up on it, beyond that the only thing I can think of would be a situation where it was done out of network
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Carl Weathers
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Post subject: Re: anyone dealt with Medical Over Billing? Posted: Wed Mar 20, 2013 12:27 am |
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Joined: Mon Mar 13, 2006 9:31 pm Posts: 3993
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Just in case it hasn't happened yet, have you called the doctor's office to confirm the bill? When I took care of all my dad's stuff I'd get all kinds of crazy bills in the mail but when I called the doctor's office they told me it wasn't actually a bill and I shouldn't worry about it.
Oh and off-topic a little, even with insurance my pops ended up paying over $80k out of pocket that year. I love reminding people of that every chance I get, what a travesty our health-care system is.
If you already confirmed that he's really billing you for that much then I hope you ream him a real good one in the public arena AC.
_________________ Televangelist Satire Lunch Special Dark Fiction / Short Stories How to Grow Organic Cannabis Step-by-step Grow Guide The Cannabis Gardener Grow Website Get Stoned with Ron Black Room Productions
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Dominator
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Post subject: Re: anyone dealt with Medical Over Billing? Posted: Mon Mar 25, 2013 11:17 pm |
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Joined: Sun Mar 26, 2006 8:19 pm Posts: 2049 Location: Yuba City, California
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holy sweet baby Jesus! I had leg surgery and only had to fork out a couple grand. Insurance covered the rest. Shouldn't your annual "out of pocket maximum" kick in? $23,000 is absurd.
_________________
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Kookookachoo
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Post subject: Re: anyone dealt with Medical Over Billing? Posted: Tue Mar 26, 2013 9:38 am |
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Renegade Heroes |
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Joined: Tue Mar 07, 2006 11:18 am Posts: 462 Location: St. George's, Bermuda
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AnxietyClown
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Post subject: Re: anyone dealt with Medical Over Billing? Posted: Sat Mar 30, 2013 4:36 am |
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Joined: Mon Mar 13, 2006 3:24 pm Posts: 9265
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Update: NBC news NY is coming out to do a story on the inflated billing. The doctor started calling on Thursday to see if we could 'resolve' the bill but we haven't called him back yet. Still pondering our options.
[ Post made via Mobile Device ]
_________________ "A problem cannot be solved with the same level of awareness that created it" - Albert Einstein
http://www.thehandsondad.com
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Ashman
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Post subject: Re: anyone dealt with Medical Over Billing? Posted: Sat Mar 30, 2013 9:07 am |
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Joined: Mon Mar 06, 2006 7:32 pm Posts: 11632 Location: Utah
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Jinxter
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Post subject: Re: anyone dealt with Medical Over Billing? Posted: Sat Mar 30, 2013 9:34 am |
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Joined: Fri Mar 24, 2006 8:26 pm Posts: 6640 Location: Silverdale, WA
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A link to the story would be appreciated as well...also, I would call the guy back and let him know that what the insurance paid him is what was allowed. Any and ALL overcharges will just have to be investigated and highlighted in the news. He wants to 'resolve' so his name is not brought up and his greed brought to light. Only resolution I would be open to would be a COMPLETE nullification of the overcharge.
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nooobieee
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Post subject: Re: anyone dealt with Medical Over Billing? Posted: Sat Mar 30, 2013 9:47 am |
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Joined: Tue Mar 14, 2006 11:57 am Posts: 9799 Location: same as it ever was
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Sic'em AC!
_________________ Knowledge isn't free, you have to pay attention.
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Tien
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Post subject: Re: anyone dealt with Medical Over Billing? Posted: Sat Mar 30, 2013 11:27 pm |
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Phoenix |
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Joined: Thu Mar 16, 2006 11:48 pm Posts: 2951 Location: Spokane, WA
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Good luck and let us know how it goes! It would be interesting if they find that he's done it to a lot of other folks...
_________________ Bye Bye Boys
Have fun storming the castle!
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AnxietyClown
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Post subject: Re: anyone dealt with Medical Over Billing? Posted: Tue Apr 02, 2013 5:58 pm |
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Joined: Mon Mar 13, 2006 3:24 pm Posts: 9265
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here's the bill, by the way
_________________ "A problem cannot be solved with the same level of awareness that created it" - Albert Einstein
http://www.thehandsondad.com
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Jinxter
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Post subject: Re: anyone dealt with Medical Over Billing? Posted: Tue Apr 02, 2013 6:09 pm |
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Joined: Fri Mar 24, 2006 8:26 pm Posts: 6640 Location: Silverdale, WA
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WOW...I wonder if I can collect back pay from all of the people I stitched up over my years as an AF Medic. Fry this guy A/C...this is ridiculous in the extreme.
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Ashman
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Post subject: Re: anyone dealt with Medical Over Billing? Posted: Tue Apr 02, 2013 10:10 pm |
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Joined: Mon Mar 06, 2006 7:32 pm Posts: 11632 Location: Utah
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Tien
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Post subject: Re: anyone dealt with Medical Over Billing? Posted: Wed Apr 03, 2013 6:25 am |
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Phoenix |
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Joined: Thu Mar 16, 2006 11:48 pm Posts: 2951 Location: Spokane, WA
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I think what is bothering me most isn't that he did it to AC and family (sorry) but that this guy's probably also done it to others that don't know their rights, how to appeal, work with their insurance carrier, or fight back through the media. AC has a voice and isn't afraid to use it - so I'm not worried that he's gonna get snookered, but how many other people have paid much or all of these obviously inflated bills, to their detriment?
_________________ Bye Bye Boys
Have fun storming the castle!
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Irminsul
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Post subject: Re: anyone dealt with Medical Over Billing? Posted: Wed Apr 03, 2013 1:22 pm |
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Joined: Thu Jun 29, 2006 7:58 pm Posts: 1937 Location: Oregon
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Tien wrote: I think what is bothering me most isn't that he did it to AC and family (sorry) but that this guy's probably also done it to others that don't know their rights, how to appeal, work with their insurance carrier, or fight back through the media. AC has a voice and isn't afraid to use it - so I'm not worried that he's gonna get snookered, but how many other people have paid much or all of these obviously inflated bills, to their detriment? Agreed Tien, I was thinking much the same thing. At the very least, perhaps the doctor in question will be on the hook to repay all the people he screwed over.
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nooobieee
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Post subject: Re: anyone dealt with Medical Over Billing? Posted: Wed Apr 03, 2013 3:42 pm |
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Joined: Tue Mar 14, 2006 11:57 am Posts: 9799 Location: same as it ever was
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While outrageous and no doubt a potential PR nightmare, I'm not sure why you all think what he did was illegal in our system and so require any sort of restitution.
_________________ Knowledge isn't free, you have to pay attention.
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AnxietyClown
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Post subject: Re: anyone dealt with Medical Over Billing? Posted: Wed Apr 03, 2013 4:04 pm |
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Joined: Mon Mar 13, 2006 3:24 pm Posts: 9265
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It appears, from some input I got, that he did - in fact - commit fraud (though it'd be hard to get a judgment). The codes he used were for critical and severe cases that require significant work that he never had to do. Up-coding is medical fraud, though then we're talking about court and getting one doctor to argue what was and wasn't necessary while he argues that it was. Hard to get a ruling.
_________________ "A problem cannot be solved with the same level of awareness that created it" - Albert Einstein
http://www.thehandsondad.com
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nooobieee
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Post subject: Re: anyone dealt with Medical Over Billing? Posted: Wed Apr 03, 2013 6:31 pm |
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Joined: Tue Mar 14, 2006 11:57 am Posts: 9799 Location: same as it ever was
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I see, maybe he was expecting to get more from the insurance company. I'm not sure what coding has to do with billing individuals.
_________________ Knowledge isn't free, you have to pay attention.
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Carl Weathers
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Post subject: Re: anyone dealt with Medical Over Billing? Posted: Wed Apr 03, 2013 7:17 pm |
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Joined: Mon Mar 13, 2006 9:31 pm Posts: 3993
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AnxietyClown
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Post subject: Re: anyone dealt with Medical Over Billing? Posted: Thu Apr 04, 2013 4:57 am |
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Joined: Mon Mar 13, 2006 3:24 pm Posts: 9265
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coding is complicated - there are two kinds of codes on this bill (and on all bills) a diagnostics code, saying what the problem is and then a set of procedural codes saying how it was fixed.
generally, you can't unbundle your codes and bill them separately. for example, you can't bill for both exploring the would and suturing it - because suturing it requires exploring it - the act of exploring is covered in the cost of sutures. if you don't need to stitch it, you bill for the exploration that determined that. he billed for both and added the 'modifier' saying that the wound included multiple cuts so he actually had to do BOTH things as separate procedures and needs to be paid for both. this is untrue, there's only a single cut involved so that could be pursued as fraud.
the code 99284for the ER visit includes a 'severity' index. the last digit (4) is on a scale of 1-5 regarding how serious the injury was. 4 is very extreme and requires the execution and documentation of 12 different aspect of the wound and medical history. if those 12 steps don't appear in her chart (which we've requested from the hospital) then he has upcoded the severity in order to bill at a higher right - which is also fraud.
_________________ "A problem cannot be solved with the same level of awareness that created it" - Albert Einstein
http://www.thehandsondad.com
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Zerocool
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Post subject: Re: anyone dealt with Medical Over Billing? Posted: Fri Apr 05, 2013 10:07 pm |
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Renegade Heroes |
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Joined: Mon Mar 13, 2006 9:50 pm Posts: 3405 Location: surrey,bc,canada
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as someone who gets upset that we have to pay $104 if we take an ambulance, I'm sickened by this AC. Something jumps out at me... can you get a copy of the bill that the insurance paid on your behalf? I'm sure there's no way he gamed the insurance company and by comparing the two you should be able to catch him out on it... and when you do catch him I'm sure you can sue his pants off for stress and damages this has caused you and your family. I mean that person won a bunch of $$$ for the hot coffee from McDonald's, so... Is your insurance through your work at the network? If so, you should be able to approach the big whig studio lawyers to represent you, no? You could come way out on top of this. Love and luck, Zero.
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