Watch your hospital bills

Posted by val64 @val64, Apr 7 3:30pm

I'm here venting again, not so much about cancer or the treatment, but about the billing. Grr. Note that this story did NOT happen at any of the Mayo locations.

I hit the (very high IMO) out of pocket maximum on my insurance for last year when I had my hysterectomy in August. But for each of the six follow-up and chemo appointments after that, they required a $150 copay. I just paid it, figuring they knew what they were doing and not really having the energy to fight. But after I finished chemo in January, I investigated, and determined that I should not have paid any of those copays, so the hospital owed me $900. I figured that they would refund it no problem when I explained this to them. Wrong again.

I first tried to ask about this through the portal, but after a week they responded that I should call their main billing number. I later decided that this was because they wanted to make sure there's no paper trail. I have repeatedly asked for documentation of the things people tell me, and they are unwilling to provide it.

I have now called them five times over the last 10 weeks, and have been subjected to endless confusion, falsehoods, and bureaucratic bumbling. As of 2 weeks ago, I thought they had fixed it, but today I realized that $300 is still lost. The woman today insisted for several rounds of putting me on hold that all the money had been credited, but she did finally acknowledge that they still owe me $300. She said it will be credited in 7-10 days. But that's what they always say.

I don't actually think that there is someone diabolically twiddling their fingers and saying, "Let's increase our bottom line by overcharging our cancer patients while they have chemo brain and are worrying about other things," but the effect is the same. I sincerely doubt that they ever would have given this money back if I didn't have the time and the pitbull-like tenacity to keep calling them. So watch your bills.

Interested in more discussions like this? Go to the Gynecologic Cancers Support Group.

So sorry you are having to go through all of that. I had a similar situation with a surgery years ago. I ended up calling the insurance company and they provided me with all the billing documentation. I'm not sure how much insurance companies care about their customers anymore, but it's worth a try. I wish you all the best getting your money back. I share your aggravation and annoyance. You have been through enough already! {{{Hugs}}}


@val64 You have been so much and of course not necessarily watching your hospital bills after surgery and each treatment.

I have had similar problems with billing at my local hospital. In the past before the hospital was bought out by a for profit company 10 years ago there used to be a billing department. When I had a mammogram at my local hospital in 2019 the Radiology dept. billed my former insurance despite the correction I made at the reception desk on the day of the mammogram. Then the billing went to an out-of-state billing agency who sent me a bill indicating I was not insured with Blue Cross/Blue Shield and to personally pay the balance. I called the billing agency and as asked scanned and sent my new Medicare information. It took 3 months to get this worked out. I was furious and decided that unless it was an emergency I would never go back to my local hospital.

I have heard similar stories from friends in other cities in the US. I’m well aware that coding and billing has become more complicated. I’d like to think that this mess is because of disorganization and poor communication within these medical systems. But then I wonder if this is by design. How many people read their bills as carefully as you and me? And what if the person is too ill to read their bills carefully?

I know @val64 that you are a tenacious individual and you will get the remainder of your charges refunded. Thank you for the reminder that we all need to watch medical billing and not assume it is accurate.

How are you feeling overall?


@tymayo, the insurance company rep actually did go above and beyond in trying to help. After one call to the hospital, where they blamed the problem on the insurance company, I called the insurance company, told the rep my story, and she actually called the hospital, with me still on the line, and tried to convince them that the insurance company had completed everything on their end and that the hospital owed me the money. She must have been on that call with me for 30 min total. I was very impressed. Whether or not it helped is debatable.

@naturegirl5, having been a hospital bureaucrat myself, I'm pretty sure that this is just disorganization, poor communication, and problems unintentionally built into Epic, which is outrageously complicated, built from scratch at every hospital system, and still relatively new (less than 10 years old). In my case, I imagine the copays are determined automatically by Epic, and nobody programmed it to check if the patient has hit the out of pocket maximum. You would hope that ~7 years out from when they started using Epic that this would have been fixed, but apparently not.

I was partly responsible for the Epic build for our lab at a different hospital, including ordering the test, tracking the specimens, and reporting the results. I was incredibly relieved when Epic went live and our lab was still functional in our role in patient care. I didn't have any responsibility for billing, other than linking the correct code to each test, but a few months later we realized that the billing was messed up. A doctor called my boss and yelled about a patient receiving a $24,000 bill for a fairly routine test. So my boss demanded to see the chargemaster (the list prices for every procedure, which at that time was a tightly held secret. Now Congress has required that every hospital make it public). She and I went through it and found all sorts of crazy things. She tried to fix it, but my impression was that, once fixed, it didn't stay fixed, as if there was a back-up copy somewhere that had stayed the same and that would periodically be reloaded into the system.

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