In July, we ran a story about my experiences trying to get answers to healthcare billing questions.
As it turns out, many Daily Yonder readers feel the same way about healthcare billing and struggle with wading through the healthcare billing system. And many of you question why the system is structured the way it is.
At the time, I faced a hip replacement, the first of three joint replacement surgeries this year. In preparing for that surgery, I struggled to find answers to my questions, even when talking with hospitals, surgeons and other providers.
Many of you commented on Facebook that you had faced similar situations. And many had suggestions on what to do.
Suffice it to say, I finally contacted my insurance agent, who spoke with my insurance provider, who assured us that if the surgery is pre-authorized by the surgeon, every provider who takes part in that surgery can use that number to be covered as an in-network provider.
It’s been two months. I’m moving on to my second surgery — knee replacement. In the meantime, I’ve met a physical therapist, who not only checked to see how many physical therapy appointments I was allowed in a year, so he could spread the visits out over all three surgeries. I’ve been to follow up appointments. I’ve been to pre-surgery testing for the upcoming surgery.
I’ve done a lot. But, I still have no clue how much this is going to cost me.
Sixty days later, and I have yet to receive a single bill from any of the providers who were part of that surgery.
I have, however, received an explanation of benefits from my health insurance provider.
The anesthesiologist who was supposed to be “in-network” because of the surgeon’s pre-authorization number? Insurance rejected the claim because they are out-of-network. The physical therapist? Insurance rejected the claim for being too high, and because I have not yet met my deductible. Also, a mandatory pre-surgery testing appointment, costing nearly $1,000, was rejected because that doctor is also out-of-network.
It’s all part of the dance, Katina Jones, a writer in Jasper, Georgia, who dealt with emergency surgery this summer, said she was told by a hospital billing specialist.
In July, one week after undergoing a procedure to remove kidney stones, Jones woke up in incredible pain. Her husband rushed her to the hospital where a urologist determined she needed immediate surgery. There was no time, she said, to ask whether providers were in her insurance company’s network. Besides, she said, she wasn’t in the right frame of mind to ask.
“They wait until you’re in massive amounts of pain and then they walk in with a clipboard and have you sign your life away,” she said. “Sometimes, they wait until you’re on medication. In my case, they waited ‘til I was on morphine, and then they came in and said, ‘Hey, can you pay us like $800?’ And I was like, ‘Sure, no problem!’ I’m in the emergency room on my phone moving money around so I can pay them.”
When she did get the bills from the hospital, the total for the emergency surgery and the kidney stone removal before it was more than $80,000, she said.
A billing specialist at the hospital told her to wait to pay the bill. It was important, the woman told her on the phone, to let the hospital and insurance company play their game.
“She goes, ‘Don’t even pay attention to these until after they process it with the insurance company,’” Jones said. “She said here’s how the game works – the hospital will tell the insurance company what they want. Then the insurance company will kick it back and say ‘Here’s what we allow for that,’ and then everything gets adjusted again, and they look at my deductible… and then they come up with a number.”
Jones said she’s since had the amount she owes drop drastically as she waits for the process to unfold.
But, in some cases, the fight with the companies that are doing the billing seems pointless, said Clare Morrison, an AmeriCorps volunteer in rural Oregon.
Morrison said she’s fought with one company for almost a year over a $400 bill. The company, a lab that did bloodwork for her, continues to bill the wrong insurance provider, regardless of what she does to correct them.
“I’ve reached out to them multiple times,” she said. “I can never get through to anyone, and then, if I do get through to someone, they tell me I have to talk to my insurance provider…. They keep saying they can’t do anything and I’m like ‘No. You’re the only person who can do something about this.’”
While a $400 medical bill may not be a lot for some people, for someone on a small stipend, it’s a fortune.
“I feel like (the system) does push people into saying ‘I might as well just pay it,’” she said. “But I literally can’t pay it. Even if they want me to do a payment plan, I can’t do it because I’m going to be a graduate student in a month or two and I’m working on a poverty level stipend… Healthcare should be for everyone, not just for the people who can pay for it.”