Mafia shakedown...
Apr 4th 2011, 12:30 pm
#16
.
Thread Starter
Joined: Nov 2002
Location: Where bad things rarely happen in movies
Posts: 8,933
Apr 5th 2011, 6:39 am
#17
BE Forum Addict
Joined: Feb 2011
Location: WA state
Posts: 3,074
Re: Mafia shakedown...
My optician sent me a check for $36 when he realised he had overcharged me. My dentist is completely useless though and keeps rebilling me when he can't get hold of my insurance. never found a dentist that charges the standard rates that my insurance covers - everyone has mystical charts of charges but won't tell you what is on them, you just have to hope that the insurance has the higher number (rarely does) or you have to cover the difference.
Apr 5th 2011, 7:18 am
#18
BE Forum Addict
Joined: Sep 2006
Location: Andover, MA
Posts: 1,703
Re: Mafia shakedown...
Oh yeah, love medical billing. My favorite was after a speech evaluation of my son. The doctor's messed up the paperwork and the insurance company refused it (legitimately).
So the doctor did another submission, rather then revising the previous one. So then the latest one was refused, since the insurance company said we're only covered for one speech evaluation per year and now they've had submissions for two!
Called insurance and explained the whole ridiculous mess which had gone on for months. The insurance company then said they don't usually pay since the claim was now outside the usual 6-month window
Thankfully, I was speaking to one of those rare health insurance people with half brain and half a heart, and she approved it with her boss while I was on the phone as goodwill.
So the doctor did another submission, rather then revising the previous one. So then the latest one was refused, since the insurance company said we're only covered for one speech evaluation per year and now they've had submissions for two!
Called insurance and explained the whole ridiculous mess which had gone on for months. The insurance company then said they don't usually pay since the claim was now outside the usual 6-month window
Thankfully, I was speaking to one of those rare health insurance people with half brain and half a heart, and she approved it with her boss while I was on the phone as goodwill.
Apr 5th 2011, 7:33 am
#19
Boomshacalaca!!
Joined: Dec 2005
Location: South of the North Pole.......Colorado
Posts: 5,066
Re: Mafia shakedown...
.... my Vet seems to get the billing and account correct and I haven't had to deal with any issues... as I'm a warm blooded mammal, maybe I should go the her for all medical needs! Way cheaper too imo.
Apr 5th 2011, 7:43 am
#20
Lost in BE Cyberspace
Joined: Feb 2004
Posts: 14,578
Re: Mafia shakedown...
In the past 2 weeks I've received 3 letters from different branches of our local mafia, all pretty much along the same lines - roughly paraphrased..... "You paid us what we asked for, but now we want more".
Of course they don't call themselves the mafia - they use updated names - Don becomes Doctor, Protection money becomes Insurance etc etc, but they fit in somewhere between pimp and drug-pusher on my own ethics scale......
Basically, I had physio back at the end of 2009 (last treatment was 1/5/2010 - ie 15 months ago), and paid for it session by session as I went. It was all pre-approved by the insurance, but because of our high deductible, I was paying it out of pocket at the insurance discounted rate, and got a receipt for each one. The physio has now sent a letter saying because of a clerical error they undercharged me by about $500 and they now want immediate payment.
I've had similar from a doctor that did some tests on my wife back in October 2009, and another for my son from a dermatologist he saw in December 2009. The total "new" claims on old treatments come to almost $2000.
Anyway, the question. I'm not trying to get out of paying what I owe, but is there any time limit specifying when any further claims are time-barred, or can they keep coming back ad infinitum saying "oops, we want a bit more"...?
Of course they don't call themselves the mafia - they use updated names - Don becomes Doctor, Protection money becomes Insurance etc etc, but they fit in somewhere between pimp and drug-pusher on my own ethics scale......
Basically, I had physio back at the end of 2009 (last treatment was 1/5/2010 - ie 15 months ago), and paid for it session by session as I went. It was all pre-approved by the insurance, but because of our high deductible, I was paying it out of pocket at the insurance discounted rate, and got a receipt for each one. The physio has now sent a letter saying because of a clerical error they undercharged me by about $500 and they now want immediate payment.
I've had similar from a doctor that did some tests on my wife back in October 2009, and another for my son from a dermatologist he saw in December 2009. The total "new" claims on old treatments come to almost $2000.
Anyway, the question. I'm not trying to get out of paying what I owe, but is there any time limit specifying when any further claims are time-barred, or can they keep coming back ad infinitum saying "oops, we want a bit more"...?
Apr 5th 2011, 11:50 am
#21
Chocoholic !
Joined: Jun 2007
Location: Houston, TX - Officially Not Shit since 2009
Posts: 2,324
Re: Mafia shakedown...
Hubby went for an MRI and before they did it he asked how much? - $500 they said and we have called Aetna and you have to pay 10% so he paid $50.
They then submitted their charges to Aetna for $3,500 of which Aetna paid $1,320 leaving us a bill for $1,480. I called hubby as soon as I received the EOB. He reiterated that he had asked for the costs prior to treatment but said lets wait and see what happens.
Low and behold we receive a bill from the MRI folk for $1,480, hubby calls them and doesn't even need to shout they just say 'Oh yeah that's a mistake', a couple of days later we receive a statement from them with a $0 balance.
So hubby has paid $50 and Aetna has paid $1,320 for a $500 procedure.
Now I could have called the Aetna and told them but is that really my job?
They then submitted their charges to Aetna for $3,500 of which Aetna paid $1,320 leaving us a bill for $1,480. I called hubby as soon as I received the EOB. He reiterated that he had asked for the costs prior to treatment but said lets wait and see what happens.
Low and behold we receive a bill from the MRI folk for $1,480, hubby calls them and doesn't even need to shout they just say 'Oh yeah that's a mistake', a couple of days later we receive a statement from them with a $0 balance.
So hubby has paid $50 and Aetna has paid $1,320 for a $500 procedure.
Now I could have called the Aetna and told them but is that really my job?
Apr 5th 2011, 12:31 pm
#22
Lost in BE Cyberspace
Joined: May 2010
Location: San Diego, California
Posts: 9,709
Re: Mafia shakedown...
I too received additional charges many months after the initial treatment.
In both cases I asked the medical provider to send the bills to either the (then) medical insurer or my current one - yes, in one case I had changed insurers in the interim.
I had been informed that claims can be submitted up to a year after the treatment - in my case one insurer paid up, the other did not due to "out of time".
Since my insurer did not pay neither did I. I sent a letter to the medical provider explaining that a) I did not have the monies to pay such a bill and b) I would never have had the treatment without the benefit of insurance.
The medical provider rescinded the bill.
In both cases I asked the medical provider to send the bills to either the (then) medical insurer or my current one - yes, in one case I had changed insurers in the interim.
I had been informed that claims can be submitted up to a year after the treatment - in my case one insurer paid up, the other did not due to "out of time".
Since my insurer did not pay neither did I. I sent a letter to the medical provider explaining that a) I did not have the monies to pay such a bill and b) I would never have had the treatment without the benefit of insurance.
The medical provider rescinded the bill.
Apr 5th 2011, 12:42 pm
#23
Lost in BE Cyberspace
Joined: May 2010
Location: San Diego, California
Posts: 9,709
Re: Mafia shakedown...
Hubby went for an MRI and before they did it he asked how much? - $500 they said and we have called Aetna and you have to pay 10% so he paid $50.
They then submitted their charges to Aetna for $3,500 of which Aetna paid $1,320 leaving us a bill for $1,480. I called hubby as soon as I received the EOB. He reiterated that he had asked for the costs prior to treatment but said lets wait and see what happens.
Low and behold we receive a bill from the MRI folk for $1,480, hubby calls them and doesn't even need to shout they just say 'Oh yeah that's a mistake', a couple of days later we receive a statement from them with a $0 balance.
So hubby has paid $50 and Aetna has paid $1,320 for a $500 procedure.
Now I could have called the Aetna and told them but is that really my job?
They then submitted their charges to Aetna for $3,500 of which Aetna paid $1,320 leaving us a bill for $1,480. I called hubby as soon as I received the EOB. He reiterated that he had asked for the costs prior to treatment but said lets wait and see what happens.
Low and behold we receive a bill from the MRI folk for $1,480, hubby calls them and doesn't even need to shout they just say 'Oh yeah that's a mistake', a couple of days later we receive a statement from them with a $0 balance.
So hubby has paid $50 and Aetna has paid $1,320 for a $500 procedure.
Now I could have called the Aetna and told them but is that really my job?
While we constantly blame the insurance companies for these high costs, I think the medical profession itself is raking in the money by hiking the cost of services without any apparent 'watchdog' regulating what is happening.
This year the cost of a mammogram with my usual provider has doubled in cost from last year. Why? who knows. Its the same equipment, the same operator, the same room.
Apr 5th 2011, 1:27 pm
#24
.
Thread Starter
Joined: Nov 2002
Location: Where bad things rarely happen in movies
Posts: 8,933
Re: Mafia shakedown...
, I think the medical profession itself is raking in the money by hiking the cost of services without any apparent 'watchdog' regulating what is happening.
This year the cost of a mammogram with my usual provider has doubled in cost from last year. Why? who knows. Its the same equipment, the same operator, the same room.
This year the cost of a mammogram with my usual provider has doubled in cost from last year. Why? who knows. Its the same equipment, the same operator, the same room.
Apr 5th 2011, 4:03 pm
#25
BE Site Lead
Joined: Aug 2004
Location: MA, USA
Posts: 92,175
Re: Mafia shakedown...
Aye, when the missus was going in for some scans at the hospital, the company doing the scans wanted her to come in for a couple more even though the doctor admitted that they weren't necessary but that the insurance would pay for them and they needed the money and it was about a grand a pop.
Didn't do it as we had the baby before the next appointment though
Oh and the charge to the insurance was way higher than they told us it would initially be, which is annoying as we've got to cover the last 10%. Waiting for all the bills to come in before tackling which ones are dodgy though.
Didn't do it as we had the baby before the next appointment though
Oh and the charge to the insurance was way higher than they told us it would initially be, which is annoying as we've got to cover the last 10%. Waiting for all the bills to come in before tackling which ones are dodgy though.
Apr 5th 2011, 5:20 pm
#26
Lapine Member
Joined: Nov 2004
Location: Austin, Texas in my own little world
Posts: 21,691
Re: Mafia shakedown...
It is unclear whether you have legal rights in Texas to not pay balance billing.
http://www.statehealthfacts.org/prof...6&cat=7&rgn=45
If your provider is out-of-network, you have the right to mediation:
http://www.karlbayer.com/blog/?p=2273
....and providers are not required to disclose whether they are OON. It can be difficult to verify this yourself, and of course, no one is responsible for any misinformation they give you ("everything is an estimate....")
Yes, the health care system is screwed, and Texas is *very* screwed.
http://www.statehealthfacts.org/prof...6&cat=7&rgn=45
If your provider is out-of-network, you have the right to mediation:
http://www.karlbayer.com/blog/?p=2273
....and providers are not required to disclose whether they are OON. It can be difficult to verify this yourself, and of course, no one is responsible for any misinformation they give you ("everything is an estimate....")
Yes, the health care system is screwed, and Texas is *very* screwed.
