TexasPenguin

Before anyone flames me down, I know the amounts of money I'm going to mention are small and pretty insignificant, but it's simply symptomatic of the scam that is US medical billing.

I'm told I need an MRI for a shoulder problem.
The PA (wrongly) tells me, "wow, I see on your insurance that you only have a $25 co-pay for an MRI - I'll schedule one!
Now, I frankly don't believe this but I figure, what the hell.
The day before the MRI I get a call from billing to say, "err...slight error on the part of the PA, your insurance has told us you must pay $357 for the MRI".
I'm slightly irritated but figure that it's still not that much money and worth it.
I have the MRI (useless as it turns out) and pay the $357.

One month goes by and I receive a bill for $239 from the Radiologist who "read the MRI".
Now I'm annoyed.
Essentially the PCP (where I had the MRI) has sub-contracted the reading to a third party who has then billed me for a service that I didn't request or authorize.
Is this not the same as taking your car for a service and then, one month later, getting a bill from Snap-On for the tools used in the service?

My point is that, in any "normal" transaction, you get quoted a price (or an estimate that you understand is an estimate) and then, after the service, you pay the price...and that's it. You do not expect to get a bill weeks later from someone else, some entirely different company, that you didn't ask to provide you with any service.
Maybe if I had been quoted the real price (or at least told I would get a bill for part of the service from a third party) I wouldn't have opted to have the test. (I probably still would but that's not the point).
It's a scam, plain and simple.

And don't get me started on trying to decipher the EOB (stunningly mis-named document) you get from the insurance con-artists.

Sorry...rant over...

Bob

You're not alone...the whole not knowing, the whole in/out network and who does what is a pain.

When the missus was pregnant and having a check up, the person doing the scan said we could do this other kind of scam and that we might as well because it was going to be covered by our insurance. No, it wasn't going to be covered by our insurance and even if it were, why would we want to do a useless scan so you could scam our insurance company of a $975 fee.

Just very annoying that...and that was at the hospital. Though they sub all the facilities out to private companies within the hospital.

Bink

I agree.

I had one recently where my wife was having blood work done and they'd sent it out to an out of network (OON) contractor without telling me. Insurance company sends me a statement saying they're only covering 10% (high deductible on OON) and that I'd be liable for the rest ($6 or $7k off the top of my head). I flipped out. Turns out that the contractor was billing it as high as possible to get as much as possible from the insurer and only sent me a bill for me standard $25 copay.

Such a stupid system.

Rete

It is standard policy. For example, when I go for my breast mammo, I pay the hospital a co-pay, later on I get a bill from the hospital's radiologist who reads the mammo for another co-pay for his services.

It was only when I had a broken arm that I only had one co-pay and that was because the xray was read by the surgeon and not a radilogist.

Speedwell

My husband went in recently for a flu shot and the last of his hepatitis vaccinations (before he went to his medical, the helpful clinic in the UK gave him everything they could think of short of a pap smear, but he had one more hepB to go). The hepB shot, covered. The flu shot, not covered. MY flu shot, on the same day, covered. It took four back-and-forth iterations between the insurance company and the doctor's office before they figured out that the doctor's clerk had mistyped the insurance number. This all happened the same week that my eye doctor miscoded an eye exam causing it to be rejected by the insurance company as not coverable when I actually fell under a covered code.

Hotscot

And yet people here are so conditioned to think their system is fine. Another reason I'm looking forward to moving home.

sir_eccles

The thing with these small out of pockets is they sort of hope that you will decide that it's too much trouble to fight it and just give up.

I have a fight with Phoenix Children's hospital over $150 (essentially they are misrepresenting a service from their urgent care clinic as an emergency room visit). I have now decided as a matter of principle to fight it and never give up.

TexasPenguin

Isn't that the truth.
I was still fuming when I went into a meeting with my (very Texan) boss.
His responses, in order:

1) You must thank God that you are under the US system - the best in the world, think how bad it would have been in the UK!

2) Surely you must know that you'd get a bill from the Radiologist, everyone knows that.

3) Thank God we don't have to use Obamacare.

Is it me or do so many people here have a brain implant that disables common sense and rational thought when it comes to healthcare? I just don't get it - in the UK we knew there were problems with the system, we never pretended it was "the best in the world" but it makes this system look like a Mafia movie.

Hotscot

I totally agree with you.
In addition if you can afford it in the UK you can also have private through BUPA etc.
When I suggest to my American chums that it's a pity they can't have a mixture of public, paid from taxes that anyone can use, and private concierge service if you can afford it, they just can't get their head around it.
Especially when I tell them my taxes here in the US work out just about the same as they did in the UK.

hungryhorace

Isn't this bullshit system enough to make you move back to England where this utter abortion of a system doesn't exist?

hungryhorace

I've found exactly the same. My tax rates are near identical to England. Yet, America chooses to spend its tax income on its war machine. England funds the NHS from it.

hoffage123

Looks like I have all this to look forward to!

Is there a website that explains the ins and outs of US healthcare, and how to avoid common pitfalls so I don't get stung for charges/services I don't need etc?

Hoffage

Bink

Get married and buy a house. Then you'll be

hungryhorace

I don't get it? Then i'll be laughing? I'm already married, and when / if we buy a home here I'll be liable for substantial property taxes and repairs due to New England's obsession with wood homes.

Hotscot

Oh yes, with a name like Hotscot that would be my first impulse