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Old 07-17-2014, 1:06pm   #1
Brett K
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Default Insurance networks and billing disputes

I had the unfortunate circumstance of being taken to the ER by ambulance last month due to a back injury and I couldn't get out of bed or walk. I'm feeling better now, but just in time for all of the insurance hassles.i have what I thought was a good plan with BCBS. I knew I would have a small copayment for the ambulance ride. My wife called 911 and an ambulance was dispatched for the 5 minute ride. Of course the ambulance service that was contacted was "out of network". My insurance issued me a check for what they would have payed for an in-network service minus my copayment. The ambulance company now sends me a bill for more than double that amount for 1000. This is where phone calls get me...

Insurance company blames the ambulance company for being greedy and not agreeing to their pricing to become an in-network provider. They say the ambulance company should be flexible in pricing and agree to their rate given it was an emergency.

The ambulance company blames my insurance company for being cheap and claim their rates our standard and in line with Medicare approved pricing. They say the insurance should be flexible in covering the additional cost given it was an emergency situation.

I seem to be in the middle and not getting anywhere with either place. I'm ok with paying extra but I'm not going to get bent over and pay more than double. I will tell them I can only afford a $1 a month for the next 1000 months I am not even sure who I should be pissed at with all of this nonsense or who I have the most leverage with to agree on a reasonable rate.
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Old 07-17-2014, 4:03pm   #2
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Your fuked and you will pay what the ambulance company charges you - what ever that amount will be - because if you don't they will destroy your credit.

Oh, and that's just the beginning. You are about to be fuked harder by the hospital and doctors you saw.

And you will pay them too, for the same reason.

Most people think they have great insurance until they actually have to use it. Something like 80% of the bankruptcies in this country are medically related. And of those people, something like 3/4ths of them had insurance when they got sick or injured.
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Old 07-17-2014, 4:04pm   #3
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"Paging NAV to the help desk"
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Old 07-17-2014, 4:41pm   #4
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your insurance should also have a 'out of pocket' max as well as a deductible. that's what will control how many checks you write.

when i was in the ER and then the ICU, the first providers basically got paid by me, and the last providers got paid by the insurance co.

in the end, i didn't pay a penny for my 135k pacemaker and surgery, as i had met my deductible and out of pocket max before then.

don't freak out, read and understand your coverage.
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Old 07-17-2014, 5:32pm   #5
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Originally Posted by Joecooool View Post
Your fuked and you will pay what the ambulance company charges you - what ever that amount will be - because if you don't they will destroy your credit.

Oh, and that's just the beginning. You are about to be fuked harder by the hospital and doctors you saw.

And you will pay them too, for the same reason.

Most people think they have great insurance until they actually have to use it. Something like 80% of the bankruptcies in this country are medically related. And of those people, something like 3/4ths of them had insurance when they got sick or injured.
Let's debunk that myth about bankruptcies right now: Even the most rabid Obamacare proponent has claimed that only about 60% of bankruptcies were precipitated by medical expenses. Proponents of the health-cost-bankruptcy theory tend to cite a Harvard study that blames high medical bills for some 62 percent of American bankruptcies. The study's authors include Elizabeth Warren, a former Obama Administration official.

A study published in the journal Health Affairs reviewed Justice Department data and discovered that among Americans who cited medical debt as a contributing factor in their bankruptcy filing, only 12 to 13 percent of their total debts were medical. Nearly 90 percent of their obligations are unrelated to health care.

BTW, Warren's earlier research on medical bankruptcies found that medical spending was a factor in no more than 17 percent of U.S. bankruptcies.

Medical bankruptcy: Fact or fiction? | TheHill

I do a lot of bankruptcy work for creditors. Almost all bankruptcies are caused by having too much debt--not just medical debt but credit card debt, mortgage debt, car debt, etc., caused by bad money management: An inability to live within their means. Just because some medical debt was among the debts they owed can't be cited as the reason for filing bankruptcy...and that's precisely what the Harvard study did.
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Old 07-17-2014, 5:51pm   #6
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Originally Posted by Joecooool View Post
Your fuked and you will pay what the ambulance company charges you - what ever that amount will be - because if you don't they will destroy your credit.

Oh, and that's just the beginning. You are about to be fuked harder by the hospital and doctors you saw.

And you will pay them too, for the same reason.

Most people think they have great insurance until they actually have to use it. Something like 80% of the bankruptcies in this country are medically related. And of those people, something like 3/4ths of them had insurance when they got sick or injured.


And it's all due to Medicare.
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Old 07-17-2014, 9:07pm   #7
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It isn't going to break me. I just find it ridiculous that ambulance services on a 911 cal can be in or out of network. I also think the rate is ridiculous. A 7 mile ride taking a half hour from time of pick up to drop off is almost 1000. The ambulance service is charging about $1800 an hour. They tell me their billing is a standard rate approved by Medicare. Holy crap!

I was in the ER the night before with severe back spasms and was discharged. The meds they gave me didn't touch them. I kept trying to get up out of bed to get myself to a car and I couldn't move my legs. I was worried about what further damage I might do until I got an X ray and MRI. If you have ever had back spasms before, you will understand what I am talking about. It feels like you are getting hit with a taser in the middle of the back every time you try and move. It was the most painful thing I ever experienced and I have a pretty high tolerance for pain.

I have a 250 deductible, and a 100 deductible for ER visits, and 15 -30 copay for office visits. The ambulance ride will be the most expensive thing that happened by a long shot.
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Old 07-17-2014, 9:22pm   #8
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I had a two hour ambulance ride at 4am. The billed cost was over 3,000
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Old 07-17-2014, 9:37pm   #9
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Quote:
Originally Posted by lspencer534 View Post
Let's debunk that myth about bankruptcies right now: Even the most rabid Obamacare proponent has claimed that only about 60% of bankruptcies were precipitated by medical expenses. Proponents of the health-cost-bankruptcy theory tend to cite a Harvard study that blames high medical bills for some 62 percent of American bankruptcies. The study's authors include Elizabeth Warren, a former Obama Administration official.

A study published in the journal Health Affairs reviewed Justice Department data and discovered that among Americans who cited medical debt as a contributing factor in their bankruptcy filing, only 12 to 13 percent of their total debts were medical. Nearly 90 percent of their obligations are unrelated to health care.

BTW, Warren's earlier research on medical bankruptcies found that medical spending was a factor in no more than 17 percent of U.S. bankruptcies.

Medical bankruptcy: Fact or fiction? | TheHill

I do a lot of bankruptcy work for creditors. Almost all bankruptcies are caused by having too much debt--not just medical debt but credit card debt, mortgage debt, car debt, etc., caused by bad money management: An inability to live within their means. Just because some medical debt was among the debts they owed can't be cited as the reason for filing bankruptcy...and that's precisely what the Harvard study did.
I ted to believe the study. After all, everybody knows that Indians, er, sorry, native Americans, are scrupulously honest.
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Old 07-18-2014, 7:49am   #10
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Quote:
Originally Posted by lspencer534 View Post
Let's debunk that myth about bankruptcies right now: Even the most rabid Obamacare proponent has claimed that only about 60% of bankruptcies were precipitated by medical expenses. Proponents of the health-cost-bankruptcy theory tend to cite a Harvard study that blames high medical bills for some 62 percent of American bankruptcies. The study's authors include Elizabeth Warren, a former Obama Administration official.

A study published in the journal Health Affairs reviewed Justice Department data and discovered that among Americans who cited medical debt as a contributing factor in their bankruptcy filing, only 12 to 13 percent of their total debts were medical. Nearly 90 percent of their obligations are unrelated to health care.

BTW, Warren's earlier research on medical bankruptcies found that medical spending was a factor in no more than 17 percent of U.S. bankruptcies.

Medical bankruptcy: Fact or fiction? | TheHill

I do a lot of bankruptcy work for creditors. Almost all bankruptcies are caused by having too much debt--not just medical debt but credit card debt, mortgage debt, car debt, etc., caused by bad money management: An inability to live within their means. Just because some medical debt was among the debts they owed can't be cited as the reason for filing bankruptcy...and that's precisely what the Harvard study did.
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Old 07-18-2014, 7:57am   #11
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As to the ambulance charges, and out of network, my one an only ambulance ride was just like that. BCBS paid their agreed price, and I paid the remainder, since the ambulance corps that scraped me off the pavement was "out of network." I was kind of incensed at the time, but I understand and agree with the way it went down. I voluntarily used their service, and didn't question the price up front, which is what I should have done.

Negotiating after the fact? Yeah, good luck with that.
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Old 07-18-2014, 12:08pm   #12
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12/15/12 Wife got hit HARD, while stopped in traffic.....45mph by an old cop car, complete with nerf bars on front.....her ambulance ride was about 20 minits, I got to hospital just as she was being offloaded.....

~6 hours in the ER, all the tests, nothing broken.....18K+ hospital bill.....

Ambulance ran about 300......they guy had that stupid NO FAULT BS at min coverage so only 10 grand was covered, the hospital wrote off the rest of it.....so I question the validity of most of this 'medical billing' .....it's all bullshit.....

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Old 07-18-2014, 12:41pm   #13
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I have heard of that "out of network" ambulance crap before.

Seems pretty scummy to me.

I'm grateful I live 5 minutes away from a hospital. I'd have a neighbor drive me there before I called for an ambulance.
I was having a god awful kidney stone experience 25 yrs. ago. A friend drove me to the ER - about a 5 minute trip. The waiting room was full. I stayed out there for an hour in terrible pain. I told them I knew my problem and to just let me go back there and get a shot of pain killer. No! The only way to go back there immediately was to be brought in by ambulance. I walked outside and called 911. The ambulance pulled up outside. They were actually stationed on the same property. I got in the back and they drove me to the ER offloading dock. I walked straight into the ER and saw the Dr. immed. it wasn't even crowded in there. The problem seemed to be only one Dr. was working. I can't remember if they charged my insurance or what happened with the ambulance bill. But I needed something for pain and not stupid rules and red tape.
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Old 07-18-2014, 1:15pm   #14
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1. The ER is over crowded thanks in part to those w/out insurance using it as their PCP.

2. That hospital sucks to deny you pain meds and/or help in your situation.

3. I wouldn't go to a hospital ER anymore. I'd probably go to one of the 3rd party ER's. I went to one before when I was really sick. No one there, the personnel were polite and professional. I was well taken care of and got the treatment I needed. Cost the same as a hospital ER but way better experience.
My primary Doc runs an 'Urgent Care Center'....down the road a bit about 30 minits away.....Jake is a good man.....managed to put a few patches on my old ass, and with help from a good tummy surgeon that he recommended....

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