Legal Advise - Medical Billing

[Soul_Patch]

Any lawyers about want to assist with this one?

Ok so a back story. I injured my knee and went to my primary care doctor (who takes my insurance, and is in network). She sent me for an MRI (in network), then to a specialist (in network). Specialist said i had to have surgery to repair my meniscus and ACL. He set me up with a date for surgery at the office located 1 floor below his, same building. Surgery was set for about 3 months out from my visit to the specialist. After about 2 months i got to wondering, i never recieved a call from the doctors office about any pre surgery blood work, insurance, etc. I called them. They said, everything is taken care of, no need for any pre visit, you are good to go for April 6th.

I show up to my surgery, the lady at the recieving desk asked me a bunch of questions, and then there seemed to be a mix up with my paper work, she asked me who had called me for my pre screen, i said no one, i was told i didnt need one. She, shrugged and said, ok well it will just take more paper work, no biggee.

Long story short...apparently this office isnt part of my doctors office at all, they are totaly seperate, and actually are out of network for my insurance. No one told me this, in fact, i didnt know until today when i recieved a bill. So...to recap. PCP in network, specialist in network, MRI in network, but the place these people do their surgery, out of network. All the doctors that worked on me that day were in network, anesthesia, etc...

Today i get a bill from the facility in which the surgery was performed for almost $11,000. 3,000 out of network deductable, plus 7,800 roughly for co-insurance owed by me.

No one EVER once told me that this place was not affiliated with my doctor, or his billing. in fact, they have basically the same name, or so i thought. I was never called to verify insurance or even asked about it. I have been places out of network before, and they tell me so before i even sign a paper. Nothing was ever done like that here.

Now i am told i owe 11k...well, i dont have 11k to pay them. Nor will i, in the near future. Do i have any legal recourse? Im really not sure what to do here.

[MannyIsGod]

You've got no legal recourse. You went to a doctor for a service and you received that service. That doesn't mean you'll have to pay the entire bill you've received but you're going to have to pay some of it at the very least and the amount you'll pay will be sizable.

I don't want to be that guy who's going to lecture, but how on earth do you go to an out of network doctor for surgery and not know it? Ultimately if someone is going to do work on you you should check it out and make sure things are OK to begin with.

In any event, being out of network isn't totally bad. For one thing the doctor you went to doesn't have to abide by any insurance rules because they're not trying to stay within the network. This means they can write off as much of the amount you owe as they want. This means they have the freedom to negotiate with you.

Now, you can try to offer an upfront cash payment of a certain amount (I would start at about 3,000 although going lower will likely not hurt you) to see if they will be willing to write off the rest in exchange for getting that money right now. They may be ok with this they may not, but it is definitely worth a shot. Otherwise, you should be able to get on some non interest or low interest payment plan. If you send them a sob story they may even write everything off but I really think that is unlikely.

Your best option is going to be paying a portion of that bill right now in order to get them to waive the rest. But you will have to pay a portion.

What type of bill would you be looking at had he been in network? i'm assuming you'd still be on the hook for 20-30% of total cost of the procedure plus a yearly deductible if you hadn't met it unless you have a yearly out of pocket max.

[Soul_Patch]

you can probably tell them how much you will be able to pay per month; and then pay them $50 per month for the rest of your life

That is exactly what i wanted to avoid.

this whole thing just seems so fucking deceptive and shady. Shouldn't someone along the line alerted me to the fact that they are out of network. No one called me to even verify. The surgery facility was located directly below my doctors office, i assumed all part of the same practice...since they shared similar logos and names.

There are literally 100s of in network facilities i could have had this done at, why on earth would i have ever willingly agreed to have this done at a place that would cost me 11 thousand dollars. It is fucking criminal.

not only that, the entire fucking surgery cost over 44 thousand dollars. The facility themselves charged 32 thousand dollars total. HAHAH 32 thousand dollars for a 2hr surgery. Not to count the doctors charges of 8000 the anesthesiologist for 3500 and some random charges for unknown shit.

wow...

[Soul_Patch]

You've got no legal recourse. You went to a doctor for a service and you received that service. That doesn't mean you'll have to pay the entire bill you've received but you're going to have to pay some of it at the very least and the amount you'll pay will be sizable.

I don't want to be that guy who's going to lecture, but how on earth do you go to an out of network doctor for surgery and not know it? Ultimately if someone is going to do work on you you should check it out and make sure things are OK to begin with.

In any event, being out of network isn't totally bad. For one thing the doctor you went to doesn't have to abide by any insurance rules because they're not trying to stay within the network. This means they can write off as much of the amount you owe as they want. This means they have the freedom to negotiate with you.

Now, you can try to offer an upfront cash payment of a certain amount (I would start at about 3,000) to see if they will be willing to write off the rest in exchange for getting that money right now. They may be ok with this they may not, but it is definitely worth a shot. Otherwise, you should be able to get on some non interest or low interest payment plan. If you send them a sob story they may even write everything off but I really think that is unlikely.

That is the thing Manny. The doctor wasnt out of network, no doctor i ever went to in the entire 3 months leading to the surgery were out of network. The only place out of network was the actual facility that the surgery was conducted in. The doctors, all of them, were in network and paid in full already by my insurance. The facility charged 32k roughly, in which i owe as my portion, 11k.

[Soul_Patch]

What type of bill would you be looking at had he been in network? i'm assuming you'd still be on the hook for 20-30% of total cost of the procedure plus a yearly deductible if you hadn't met it unless you have a yearly out of pocket max.

If the FACILITY had been in network, id owe absolutely nothing. I was well aware of all of this before hand. In fact when i was told i needed surgery, i even asked the lady scheduling (half-heartedly i admit) i assume all of this is covered by insurance right??

She said, oh yea, definately. I asked because they were ordering me a brace (expensive) crutches, pills, etc etc eetc...and i was worried it would cost me a lot.

[MannyIsGod]

That is exactly what i wanted to avoid.

this whole thing just seems so fucking deceptive and shady. Shouldn't someone along the line alerted me to the fact that they are out of network. No one called me to even verify. The surgery facility was located directly below my doctors office, i assumed all part of the same practice...since they shared similar logos and names.

There are literally 100s of in network facilities i could have had this done at, why on earth would i have ever willingly agreed to have this done at a place that would cost me 11 thousand dollars. It is fucking criminal.

not only that, the entire fucking surgery cost over 44 thousand dollars. The facility themselves charged 32 thousand dollars total. HAHAH 32 thousand dollars for a 2hr surgery. Not to count the doctors charges of 8000 the anesthesiologist for 3500 and some random charges for unknown shit.

wow...

Its not shady at all, to be honest. If anything, the doctor takes a risk taking patients out of network because they get a smaller portion of money from the insurance company and they run of the risk of the patient never paying.

Surgery is expensive. I would tend to agree that they charge way to much but there's a lot of reasons for that and insurance companies are definitely at the top of the list. One reason they bill so much is because insurance companies pay so little and its a way of getting more money. But its also a reason they're willing to negotiate.

[MannyIsGod]

That is the thing Manny. The doctor wasnt out of network, no doctor i ever went to in the entire 3 months leading to the surgery were out of network. The only place out of network was the actual facility that the surgery was conducted in. The doctors, all of them, were in network and paid in full already by my insurance. The facility charged 32k roughly, in which i owe as my portion, 11k.

I hear what you're saying but the fact of the matter is medical procedures are expensive as fuck and you should never just take someone's word for it. You should look at all the forms you are signing etc etc.

I'm honestly not trying to shit on you, but medical bills are something you don't fuck around with. I used to sell insurance and I know how insanely high those bills can get and why you should make sure all your bases are covered.

Never assume shit.

[MannyIsGod]

If the FACILITY had been in network, id owe absolutely nothing. I was well aware of all of this before hand. In fact when i was told i needed surgery, i even asked the lady scheduling (half-heartedly i admit) i assume all of this is covered by insurance right??

She said, oh yea, definately. I asked because they were ordering me a brace (expensive) crutches, pills, etc etc eetc...and i was worried it would cost me a lot.

If you would have paid nothing then I really feel for you because the chances of you getting out of this by paying nothing are really fucking slim. If you have any lawyer friends you can try having them send a letter on official letterhead stating that you were told it was in network and then not, but if the practice wants to take you to the woodshed they certainly can because I have no doubts they made you sign forms stating you were ultimately responsible for anything the insurance didn't cover.

I'm not so sure if I'd hire a lawyer, though. Thats probably just going to add to your bills.

You're going to have to negotiate in some form here with the practice. You can try the lawyer route or you can try being flat out honest with them. The doctor may choose to just take whatever the insurance gave him and just write off the rest. If that doesn't work then you can offer to pay a small amount in cash and go from there.

[MannyIsGod]

pfff

even if you ask the doctor beforehand if you are covered and what it might cost, they won't EVER tell you shit because if they tell you wrong they could be held liable

so it's really close your eyes and wait for Kobe's 14-incher

Did Mookie punch the soft spot in your head while you were a baby? I need a reason why you're the dumbest and worst Victoria poster here.

[Soul_Patch]

I hear what you're saying but the fact of the matter is medical procedures are expensive as fuck and you should never just take someone's word for it. You should look at all the forms you are signing etc etc.

I'm honestly not trying to shit on you, but medical bills are something you don't fuck around with. I used to sell insurance and I know how insanely high those bills can get and why you should make sure all your bases are covered.

Never assume shit.

I would never guess, in a million years, that when a doctor says you need surgery and says, oh yea i do them right here! That i should have said, Oh well is right here part of my coverage too? I cant imagine anyone that would. No one from the surgery office ever even called me to ask me about insurance, i called them once to ask if they needed anything from me, and was told no, i was all set, everything was ready...no mention ever of being out of network....

Lets say you visit your primary care doctor and she says i need you to go down the hall and pee in a cup and come back. Would you say, well is that room down the hall part of my coverage? I wouldn't, you would go pee in the cup, or give them blood or whatever the case may be.


I agree...im pretty fucked. No way im paying them 11k. I dont have it to pay.

[CubanMustGo]

There's a reason why medical bills are a leading cause of bankruptcy filings in the US. Sorry you had to find this out the hard way.

It's pure bullshit that people who are not in a network are billed so much more than people (and their insurers) who are. That's our wonderful healthcare system.

[MannyIsGod]

I would never guess, in a million years, that when a doctor says you need surgery and says, oh yea i do them right here! That i should have said, Oh well is right here part of my coverage too? I cant imagine anyone that would. No one from the surgery office ever even called me to ask me about insurance, i called them once to ask if they needed anything from me, and was told no, i was all set, everything was ready...no mention ever of being out of network....

Lets say you visit your primary care doctor and she says i need you to go down the hall and pee in a cup and come back. Would you say, well is that room down the hall part of my coverage? I wouldn't, you would go pee in the cup, or give them blood or whatever the case may be.


I agree...im pretty fucked. No way im paying them 11k. I dont have it to pay.


Perhaps my view is skewed because I sold insurance and I know exactly what to look for, but if I'm going to have a procedure done by a doctor I'm going to make sure that I know what I'm on the hook for beforehand. I'm pretty sure that next time you will too.

That being said, if you really feel strongly that you were told it was all in network take it up directly with the surgeon who did your surgery and explain to him what the office staff told you. In the end I have no doubt you legally signed a form that put you on the hook for the balance, but if they had a problem with office staff he might just write it off. The problem is that you don't have much leverage and you have to basically rely on him not being a total dick.

[MannyIsGod]

http://2.bp.blogspot.com/_WyEfBSiGITc/TQkItFRzbQI/AAAAAAAAAeU/pH2GKR6dxLU/s1600/mountain-gorilla-of-rwanda.jpg

I look like a monkey. You're an idiot. I can live with that.

[MannyIsGod]

There's a reason why medical bills are a leading cause of bankruptcy filings in the US. Sorry you had to find this out the hard way.

It's pure bullshit that people who are not in a network are billed so much more than people (and their insurers) who are. That's our wonderful healthcare system.

Well, being in network means you agree to a payment schedule and the procedures of that insurance company. The insurance company basically negotiates you a rate. When you go to out of network doctor you go alone and without the backing of the insurance company.

[MannyIsGod]

it's amazing that you've learned to type using home row

props :tu


Did Mookie punch the soft spot in your head while you were a baby? I need a reason why you're the dumbest and worst Victoria poster here.

[MannyIsGod]

SP, in the end don't let me persuade you from getting at least talking to a lawyer. I'm sure you can get some free consolations to see if you have any options. Its my personal opinion that you don't have much legal recourse here if any but thats from someone who isn't a lawyer but dealt with this field in the past. I haven't had an insurance license for almost a decade and while most of the shit is still the same my opinion is what it is. If you can get free consolations then get some legal opinions on your options. It can't hurt to try.

[MannyIsGod]

it's amazing that you've learned to type using home row

props :tu

Also, I'm working on sign language next.

[MannyIsGod]

Yes

[Soul_Patch]

Perhaps my view is skewed because I sold insurance and I know exactly what to look for, but if I'm going to have a procedure done by a doctor I'm going to make sure that I know what I'm on the hook for beforehand. I'm pretty sure that next time you will too.

That being said, if you really feel strongly that you were told it was all in network take it up directly with the surgeon who did your surgery and explain to him what the office staff told you. In the end I have no doubt you legally signed a form that put you on the hook for the balance, but if they had a problem with office staff he might just write it off. The problem is that you don't have much leverage and you have to basically rely on him not being a total dick.


That is the thing, and i know im just beating a dead horse, but i totally understand various doctors that are out of network. Doctors are like free agents, and work where they can and are on certain insurance panels. I get that, my wife is a Mental Health Therapist, and regardless of where she works, she can only bill certain insurance. But the physical suite in a building that the surgery takes place in, conducted by doctors that are in your network, not so much. It was literally down the stairs from my initial exam room, and through a door. Nothing suggesting it wasn't part of the same place i originally went IN NETWORK. I actually didn't even know the facility was a completely separate billing party. Did you know that? Everyone i dealt with was a part of the doctors office, and in network (verified when i first went there long before the surgery) yet the surgery room was not.

Just seems like a completely fucked up system. I know even if i convince you of that fact, it isnt going to change the fact that i could potentially be financially fucked for the foreseeable future...but im at least able to vent, so fcuk it.

[MannyIsGod]

I think a lot of things are fucked up with the way medical billing/insurance is handled and I honestly feel your pain man. There's a reason I want people of this country to have the option to buy into medicare/medicaid type healthcare and I'm no fan of private insurance companies.

You don't have to convince me that things are fucked up. I could tell you stories that I heard from clients being screwed by the system one way or another that would make yours look like peanuts (11k is a lot of money but you won't have to sell your home to take care of this in the end). Thats probably why I don't take shit for granted. I think its really shitty that you had to learn the lesson this way, and I hope you get a fair resolution.

[DMC]

Any lawyers about want to assist with this one?

Ok so a back story. I injured my knee and went to my primary care doctor (who takes my insurance, and is in network). She sent me for an MRI (in network), then to a specialist (in network). Specialist said i had to have surgery to repair my meniscus and ACL. He set me up with a date for surgery at the office located 1 floor below his, same building. Surgery was set for about 3 months out from my visit to the specialist. After about 2 months i got to wondering, i never recieved a call from the doctors office about any pre surgery blood work, insurance, etc. I called them. They said, everything is taken care of, no need for any pre visit, you are good to go for April 6th.

I show up to my surgery, the lady at the recieving desk asked me a bunch of questions, and then there seemed to be a mix up with my paper work, she asked me who had called me for my pre screen, i said no one, i was told i didnt need one. She, shrugged and said, ok well it will just take more paper work, no biggee.

Long story short...apparently this office isnt part of my doctors office at all, they are totaly seperate, and actually are out of network for my insurance. No one told me this, in fact, i didnt know until today when i recieved a bill. So...to recap. PCP in network, specialist in network, MRI in network, but the place these people do their surgery, out of network. All the doctors that worked on me that day were in network, anesthesia, etc...

Today i get a bill from the facility in which the surgery was performed for almost $11,000. 3,000 out of network deductable, plus 7,800 roughly for co-insurance owed by me.

No one EVER once told me that this place was not affiliated with my doctor, or his billing. in fact, they have basically the same name, or so i thought. I was never called to verify insurance or even asked about it. I have been places out of network before, and they tell me so before i even sign a paper. Nothing was ever done like that here.

Now i am told i owe 11k...well, i dont have 11k to pay them. Nor will i, in the near future. Do i have any legal recourse? Im really not sure what to do here.

No one is required to tell you they are out of network. It's your job to find out.

They fuck you at the Dr's office... they get you, and they fuck you... and don't even get me started on cell phones.

[Kori Ellis]

Did you sign something saying you were responsible for whatever wasn't covered by insurance? If so, there's nothing you can do.

However, they'll accept a small percentage (25-35%) as payment in full -- all hospitals/doctors do for cash payments.

If the bill is $7,800 that you owe, offer $2500 in one payment and they'll accept that as payment in full.

[Nick Manning]

Did you sign something saying you were responsible for whatever wasn't covered by insurance? If so, there's nothing you can do.

However, they'll accept a small percentage (25-35%) as payment in full -- all hospitals/doctors do for cash payments.

If the bill is $7,800 that you owe, offer $2500 in one payment and they'll accept that as payment in full.

I did that with a credit card a few years ago. i owed around $8500 and settled for around one payment of 3k. I had to declare the remainder as taxable income though. I don't know if it's the same scenario with medical expenses. Probably not.

[MannyIsGod]

I did that with a credit card a few years ago. i owed around $8500 and settled for around one payment of 3k. I had to declare the remainder as taxable income though. I don't know if it's the same scenario with medical expenses. Probably not.

WTF? That sounds wrong as shit. Did this affect your credit poorly?

[CubanMustGo]

WTF? That sounds wrong as shit. Did this affect your credit poorly?

It is {taxable income}, according to the Internal Revenue Code. For example, a person with $10,000 in credit card debt who negotiates to pay only $6,000 of the balance would have $4,000 in forgiven debt income. That $4,000 must be reported as "other income" on Line 21 of the 1040 tax form. Depending on the amount of debt forgiven, the taxpayer's income level, deductions and other factors, the consumer could face a sizable tax bill come mid-April.

Read more: http://www.creditcards.com/credit-card-news/forgiven-debt-1099C-income-tax-3513.php#ixzz1MZiKNP1N

[CubanMustGo]

And re written off medical debt being taxable:

http://www.debtsettlementlawyers.com/resources/debt-settlement/unsecured-debt-settlement/unsecured-debt-settlement-process-tax-i

What are the Tax Implications of Unsecured Debt Settlement?

Any amounts forgiven by a creditor on an unsecured debt are treated as income for tax purposes. The creditor will send the consumer a 1099-C which reflects the amount forgiven on the debt and the consumer must list this amount as income on his tax return.

[Nick Manning]

WTF? That sounds wrong as shit. Did this affect your credit poorly?

No, my credit was bad before from all the delinquency on that card (as well as a plethora of student loans that I wasn't paying). Paying it off (the settlement) actually improved my credit.

As far as them claiming that the remainder was my taxable income, yeah...I thought it was sketchy. I didn't declare it and thought nothing of it. Didn't notice anything till 5 years later (now) when I filed my taxes online and they took it out of my refund. Fuckers.

[Nick Manning]

And re written off medical debt being taxable:

http://www.debtsettlementlawyers.com/resources/debt-settlement/unsecured-debt-settlement/unsecured-debt-settlement-process-tax-i

What are the Tax Implications of Unsecured Debt Settlement?

Any amounts forgiven by a creditor on an unsecured debt are treated as income for tax purposes. The creditor will send the consumer a 1099-C which reflects the amount forgiven on the debt and the consumer must list this amount as income on his tax return.

Thanks for the clarification.

Suppose I owe a company $10,000 (a sign-on bonus)...Can I settle with them and have the same tax/settlement agreement?

[MannyIsGod]

Wow I never knew you had to claim that as income. I've never heard of anyone doing that. Pretty fucking crazy.

[ploto]

Lets say you visit your primary care doctor and she says i need you to go down the hall and pee in a cup and come back. Would you say, well is that room down the hall part of my coverage? I wouldn't, you would go pee in the cup, or give them blood or whatever the case may be.

Actually I would. The lab down the hall may not be in network.

Lots of physicians may be in network but the facilities may not be. Just because your physician is in network and he wants to send you to Methodist for Outpatient Surgery does not mean that it is in your network.

Know, however, that if you were in network, he would be getting paid a whole helluva lot less than what you were billed. You might be able to find what that rate is and see if he will agree to it.

[ploto]

Wow I never knew you had to claim that as income. I've never heard of anyone doing that. Pretty fucking crazy.


I think there are many doctor's offices that do it and never send out the 1099. Credit card companies are probably more likely to do so.

[CubanMustGo]

Thanks for the clarification.

Suppose I owe a company $10,000 (a sign-on bonus)...Can I settle with them and have the same tax/settlement agreement?

This is a consult a tax lawyer area. :greedy

[Nick Manning]

This is a consult a tax lawyer area. :greedy

How much you charge? :lol

I've evaded them for a couple years, but it's only a matter of time before I get that knock on the door with some certified mail...

[MannyIsGod]

I think there are many doctor's offices that do it and never send out the 1099. Credit card companies are probably more likely to do so.

Yeah I've done it i the past and never gotten a 1099. :lol I advised many clients to do it in the past and never once thought of a 1099. Oops?

[Soul_Patch]

I'm at jury duty today but i called the place this morning and after explaining my situation, was told that i had no balance...i asked are you sure and was told yes, to disregard the bill...still pessimistic, but ok.

[bus driver]

I'm at jury duty today but i called the place this morning and after explaining my situation, was told that i had no balance...i asked are you sure and was told yes, to disregard the bill...still pessimistic, but ok.

NICE! Now just change your address and phone number just in case they do an audit
:cheer