All,

As you may remember, I was admitted to the ER back in January and kept in the hospital for a few days. While in the hospital, the performed an angiogram. The hospital portion of the bill was paid, but today I received a bill for almost $11,000 for the doctors who ran the angio...aparently they are not part of my insurance network. I thought that any admition to the hospital after an ER admitance that everything was covered.

Any ideas on how to get around this bill?

Thanks,
Greg

Hi Greg,

You are correct in that this bill should be paid based on the fact it is an emergency admission. Does the bill say this was filed with your insurance company? Have you contacted the doctors' billing office to determine if they have your insurance information and if so, have they filed the claim? If so, contact your insurance company to determine if they have received the bill. Sometimes bills and insurance information don't get together. Also, I believe you mentioned you have a PPO which means you would also have an out-of-network benefit. Still, this bill should be paid one way or the other.

I would start by contacting the doctors to see if they have your insurance information. Then ask if they filed the claim.

Let me know what you find out.

Hugs,

Lore

Hey Greg:

I had the same thing happen to me.  After I was admitted to ER/hospital for a stroke, I had my angiogram.  At the time, they had not asked me for my insurance card (I later realized it was because I was an employee at the hospital so they were able to pull it up).  However, at the time, I made clear that everything should be within my network.  Still, the doctor who did my angiogram apparently wasn't.  I got stuck with a $4000 bill.  I fought it all the way and after 8 months, it was processed in-network.  I had to battle the hospital, but eventually it worked.  I had lots of NOs but still fought it.  It's annoying, and it's the last thing you want during a sickness, but persistence pays off.  

Best of luck to you and let us know if there is anything we can do to help.  

Hugs,
Trina

Lore you are correct, I do have a PPO.

What is interesting is that the original hopsital bill only had the hospital stay and the charge for the surgery room, but no doctors charges. Fortunately, the hospital that I was admitted to is an in network hospital, not that that should matter for an ER stay. Unfortunately, all of the doctors involved are billing my insurance company separtely from the hospital stay...and unfortunately, the angio doctor is not in network. The total doctor bill is for just under 19K...based on the out of network and resonable and customary changers, the insurance company only wants to cover ~9K, leaving me with the bill. I'll be calling them again tomorrow to fight that I did not choose the doctor during my hospital stay and to make sure that they realize that these charges are for the hospital stay.

Wish me luck,
Greg

Greg,

You're right in that you should be held harmless since this was an emergency admission and obviously you didn't have the opportunity to "choose" your docs. Sounds like you have a handle on the situation. Hopefully this will be resolved in a positive manner soon.

You know, it's ridiculous what these insurance companies put people through. I can't tell you how many times I have had to work through claims much like your situation. It can beat you done if you let it. It's nuts!

Hang in there and let us know the outcome.

On another note, how has your health been?

Let us know how you are doing.

Hugs,

Lore

Lore,

I spoke with my insurance company this morning, they are going to "reprocess" the bill and see what they can do....at least they are looking into it.

I can't complain about the health. Up till a week ago, I was actually feeling great. For a few weeks, I actually felt normal and healthy. Last week, I had a very small dizzy spell attack, unfortunately, these dizzy spell attacks usual end with a few days of bad fatigue. So, after a few days off work, I'm startign to feel better each day. Only 3 more months to the next round of follow up studies to see if the Plavix is helping.

The good news is that my angiogram showed that I have colateral vessels growing from other portions of the brain to help feed the bad areas. Doctors said this is promissing because if they actually manage to contect to the right area that I may not need the bypass surgery. (Please remember, that they determined that I don't have MM, but rather a bad restriction in the left MC1).

Thanks for the response,
Greg

Good news....between the insurance company and my battling with the hospital, my out of pocket bill is now down to just under $1,500. I'm not giving up yet, as my insurance company is still talking with the doctors, but I am truely grateful that my potential bill has been reduced by so much with just a few phone calls. My goal is still to pay nothing, seeing that the angio was part of an ER admittance.

Greg

Well, the battles continue....after a few weeks of constant battling between the doctors and the insurance company, I just filed an appeal with my insurance company to pay the final bill.

I stil find it interesting that even though you are admited to a hospital via the ER (in this case an in network hospital for my PPO) that you still end up with hospital bills.  I can only imagine how large of a bill I would be fighting if the actual did the EDAS procedure as Dr. C is not part of my insurance either....

Oh well, just need to vent.
Greg

My first surgery was around a million dollars :'(and  i was between insurances so it didn't pay anything)but because I was in a coma for a couple weeks and had the brain of a 7 year old  ::) [smiley=huh.gif] so the hospital just wrote it off because they didn't want me upset afraid i'd have another stroke :'(and of course now i'm uninsurable) :o but i do get medicare & medicaid and i think i have grown up since then (in my brain) :o

Good News....after 4 months of fighting and appealing....the insurance finally agreed to cover the outstanding balance.....I'm psyched.

Thanks for all of the insight,
Greg