DoctorTricks.Com

I’m going to turn a slightly crude phrase here: “The doctors, hospitals, and insurance companies are involved in a pissing contest, but it’s the consumers who are getting soaked.” Please feel free to quote me on that one.

I’m currently waiting, and waiting, and waiting, for a check from a radiology company who screwed up our billing, got paid by us, then finally got paid by the insurance company and owes us a BIG chunk of money that they acknowledge, but seem to keep forgetting about.

My wife was having severe headaches and went to see a headache specialist. Her doctor sent her to Seattle Radiologists who performed MRI and MRA scans on her head and neck. No big deal, you’d think, until we got the bill for nearly $2,800.

My wife, being conscientious, put our credit card number on the bill, signed it and sent it back… before telling me. Of course, when I found out, I hit the roof.

I called our insurer, who looked at the billing record and discovered the problem. The radiologists submitted two bills in the same day (revising the amount on one procedure by about $4). The unrevised amounts were flagged as a double billing and denied. So we were on the hook for the full portion the insurance denied.

The insurance company rep immediately got Seattle Radiologists on the phone and they agreed to take those charges off the bill, pending resolution of a review process with the insurance company. But when Seattle Radiologists got my wife’s payment coupon, did they charge us for the revised amount they agreed to? Nope. They charged our card for every penny of the erroneous bill.

When I got the statement at the end of April, there was the charge for nearly $2800. I called the credit card company, and asked them to put the amount into review so we wouldn’t be charged interest. Then I called Seattle Radiologists.

The review with the insurance company had been completed, they had revised the bill, and acknowledged that they owed us a refund of over $2200. So, I asked, would they credit that back to the credit card? No, they said, they were going to issue a check. When would that be, I asked? They weren’t sure. Their bookkeeper issued refund checks on the third week of the month, they thought. I asked them to make sure that my refund check was going to be cut ASAP. They said they’d call me back.

Are you at all surprised that they never called back?

But once again, my horror story pales in comparison to one I read.

According to a recent issue of U.S. News & World Report, a gentleman by the name of Joseph Lee got nailed on various doctor tricks (out of network, billing errors) to the tune of $238,000. And he had to get professional consumer advocates to help get him out from under that (for a fee).

His story goes like this: He was walking on the sidewalk, a car jumped the curb and slammed him into a building, crushing his legs. The doctors were able to save his legs, but it took 2 1/2 months in the hospital.

When he got the bill for $238,000, his insurer claimed he’d spent too much time in rehabilitation (going over the allowed limit) and they were refusing to pick up the tab for certain out-of-network docs who worked on him. As U.S. News & World Report noted, Lee had “hardly been in a position to object or obtain proper referrals.”

When he got Healthcare Associates on his side, they scrutinized the bill and found a saving grace on the over-limit objection from his insurer. Part of Lee’s time in the hospital was on a regular hospital floor, not rehab, because he had developed an infection. He never went over his limit there. Eventually, the insurer gave in and struck the $238,000 bill.

But Lee’s story wasn’t over. The road back from such a severe injury is longer than 2 1/2 months, and his insurer is still unhappy about how the hospital is billing items involved in his treatment, and Lee is caught in the middle with another potential big bill looming if the insurer decides to disallow charges because they don’t like how they’re submitted.

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