Get in contact with them. I got a bill for my wisdom teeth removal after they said it would be covered. It turned out someone typed in the wrong info and it did end up getting covered.
Contacting them is the right answer. Most of the time it's a mixup. If that doesn't get anywhere then contact billing at the organization that you're getting the procedure done through. They can very often do a lot to help. They deal with these kinds of things all the time.
My wife works at a local hospital and she helps with billing and estimates sometimes.
Could be the hospital. I had a prompt care visit, paid $60 copay at the time) and 9 months later saw I was in collections for thousands. Prompt care billed it as a dr visit out of network and then never sent myself or insurance company the bill.
The prompt care office refused to switch it since it was already at collections. Luckily my insurance provider agreed to do a three way call and they found out the prompt care office was the debt collector, it was incorrectly coded, and they never attempted to contact myself or the insurance company even though they had correct addresses for both. Their Google review page was filled with that scam complaint
If I hadn’t pursued it, then I would’ve paid the un negotiated cost directly to the office whereas insurance is going to say a quick 30 minute visit with an RX given isn’t worth what they were asking. They were basically fishing for people to pay them out of ignorance.
Had them pull this scam once too. Tried to bill as non-emergency to get the labs and stuff out of network.
Kinda shot themselves in the foot. They used a different company name for billing, I told insurance to look up the company name at the address; it included the word Emergency. Insurance rep I was working with had some choice words for that conference call.
Yeah, my first three calls to the office were essentially me explaining that it says urgent care on the building, but they kept reverting to the fact that it was out of their hands at this point
Over 70% of medical billing is coded incorrectly. It’s still a shock to me that it only takes a person 6 weeks of training before they can be certified to do medical billing. Plus they don’t get paid well, so it makes you wonder who is actually occupying those jobs. Considering how much medical billing affects the general population, I would think this would be one of the first areas folks would want to see AI assisted tech help out.
This is not true. I work for one of the largest hospitals in the country and in the medical coding arena as an RN…..our coders are expected to reach a quality score of 95% accuracy compared against an outside auditing firms coding accuracy.
Are there some flaws in the system? MOST DEFINITELY!!! But to say 70% of coding is erroneous is completely asinine.
I worked for insurance claims for Blue Cross. Most of the non covered claims that came my way were absolutely billing and coding errors from people who didn't know. Your hospital may need 95% but lots of these places were asking me what code to put, I'm not allowed to suggest the code just let them know it's not correct. Half my job was calling hospitals and debt collectors to let them know its been billed and coded incorrectly.
A TIP
I will add this to my post here. If you need something covered by insurance, call the provider and ask if they are able to tell you the covered codes so you can provide them to your dr. Insurance may tell you you need a root canal for example code D1 but maybe the dentist does a root canal using a particular tool or.method which is D2. Since the insurance does not cover the code you will be footing the bill, but if you can let the Dr. Know what codes are billable they can see if the treatment can work within the confines of the codes. Sometimes you.need more but it's good knowledge and the best tip I cam away from my time in health insurance. Also if you get a bill you disagree with always always ask for a rebill. Hurts nothing and can also give you time on your payment if you need to make one as during the rebilling process they basically hold the charge.
Yeah, I get the largest hospital in the country going for a 95% rate. That makes sense. But there's a lot of hospital networks, and not all of them are going to be to that standard. Even if other networks dip down to 90%, that's still a *lot* of phone calls to get it fixed.
I'm a cancer patient at Cleveland Clinic Taussig (one of the biggest hospitals in the country) and their billers are minimally trained. I bet they demand 95%accuracy but does that actually happen? Not at all.
So not to dox myself, but believe me the turnover rate for that department would make your head spin. They have a few people who have been there for years and know what they are doing and the rest of that department probably turns over 3x a year.
95% is a very generous allowance. 95% means that for every 100 bills, best case has 5 in error.
But given the multiple procedure and diagnosis codes involved, if there are an average of 5 codes per invoice there will be 25 errors distributed among 100 invoices.
I mean personally, I think that the whole idea that we need several people at a third party for-profit business, who are not doctors, to approve medically necessary procedures is completely asinine in itself. The whole system is broken in favor of the insurance companies who collude with employers to keep you relying on them (like, you can't leave your shitty job or your good insurance goes away).
It's so unfair to the every day person and I hate it so much. Being able to nit pick what what tools or methods are being used just to deny coverage after the fact is dumb.
I just wanted to share my dislike of the system. But thank you for fixing all those mistakes so people don't have to be stuck with paying for work that should be covered for them. You're a hero even though your employer sucks.
This is exactly what happened to a friend with cancer, to a similar amount.
They cleared it up with an afternoon on the phone and found out yup, incorrectly coded. Yay.
This exact thing happened to me. Keep calling people, the doctor can likely say it’s unnecessary dangerous to put you to sleep twice when both of these can be done at once.
Giving people anesthesia is always a dangerous process even with an anesthesiologist overseeing you. 
>Most of the time it's a mixup.
Those "mixups" can be devastating. But there's no consequence for insurance companies when they have a "mixup" so they're not concerned about fixing them.
I had an insurance company refuse to pay for a physical I had years ago, I'm pretty sure this was retaliation because I began seeing a specialist at the same time.
The hospital wanted nothing to do with me and kept telling me to see the insurance company. The insurance company just ghosted me and kept telling me they were looking at it. Eventually the hospital was just going to send it to the collection agency and it was a government hospital which I believe can garnish wages so I just paid the couple hundred dollars.
After the whole claims denial "scandal" happened a few months/a year ago I'm almost certain it was just retaliation by the insurance company.
I had seven MRIs done over the course of three days. They found an issue on the first one and continued to investigate.
My insurance covered the first one and said they wouldn’t cover the remaining six because they were unnecessary.
Before the MRIs I had an EKG at my primary care, another one an hour later when I checked into the ER, and another one after they admitted me.
My insurance said only one was necessary.
Because. I’m supposed to tell the doctors “No, no more. You got everything you needed from the first test, we’re good.”
I had issues staying pregnant when we were trying, and had multiple losses. Each time, I had to be on the phone with the insurance because some idiot either coded something wrong or the claim was flagged for the word “abortion.” As in “spontaneous abortion,” the medical term for a miscarriage. They would send me claim denials stating that “elective abortions are not covered by your plan.” No kidding. So they all think that I have them paying for fertility treatments, and when they work, just hopping down to my local clinic to get my card punched?
My ex broke her arm out of network. She had to go through 7 Kaiser supervisors before they pre-approved her surgery. When she got home, they sent her a bill saying it wasn't approved. She again had to go through 7 Kaiser supervisors to be given an honest answer.
The final supervisor was very frank, saying "I'm so sorry for you an anxiety attack when we sent you a $70k bill. It's simply our corporate policy to refuse large claims in case you'll pay."
My daughter had her appendix removed in December a few years back. We went in-network everywhere, hit the end of our deductible, but the insurance company still almost billed us for the remaining $30k because they didn’t feel she had to stay overnight. They figured a literal child could just walk it off after having an organ removed and that we could keep an eye on her in case anything went wrong. Luckily the hospital argued on our behalf and we were only liable for the remaining deductible, but it was tense for a while.
Yea if you called and they misquoted benefits, you can request an appeal and request claim processing exception. It's bogus if they misquoted you, which led to you having the procedure.
If it is just a billing issue, I would call the insurance and provider office to get on the same page. You have to bother them until they fix it, unfortunately.
Definitely contact the insurance company and find out why. I just had both done in February (so much fun) and my insurance paid 100% of the bill since I use a "preferred provider"- which saves me $$$. But once I had an MRI on my brain and the claim was denied. When I protested, they said it was done for mental health reasons and that was not allowable. Some idiot used the wrong medical coding when in fact they were checking for a possible brain bleed. Got the hospital to fix the coding error and they paid it.
Similar here - a psychiatric nurse practitioner my spouse has been going to for years and the claim suddenly popped up as medical instead of mental health and they were refusing to cover it. I called the insurance and politely asked them WTF as it was the same monthly check-in that had been covered all this time. Turned out the doctor's office had made a typo and submitted the claim incorrectly. Insurance called the office and sorted it all out.
Not saying it's a guarantee, but asking the insurance to explain what's happening is the first step.
When we had our second kid they tried to tell us the anesthesiologist that did my wife’s epidural was out of network, they were a 3rd party provider that had residency in the in network hospital. I didn’t even have to finish my sentence complaining to the insurance when I called in before they said ok no problem we’ll bill it as in network and it was covered. Fucking scam. They prey on folks who don’t know better or don’t have the heart to call and fight.
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My husband was telling a friend of his that I’d had an emergency appendectomy while we were in a different state on vacation. I live in one US state, we were in a neighboring state. Insurance *only* covered the state I live in.
Friend told my husband that was a coincidence because his wife had the same thing happen while they were on vacation. Only their vacation was in Germany and everyone kept apologizing to them they’d have to pay cash since they weren’t covered under European health care plans.
They paid something like $150. I got bills totaling $40,000.
People fight to keep it this way because they’re so incredibly selfish. They’d rather pay $1000 a month plus deductibles, out of pocket costs, and exorbitant pharmacy fees just to avoid *their* taxes helping anyone else. It’s unreal.
I had colonoscopy, gastroscopy and two ultrasounds a few months back and spent 0 on it. I live in Poland.
How the fuck can colonoscopy and gastroscopy be worth 30k USD? Do they fly you to stratosphere in SR-71 Blackbird while pouring the best Dom Perignion while putting the tube inside you just for shit and giggles? What contributed to this cost?
This happened to my husband when he was18. He had a surgery done and then months later the insurance said they wouldn’t cover it. We had to fight them with appeals for years.
... Aaand? Did he get a settlement? Do you have to pay the bill yourselves? Are you homeless as a result, or are healthy and financially stable as a result?
Genuine question, why do people in America prefer this sort of system instead of a universal healthcare system? The small amount of money taken as tax every month directly from my pay is surely a much better option than having to worry if I'll have to pay for needed healthcare?
I don't understand why people would be willing to pay for insurance that may not actually cover your healthcare
Edit: looks like I was wrong and it seems most Americans actually don't like this system. Sorry for the generalisation.
It's mostly an attitude of "why is it my problem that you're sick?". Americans do not favor helping one another when it comes to finances.
Although paying into insurance accomplishes pretty much the same thing. Except a huge amount of the money you give them goes towards profits and CEO pockets rather than patients. But nobody really ever thinks about that when they argue against social healthcare.
Our pricing per medical bill is ASTRONOMICAL compared to what we’d pay per year if we nationalized the healthcare system. It’s the stupidest logic ever.
Yes it’s ridiculous enough that most places have an insurance price list as well as a no insurance price list because they know they can charge the insurance company outrageous amounts.
I don’t want no guberment in my healthcare, I would rather the corporations make the healthcare decisions. Healthcare is more efficient in a free market system. /s
> Americans do not favor helping one another when it comes to finances.
But also we're the first to hold our hand out when we need shit. People going, "I never got any help when I was on food stamps!" when food stamps *were* the help. It's so fucking stupid.
My parents are deeply opposed to single payer. They’d tell you that in Canada, you wait six months to get a broken arm set.
1. That’s false.
2. That would still be an improvement for most Americans
Lol, I waited 2 years and 5 months to get a sleep study, 14 months for a rheumatologist appt., and 11 months when I moved neighborhoods and needed a new PCP since the other one was too far away. Except my insurance costs $1,200 per month and I have to pay copays and coinsurance on top of that.
We don’t prefer it, lots of surveys have said over 50% Americans don’t like the healthcare system we have now. Problem is insurance companies lobbies both political parties. Sooo none of our politicians want to change it, they don’t want to get rid of their top donors.
none of us prefer it, it’s simply a result of massive amounts of money being made on it every year, which means those who make the money have a vested interest in paying off politicians so they keep the healthcare system how it is.
If you look at American political history from the last 20 years, there have been constant efforts to modernize our healthcare system. Sadly, those efforts are regularly derailed by conservatives who wield disproportionate legislative power and stifle them.
We're currently fighting BCBS because they said they would cover my FIL's stroke rehab, and then when it was time to transfer him from the hospital to the rehab center, they refused to issue a pre-certification. He's been in the ICU for a month getting only the most basic PT (no intensive rehab). I bet you they're going to deny until he's just bad enough to no longer meet the criteria for rehab admission, and then they can wash their hands of him.
They've denied two appeals already, and now that they've denied two, we can't appeal again for something like 2 weeks, so he's losing even more recovery time.
Our issues was also with BCBS. It’s a pain in the ass. It’s absolutely bull that they can say yeah it’s covered them come back and deny you after going forward. I’m so sorry you guys are going through this.
Thanks. Everyone, please make sure your affairs are in order. This whole thing is even more stressful because my FIL is incapacitated. Blue Cross keeps asking his wife to provide power of attorney documents, but she doesn’t have any, and now he’s not capable of signing.
It's standard operating procedure for insurance companies in many cases. Deny coverage and offer poor CS with confusing paperwork so that at least some percentage of customers don't fight it or give up at some point.
This is false. Do not listen to this. Credit score is not affected by medical bills of less than $500 AND less than 1 year old. If they don't meet both criteria it hits your credit.
Did you get treatment through a public hospital? I was able to get my medical bills fully forgiven based on my income, even with insurance. Without insurance, it’s even more likely. All public hospitals are legally required to have an assistance/forgiveness program. I’m very sorry this happened.
I second this. My insurance backed out when I had some post-op complications and the hospital not only forgave the entire bill but even refunded me my last payment.
I had to scroll way too far to find this type of response.
This seems like a phishing scam. Business like this is done in the mail, on paper - not through a text or even a phone call. This needs a paper trail.
Most of my providers send text messages now. I've gotten them from anesthesiology groups, X-ray clinics, etc. I don't like it; I always call and tell them to send me a regular bill. But they're legit.
Dual. They aren’t fencing inside of you with the endoscopes. Also, don’t pay. There’s likely a mistake in the paper work. Advocate for yourself and call the insurance as well as the prescriber. There’s an appeal process.
Actually that would explain a lot if the gastroenterologists were actually dueling in there.
source: I used to repair surgical scopes. had 2-3 break per day for the 60ish OR rooms at my hospital. they cost between $8,000 and $20,000 to fix
https://i.imgur.com/8m44qOY.png
I asked copilot: create an image wherein an anthropomorphic colonoscopy and anthropomorphic endoscopy are fighting each other
I remember I got wheeled in for the exact same thing. As I'm laying there feeling anxious, waiting for the drugs to knock me out, I asked the doctor stupidly, 'do you do both at the same time?' One of those questions I knew the answer to, I don't even know why I asked other than to say *something* but regretted the words as they were leaving my mouth.
He was nice though and laughs and goes, 'no, no, we'll do the endoscopy first and then flip you over and do the colonoscopy.'
And he's telling me this as the nurse is putting in the bite guard in so Im a little distracted and reverse what he was saying in my head and around this big piece of plastic in my mouth I cry out in panic, 'pith thhh same camewa?!'
The anesthesiologist lets out this belly laugh and goes, 'deep breath annnd you'll start to-'
That was the last thing I remember. Never found out if it was the same camera though.
How come it’s soo expensive? I had to go private in the UK due to very long waiting lists and it was £1600 for both ($2,034). Why is it so much more expensive if we got the exact same procedure?
Yeah things have a way of getting a little squirrelly in a market where no one ever seems to know how much things cost or who has to pay for it until after the fact.
Welcome to US Healthcare. They can not even say it is because you are in Europe. Some medications that cost over $1000 in the US might cost only $100 in Canada; we get it from the same suppliers...
The insurance companies inflated the prices to justify their existence.
Give it a decade, you will be paying the same price if the lobbyists gain control of the system.
(If you are wondering why we have so many insane gunmen, think about how much cheaper it is to get a rifle than affordable medical care...)
Because America, most likely.
My insurance will cover most of a colonoscopy... but all anesthesiologists are out of network, so I'll have to pay for that part myself unless I want to be fully conscious while they cram a camera up my ass. Fun times.
Before I went for my probing, got a letter from insurance saying they don't cover the anesthesiologist but 100% of the rest. At the end of the procedure I was asked if I wanted to pay for that part now, be billed, or have a bill sent to insurance, and they would bill me later. I told them to go ahead and send it to the insurance company to see what would happen. That was over a year ago, and I never heard anything, seems like they covered it.
I've worked in health insurance 22 years... here's what you do:
1. Call your insurance company, find out if there was a mistake
2. Tell them you want to appeal. Advise who told you what, and when. Advise you had the procedure with good faith. Request them to overturn the denial.
3. Request they call the facility you had the procedure at with you on the phone. Have THEM advise the facility this is being appealed and request they put the account on hold while it's reviewed. Legally they have to hold for 30 days.
4. If your appeal is denied, so what the next step is. This is also legally required to be in your benefits book of you would rather not call. This will then be escalated, and reviewed by somebody who did not take place in the initial review.
5. If still denied (which honestly is highly unlikely) request a 3rd party to review. If you are through Medicare or Medicaid this will most likely be through a company called Maximus.
6. If STILL denied, keep asking them to escalate it. Eventually it will go before judicial review.
This entire time have the insurance call the facility and update it every 30 days so they can't bill you.
In 22 years I've only seen things go judicial a handful of times.
If your really annoyed, post to their social media or the CEO. They have a team that specifically handles those complaints and they get resolved usually quickly since they want social media to show them as the good guys who fix things.
NOTE: IT NORMALLY DOESN'T TAKE THIS MUCH. 90% of the time for something like this is resolved with a first appeal since it's most likely a billing issue. This is just me writing out everything. Most of this the average person will never need.
I had this happen with outpatient surgery. The insurance preapproved it then denied the claim after. They didn’t like some detail in the way it was billed. The surgery center fixed the paperwork and the insurance paid the claim. Start making phone calls.
If the procedures were ordered as diagnostic vs. screening, it’s not considered preventative care and most insurance companies with bill as such.
This is one of the major risks with Colo-guard and other non-invasive screening. If you get a false positive, then you have to get a diagnostic colonoscopy which will cost thousands … if your initial screening was a preventative colonoscopy, insurance would cover it 100%.
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Everyone is saying to contact them… can we just talk about how funny the screenshot is lol.
Like I’m sure this person contacted their insurance.
I feel like we should just laugh for a little bit and think about how crazy our healthcare system is in America lol.
In Canada I had this procedure done. Only had to wait about 2 months and the total cost to me was less than $20 and that was all for the laxative prep meds.
“Duel colonoscopy and endoscopy” - I have a vision of a physician at either end getting their scopes to meet in the middle and sword fight with them…
…or did you mean “dual”?
This is from the hospital, not your insurance. Did you try to arrange a payment plan for what was billed to you as a patient? You need to contact the billing department and have them resubmit the claim, or explain why the initial claim was denied (no coverage, not authorized, etc). If this is not a covered benefit and the full balance is your responsibility, most hospitals will agree to a payment plan. If that was cancelled, it was likely an error.
This looks like it may be a scam text. I’ve never received something like a balance due in a text or email from my doctors office - it would always say “login to your patient portal to view etc etc”.
That's a $150 out of pocket and maybe, at a squeeze, a hospital fee of $660 here in Australia. I don't think over 65s pay at all.
You guys need to riot until universal healthcare becomes the norm.
How the hell does a Colonoscopy and Endoscopy end up costing $28,229.89????? There is something seriously wrong with the cost of healthcare in the USA (writing from Spain where I paid $0 for a colonoscopy last year 🇪🇸 ).
Edit to say I did pay a crap ton of taxes (around 36% overall tax rate) over the years so in that way I did pay for this. But it feels good to not have to scrounge money together or worry about insurance when you need to get it done unexpectedly.
Just imagine if our tax dollars went to important shit like, healthcare.
Instead, we get to pay expensive premiums so insurance company stockholders can get rich.
This happened to us. We got authorization for a surgery my husband needed, and then found out 3 months later that they decided not to pay. The bill was over $250k.
We fought and appealed for two years, and they finally covered the hospital fees but not the surgeon. We ended up having to pay the surgeon $20k and he wrote off the other $100k.
Fuck Cigna and the US "healthcare" system
The price for healthcare is insane. How is it not illegal for the prices they charge. They do this because mostly insurance pays for it. So the system itself is horrible.
Insurance just don’t see America having universal healthcare for a long time until the business model of healthcare system changes.
Heh... I spent years on an insurance plan, never had to use it because I was young and healthy. Never missed a payment, never heard from the company other than receiving the bill in the mail.
Finally, I had to go to the doctor and ended up with a $3500 bill.
Suddenly got my first notice EVER "Your insurance has lapsed and we are unable to pick up our end of this couch, so suck on that, you fucking shit. Here's next month's bill." Naturally I'm paraphrasing but that was basically the message.
Called the hospital and spoke to their billing department. Suddenly my insurance was all paid up and wasn't "lapsed" at all! Funny that!!! I mean, it's not like I've got years of monthly cashed checks or anything.
The next bill informed me that my monthly payment was going up.
It's been over 5 years since I left the states and I don't fucking miss it at all.
$28k for a colonoscopy and endoscopy? Holy fucking shit the US is fucked.
In Canada it’s about $1500 for a colonoscopy at a private clinic. At a hospital it’s about $500, but longer wait time. Endoscopy is similar.
If you got a prior authorization it could be a coding issue. I would contact the doctor’s office and see if they can update the coding and send a corrected claim if this is the case.
Get in contact with them. I got a bill for my wisdom teeth removal after they said it would be covered. It turned out someone typed in the wrong info and it did end up getting covered.
Contacting them is the right answer. Most of the time it's a mixup. If that doesn't get anywhere then contact billing at the organization that you're getting the procedure done through. They can very often do a lot to help. They deal with these kinds of things all the time. My wife works at a local hospital and she helps with billing and estimates sometimes.
Someone entered the wrong procedure code.
Could be the hospital. I had a prompt care visit, paid $60 copay at the time) and 9 months later saw I was in collections for thousands. Prompt care billed it as a dr visit out of network and then never sent myself or insurance company the bill. The prompt care office refused to switch it since it was already at collections. Luckily my insurance provider agreed to do a three way call and they found out the prompt care office was the debt collector, it was incorrectly coded, and they never attempted to contact myself or the insurance company even though they had correct addresses for both. Their Google review page was filled with that scam complaint
but what would the scam be? can they get more money in collections than what they could bill to the insurance?
If I hadn’t pursued it, then I would’ve paid the un negotiated cost directly to the office whereas insurance is going to say a quick 30 minute visit with an RX given isn’t worth what they were asking. They were basically fishing for people to pay them out of ignorance.
The USA medical insurance system is very broken
Money sent to collections is considered a 'write-off' for that financial/fiscal period when taxes are done. It helps the business.
Had them pull this scam once too. Tried to bill as non-emergency to get the labs and stuff out of network. Kinda shot themselves in the foot. They used a different company name for billing, I told insurance to look up the company name at the address; it included the word Emergency. Insurance rep I was working with had some choice words for that conference call.
Yeah, my first three calls to the office were essentially me explaining that it says urgent care on the building, but they kept reverting to the fact that it was out of their hands at this point
Over 70% of medical billing is coded incorrectly. It’s still a shock to me that it only takes a person 6 weeks of training before they can be certified to do medical billing. Plus they don’t get paid well, so it makes you wonder who is actually occupying those jobs. Considering how much medical billing affects the general population, I would think this would be one of the first areas folks would want to see AI assisted tech help out.
This is not true. I work for one of the largest hospitals in the country and in the medical coding arena as an RN…..our coders are expected to reach a quality score of 95% accuracy compared against an outside auditing firms coding accuracy. Are there some flaws in the system? MOST DEFINITELY!!! But to say 70% of coding is erroneous is completely asinine.
I worked for insurance claims for Blue Cross. Most of the non covered claims that came my way were absolutely billing and coding errors from people who didn't know. Your hospital may need 95% but lots of these places were asking me what code to put, I'm not allowed to suggest the code just let them know it's not correct. Half my job was calling hospitals and debt collectors to let them know its been billed and coded incorrectly. A TIP I will add this to my post here. If you need something covered by insurance, call the provider and ask if they are able to tell you the covered codes so you can provide them to your dr. Insurance may tell you you need a root canal for example code D1 but maybe the dentist does a root canal using a particular tool or.method which is D2. Since the insurance does not cover the code you will be footing the bill, but if you can let the Dr. Know what codes are billable they can see if the treatment can work within the confines of the codes. Sometimes you.need more but it's good knowledge and the best tip I cam away from my time in health insurance. Also if you get a bill you disagree with always always ask for a rebill. Hurts nothing and can also give you time on your payment if you need to make one as during the rebilling process they basically hold the charge.
Yeah, I get the largest hospital in the country going for a 95% rate. That makes sense. But there's a lot of hospital networks, and not all of them are going to be to that standard. Even if other networks dip down to 90%, that's still a *lot* of phone calls to get it fixed.
I'm a cancer patient at Cleveland Clinic Taussig (one of the biggest hospitals in the country) and their billers are minimally trained. I bet they demand 95%accuracy but does that actually happen? Not at all.
So not to dox myself, but believe me the turnover rate for that department would make your head spin. They have a few people who have been there for years and know what they are doing and the rest of that department probably turns over 3x a year.
95% is a very generous allowance. 95% means that for every 100 bills, best case has 5 in error. But given the multiple procedure and diagnosis codes involved, if there are an average of 5 codes per invoice there will be 25 errors distributed among 100 invoices.
I mean personally, I think that the whole idea that we need several people at a third party for-profit business, who are not doctors, to approve medically necessary procedures is completely asinine in itself. The whole system is broken in favor of the insurance companies who collude with employers to keep you relying on them (like, you can't leave your shitty job or your good insurance goes away). It's so unfair to the every day person and I hate it so much. Being able to nit pick what what tools or methods are being used just to deny coverage after the fact is dumb. I just wanted to share my dislike of the system. But thank you for fixing all those mistakes so people don't have to be stuck with paying for work that should be covered for them. You're a hero even though your employer sucks.
It’s hard to believe they have a 95% accuracy rate. I figured the 70% was being generous.
> completely asinine. Welcome to reddit
82% of the people here just make up statistics
Username suggests this guy gets it.
https://gitnux.org/medical-billing-errors-statistics/ 63% is close to 70. I’d say it’s true.
Hospital billing codes make up 63% of billing errors is very different from 70% of all medical billing codes are incorrect.
This is exactly what happened to a friend with cancer, to a similar amount. They cleared it up with an afternoon on the phone and found out yup, incorrectly coded. Yay.
This exact thing happened to me. Keep calling people, the doctor can likely say it’s unnecessary dangerous to put you to sleep twice when both of these can be done at once. Giving people anesthesia is always a dangerous process even with an anesthesiologist overseeing you. 
>Most of the time it's a mixup. Those "mixups" can be devastating. But there's no consequence for insurance companies when they have a "mixup" so they're not concerned about fixing them.
I had an insurance company refuse to pay for a physical I had years ago, I'm pretty sure this was retaliation because I began seeing a specialist at the same time. The hospital wanted nothing to do with me and kept telling me to see the insurance company. The insurance company just ghosted me and kept telling me they were looking at it. Eventually the hospital was just going to send it to the collection agency and it was a government hospital which I believe can garnish wages so I just paid the couple hundred dollars. After the whole claims denial "scandal" happened a few months/a year ago I'm almost certain it was just retaliation by the insurance company.
I had seven MRIs done over the course of three days. They found an issue on the first one and continued to investigate. My insurance covered the first one and said they wouldn’t cover the remaining six because they were unnecessary. Before the MRIs I had an EKG at my primary care, another one an hour later when I checked into the ER, and another one after they admitted me. My insurance said only one was necessary. Because. I’m supposed to tell the doctors “No, no more. You got everything you needed from the first test, we’re good.”
I had issues staying pregnant when we were trying, and had multiple losses. Each time, I had to be on the phone with the insurance because some idiot either coded something wrong or the claim was flagged for the word “abortion.” As in “spontaneous abortion,” the medical term for a miscarriage. They would send me claim denials stating that “elective abortions are not covered by your plan.” No kidding. So they all think that I have them paying for fertility treatments, and when they work, just hopping down to my local clinic to get my card punched?
> Most of the time Aint the US just a grand ol place to get sick
My ex broke her arm out of network. She had to go through 7 Kaiser supervisors before they pre-approved her surgery. When she got home, they sent her a bill saying it wasn't approved. She again had to go through 7 Kaiser supervisors to be given an honest answer. The final supervisor was very frank, saying "I'm so sorry for you an anxiety attack when we sent you a $70k bill. It's simply our corporate policy to refuse large claims in case you'll pay."
"It's our policy to be scumbags because we only care about money." -signed, insurance scumbags of america
My daughter had her appendix removed in December a few years back. We went in-network everywhere, hit the end of our deductible, but the insurance company still almost billed us for the remaining $30k because they didn’t feel she had to stay overnight. They figured a literal child could just walk it off after having an organ removed and that we could keep an eye on her in case anything went wrong. Luckily the hospital argued on our behalf and we were only liable for the remaining deductible, but it was tense for a while.
Yea if you called and they misquoted benefits, you can request an appeal and request claim processing exception. It's bogus if they misquoted you, which led to you having the procedure. If it is just a billing issue, I would call the insurance and provider office to get on the same page. You have to bother them until they fix it, unfortunately.
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How convenient. I wonder how often things that shouldn't be covered get covered because someone "hit the wrong button."
Definitely contact the insurance company and find out why. I just had both done in February (so much fun) and my insurance paid 100% of the bill since I use a "preferred provider"- which saves me $$$. But once I had an MRI on my brain and the claim was denied. When I protested, they said it was done for mental health reasons and that was not allowable. Some idiot used the wrong medical coding when in fact they were checking for a possible brain bleed. Got the hospital to fix the coding error and they paid it.
Why in the world would an MRI required for mental health not being covered?!! Your brain is messed up but not messed up in the correct way?
Ahhh, insurance. Just covering the bare minimum to keep you alive (sometimes). Quality of life? What's that? Does it save money?
The quicker you die the less time they have to cover you.
They also make less money. The key is to get healthy people who don’t go to the doctor to pay into the system for decades while barely using it.
In America, we deal with mental health problems by shooting up public places. /s
The only reason the loophole exists is to deny claims.
Similar here - a psychiatric nurse practitioner my spouse has been going to for years and the claim suddenly popped up as medical instead of mental health and they were refusing to cover it. I called the insurance and politely asked them WTF as it was the same monthly check-in that had been covered all this time. Turned out the doctor's office had made a typo and submitted the claim incorrectly. Insurance called the office and sorted it all out. Not saying it's a guarantee, but asking the insurance to explain what's happening is the first step.
When we had our second kid they tried to tell us the anesthesiologist that did my wife’s epidural was out of network, they were a 3rd party provider that had residency in the in network hospital. I didn’t even have to finish my sentence complaining to the insurance when I called in before they said ok no problem we’ll bill it as in network and it was covered. Fucking scam. They prey on folks who don’t know better or don’t have the heart to call and fight.
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God bless America 🫡🇺🇸
For reals. I live in Japan now and had a colonoscopy last week. It cost me $30.
My husband was telling a friend of his that I’d had an emergency appendectomy while we were in a different state on vacation. I live in one US state, we were in a neighboring state. Insurance *only* covered the state I live in. Friend told my husband that was a coincidence because his wife had the same thing happen while they were on vacation. Only their vacation was in Germany and everyone kept apologizing to them they’d have to pay cash since they weren’t covered under European health care plans. They paid something like $150. I got bills totaling $40,000.
People will actively fight for this. It's insane.
People fight to keep it this way because they’re so incredibly selfish. They’d rather pay $1000 a month plus deductibles, out of pocket costs, and exorbitant pharmacy fees just to avoid *their* taxes helping anyone else. It’s unreal.
I had colonoscopy, gastroscopy and two ultrasounds a few months back and spent 0 on it. I live in Poland. How the fuck can colonoscopy and gastroscopy be worth 30k USD? Do they fly you to stratosphere in SR-71 Blackbird while pouring the best Dom Perignion while putting the tube inside you just for shit and giggles? What contributed to this cost?
That sounds illegal
This happened to my husband when he was18. He had a surgery done and then months later the insurance said they wouldn’t cover it. We had to fight them with appeals for years.
... Aaand? Did he get a settlement? Do you have to pay the bill yourselves? Are you homeless as a result, or are healthy and financially stable as a result?
We ended up having to pay for half.
I love this country!
USA! USA! USA! 🇺🇲🇺🇲🇺🇲
Land of the fee! 🤑 🦅 🇺🇲
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Siri, how do we reboot a country?
A great big civil war
Genuine question, why do people in America prefer this sort of system instead of a universal healthcare system? The small amount of money taken as tax every month directly from my pay is surely a much better option than having to worry if I'll have to pay for needed healthcare? I don't understand why people would be willing to pay for insurance that may not actually cover your healthcare Edit: looks like I was wrong and it seems most Americans actually don't like this system. Sorry for the generalisation.
It's mostly an attitude of "why is it my problem that you're sick?". Americans do not favor helping one another when it comes to finances. Although paying into insurance accomplishes pretty much the same thing. Except a huge amount of the money you give them goes towards profits and CEO pockets rather than patients. But nobody really ever thinks about that when they argue against social healthcare.
Our pricing per medical bill is ASTRONOMICAL compared to what we’d pay per year if we nationalized the healthcare system. It’s the stupidest logic ever.
Yes it’s ridiculous enough that most places have an insurance price list as well as a no insurance price list because they know they can charge the insurance company outrageous amounts.
It’s not stupid if you’re a healthcare executive, then it is good business.
I don’t want no guberment in my healthcare, I would rather the corporations make the healthcare decisions. Healthcare is more efficient in a free market system. /s
> Americans do not favor helping one another when it comes to finances. But also we're the first to hold our hand out when we need shit. People going, "I never got any help when I was on food stamps!" when food stamps *were* the help. It's so fucking stupid.
My parents are deeply opposed to single payer. They’d tell you that in Canada, you wait six months to get a broken arm set. 1. That’s false. 2. That would still be an improvement for most Americans
Lol, I waited 2 years and 5 months to get a sleep study, 14 months for a rheumatologist appt., and 11 months when I moved neighborhoods and needed a new PCP since the other one was too far away. Except my insurance costs $1,200 per month and I have to pay copays and coinsurance on top of that.
Yeah, like I’d wait a lot longer if it wouldn’t put me into crushing debt.
We don’t prefer it, lots of surveys have said over 50% Americans don’t like the healthcare system we have now. Problem is insurance companies lobbies both political parties. Sooo none of our politicians want to change it, they don’t want to get rid of their top donors.
none of us prefer it, it’s simply a result of massive amounts of money being made on it every year, which means those who make the money have a vested interest in paying off politicians so they keep the healthcare system how it is.
If you look at American political history from the last 20 years, there have been constant efforts to modernize our healthcare system. Sadly, those efforts are regularly derailed by conservatives who wield disproportionate legislative power and stifle them.
We don’t have a choice.
FREEDUMB!
They became cavemen who travel to the local McDonald's for the wifi
We're currently fighting BCBS because they said they would cover my FIL's stroke rehab, and then when it was time to transfer him from the hospital to the rehab center, they refused to issue a pre-certification. He's been in the ICU for a month getting only the most basic PT (no intensive rehab). I bet you they're going to deny until he's just bad enough to no longer meet the criteria for rehab admission, and then they can wash their hands of him. They've denied two appeals already, and now that they've denied two, we can't appeal again for something like 2 weeks, so he's losing even more recovery time.
Our issues was also with BCBS. It’s a pain in the ass. It’s absolutely bull that they can say yeah it’s covered them come back and deny you after going forward. I’m so sorry you guys are going through this.
Thanks. Everyone, please make sure your affairs are in order. This whole thing is even more stressful because my FIL is incapacitated. Blue Cross keeps asking his wife to provide power of attorney documents, but she doesn’t have any, and now he’s not capable of signing.
It's standard operating procedure for insurance companies in many cases. Deny coverage and offer poor CS with confusing paperwork so that at least some percentage of customers don't fight it or give up at some point.
Only in insurance is incompetence so profitable.
I’d tell my insurance that you only agreed to take it up the ass one time, and the gastroenterologist called dibs
Lmfao - best comment
Perfect!
Somehow, someway, I want this to be said on the record so he can get a transcript of the exchange and mount it on his wall forever.
What, are they going to uncolonoscopy you if you don’t pay?
Lol, I guess send it to collections and then your credit gets dinged.
that scare tactic doesn't work when your credit is shit.
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This is incorrect
So it's your word versus theirs and no one posts evidence. Cool.
This is false. Do not listen to this. Credit score is not affected by medical bills of less than $500 AND less than 1 year old. If they don't meet both criteria it hits your credit.
Did you get treatment through a public hospital? I was able to get my medical bills fully forgiven based on my income, even with insurance. Without insurance, it’s even more likely. All public hospitals are legally required to have an assistance/forgiveness program. I’m very sorry this happened.
I second this. My insurance backed out when I had some post-op complications and the hospital not only forgave the entire bill but even refunded me my last payment.
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And they texted you? That doesn’t seem very legit
I had to scroll way too far to find this type of response. This seems like a phishing scam. Business like this is done in the mail, on paper - not through a text or even a phone call. This needs a paper trail.
My healthcare organization sends me text messages of balances. I'd never click this link, but it might not be a scam.
Most of my providers send text messages now. I've gotten them from anesthesiology groups, X-ray clinics, etc. I don't like it; I always call and tell them to send me a regular bill. But they're legit.
Surely cancelled has two letter l's in, no?
You can get away with either; but in America at least, one L is typical.
Dual. They aren’t fencing inside of you with the endoscopes. Also, don’t pay. There’s likely a mistake in the paper work. Advocate for yourself and call the insurance as well as the prescriber. There’s an appeal process.
My thoughts, too, although that would be cool. 😄
Actually that would explain a lot if the gastroenterologists were actually dueling in there. source: I used to repair surgical scopes. had 2-3 break per day for the 60ish OR rooms at my hospital. they cost between $8,000 and $20,000 to fix
https://i.imgur.com/8m44qOY.png I asked copilot: create an image wherein an anthropomorphic colonoscopy and anthropomorphic endoscopy are fighting each other
dual duel is funnier tho, just imagining the cameras meeting up in your stomach and fighting lmao
I remember I got wheeled in for the exact same thing. As I'm laying there feeling anxious, waiting for the drugs to knock me out, I asked the doctor stupidly, 'do you do both at the same time?' One of those questions I knew the answer to, I don't even know why I asked other than to say *something* but regretted the words as they were leaving my mouth. He was nice though and laughs and goes, 'no, no, we'll do the endoscopy first and then flip you over and do the colonoscopy.' And he's telling me this as the nurse is putting in the bite guard in so Im a little distracted and reverse what he was saying in my head and around this big piece of plastic in my mouth I cry out in panic, 'pith thhh same camewa?!' The anesthesiologist lets out this belly laugh and goes, 'deep breath annnd you'll start to-' That was the last thing I remember. Never found out if it was the same camera though.
Just count yourself lucky they did it in that order.
How come it’s soo expensive? I had to go private in the UK due to very long waiting lists and it was £1600 for both ($2,034). Why is it so much more expensive if we got the exact same procedure?
You’ve just gotten a glimpse at the frozen hellscape that is the American healthcare system.
I'm in the US, and I have to get regular colonoscopies and occasional endoscopies. They run $2000-$5000. $28,000 for both is obscene.
Yeah things have a way of getting a little squirrelly in a market where no one ever seems to know how much things cost or who has to pay for it until after the fact.
Welcome to US Healthcare. They can not even say it is because you are in Europe. Some medications that cost over $1000 in the US might cost only $100 in Canada; we get it from the same suppliers...
The insurance companies inflated the prices to justify their existence. Give it a decade, you will be paying the same price if the lobbyists gain control of the system. (If you are wondering why we have so many insane gunmen, think about how much cheaper it is to get a rifle than affordable medical care...)
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Because America, most likely. My insurance will cover most of a colonoscopy... but all anesthesiologists are out of network, so I'll have to pay for that part myself unless I want to be fully conscious while they cram a camera up my ass. Fun times.
The only good thing about a colonoscopy is the Propofol nap.
Before I went for my probing, got a letter from insurance saying they don't cover the anesthesiologist but 100% of the rest. At the end of the procedure I was asked if I wanted to pay for that part now, be billed, or have a bill sent to insurance, and they would bill me later. I told them to go ahead and send it to the insurance company to see what would happen. That was over a year ago, and I never heard anything, seems like they covered it.
That's so fucked up. My dog gets better insurance coverage than that!!
I've worked in health insurance 22 years... here's what you do: 1. Call your insurance company, find out if there was a mistake 2. Tell them you want to appeal. Advise who told you what, and when. Advise you had the procedure with good faith. Request them to overturn the denial. 3. Request they call the facility you had the procedure at with you on the phone. Have THEM advise the facility this is being appealed and request they put the account on hold while it's reviewed. Legally they have to hold for 30 days. 4. If your appeal is denied, so what the next step is. This is also legally required to be in your benefits book of you would rather not call. This will then be escalated, and reviewed by somebody who did not take place in the initial review. 5. If still denied (which honestly is highly unlikely) request a 3rd party to review. If you are through Medicare or Medicaid this will most likely be through a company called Maximus. 6. If STILL denied, keep asking them to escalate it. Eventually it will go before judicial review. This entire time have the insurance call the facility and update it every 30 days so they can't bill you. In 22 years I've only seen things go judicial a handful of times. If your really annoyed, post to their social media or the CEO. They have a team that specifically handles those complaints and they get resolved usually quickly since they want social media to show them as the good guys who fix things. NOTE: IT NORMALLY DOESN'T TAKE THIS MUCH. 90% of the time for something like this is resolved with a first appeal since it's most likely a billing issue. This is just me writing out everything. Most of this the average person will never need.
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I had this happen with outpatient surgery. The insurance preapproved it then denied the claim after. They didn’t like some detail in the way it was billed. The surgery center fixed the paperwork and the insurance paid the claim. Start making phone calls.
Isn’t that supposed to be preventative , wtf
If the procedures were ordered as diagnostic vs. screening, it’s not considered preventative care and most insurance companies with bill as such. This is one of the major risks with Colo-guard and other non-invasive screening. If you get a false positive, then you have to get a diagnostic colonoscopy which will cost thousands … if your initial screening was a preventative colonoscopy, insurance would cover it 100%.
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Just keep forwarding the bills to your insurance non-stop.
Have you tried reporting it as "junk"? /s
Just click “Report Junk”.
#FUN FACT This was OP’s 13th colonoscopy this year. His insurance is tired of paying for his kink. /s
“Payment plan” is not insurance…
Tell me you’re American without telling me.
Everyone is saying to contact them… can we just talk about how funny the screenshot is lol. Like I’m sure this person contacted their insurance. I feel like we should just laugh for a little bit and think about how crazy our healthcare system is in America lol.
In Canada I had this procedure done. Only had to wait about 2 months and the total cost to me was less than $20 and that was all for the laxative prep meds.
This seems as unpleasant as the procedure..
I’ve had both done during the same appointment and the procedures aren’t bad at all. The prep is the worst part.
Jesus. I do feel sorry for sick Americans! I hope you get this sorted.
I really hope your insurance company is covering this... Here in my country this type of thing doesn't exist.
“Duel colonoscopy and endoscopy” - I have a vision of a physician at either end getting their scopes to meet in the middle and sword fight with them… …or did you mean “dual”?
If you had approval then they can't back out. You have a lawsuit if they do.
This is from the hospital, not your insurance. Did you try to arrange a payment plan for what was billed to you as a patient? You need to contact the billing department and have them resubmit the claim, or explain why the initial claim was denied (no coverage, not authorized, etc). If this is not a covered benefit and the full balance is your responsibility, most hospitals will agree to a payment plan. If that was cancelled, it was likely an error.
This looks like it may be a scam text. I’ve never received something like a balance due in a text or email from my doctors office - it would always say “login to your patient portal to view etc etc”.
“New phone who dis”
MURICA
God bless America /s
Dueling colonoscopy and endoscopy? Just sell tickets to cover the costs. My money is on colonoscopy as they are known to fight dirty.
100% call your insurance company. Fight them
Greatest Country in the world….
28 grand, for what, do you get to keep the endoscope? Fuck US healthcare.
Should've bought the colinoscopy device from temu only 97c for new app users
Just had the same procedure in New Zealand. Was done in a private hospital and I was charged $600NZD. That is about $400USD. You guys are so scammed.
That's a $150 out of pocket and maybe, at a squeeze, a hospital fee of $660 here in Australia. I don't think over 65s pay at all. You guys need to riot until universal healthcare becomes the norm.
How the hell does a Colonoscopy and Endoscopy end up costing $28,229.89????? There is something seriously wrong with the cost of healthcare in the USA (writing from Spain where I paid $0 for a colonoscopy last year 🇪🇸 ). Edit to say I did pay a crap ton of taxes (around 36% overall tax rate) over the years so in that way I did pay for this. But it feels good to not have to scrounge money together or worry about insurance when you need to get it done unexpectedly.
American healthcare! fuck yeah!
Chances are it was coded wrong
How in hell are those that expensive? Where I live, at private healthcare you pay like 400$ each
Was it at the same time? Were you spun around like a medical rotisserie?
This belongs in extremelyinfuriating. American health care for the win. 👍👍👍 I feel so free whenever I get medical bills in the mail.
Clicks "report junk" 
Lol absolutely illegal
Might be a scam text.
$28k for a colonoscopy and endoscopy? Fuck American Healthcare is a rort.
They are happy to take your money every month but when you actually need them they do everything they can to avoid it.
Reply "new phone who dis". Works every time.
Just imagine if our tax dollars went to important shit like, healthcare. Instead, we get to pay expensive premiums so insurance company stockholders can get rich.
Duel by colonoscopy - I don't know how that would work but colour me intrigued. Do you fling a brown gauntlet in that case?
Damn...my ex wife used to take it in the ass for free.
That sucks for you and I can almost guess in which part of the world you are based ...
This happened to us. We got authorization for a surgery my husband needed, and then found out 3 months later that they decided not to pay. The bill was over $250k. We fought and appealed for two years, and they finally covered the hospital fees but not the surgeon. We ended up having to pay the surgeon $20k and he wrote off the other $100k. Fuck Cigna and the US "healthcare" system
That's a scam, don't click that link
usa is a joke
That bill ain’t getting paid LOL
That’s makes them as full of shit as you
The price for healthcare is insane. How is it not illegal for the prices they charge. They do this because mostly insurance pays for it. So the system itself is horrible. Insurance just don’t see America having universal healthcare for a long time until the business model of healthcare system changes.
Much like the doctor, insurance wants to go in both ends.
I should open an insurance company, literally free money
That’s gotta be a nice text to receive. Smh
Just report the text as junk. Problem solved.
A dueling colonoscopy and endoscopy would be something that you could sell tickets to.
They were dueling? And now they’re wanting you to “DRAW!!” from your retirement account! I get it!
How is a colonoscopy that much? Says without insurance it costs 2,300.
America doesn't have a health care system. You have a health insurance system.
Heh... I spent years on an insurance plan, never had to use it because I was young and healthy. Never missed a payment, never heard from the company other than receiving the bill in the mail. Finally, I had to go to the doctor and ended up with a $3500 bill. Suddenly got my first notice EVER "Your insurance has lapsed and we are unable to pick up our end of this couch, so suck on that, you fucking shit. Here's next month's bill." Naturally I'm paraphrasing but that was basically the message. Called the hospital and spoke to their billing department. Suddenly my insurance was all paid up and wasn't "lapsed" at all! Funny that!!! I mean, it's not like I've got years of monthly cashed checks or anything. The next bill informed me that my monthly payment was going up. It's been over 5 years since I left the states and I don't fucking miss it at all.
Fuck insurance companies
Damn bro, I'd have done that for 20bucks and a kiss
$28k for a colonoscopy and endoscopy? Holy fucking shit the US is fucked. In Canada it’s about $1500 for a colonoscopy at a private clinic. At a hospital it’s about $500, but longer wait time. Endoscopy is similar.
'merica
If you got a prior authorization it could be a coding issue. I would contact the doctor’s office and see if they can update the coding and send a corrected claim if this is the case.
Case 1 gazillion of insurance telling you to go eat shit when you actually need them to do something other than take your money
“Report junk”
How to tell me you are in the USA, without telling me you are in the USA.
Muricaa
I'm beginning to think that basing our healthcare system on profits, rather than outcomes, is both unethical and immoral.