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Alert: Doctor's Don't Tell You All The Facts! Dangerous Grounds!

Friday, May 09, 2014

I wanted to let everyone know, not only were we foolish, uneducated, or misinformed, we were billed exorbitantly.

My DH just had a stint put into a vein that leads to the back of his heart. Everything went well. I was there the entire time and spoke to the doctor asking all the questions I could think of, but bottom line was; All is Well.

Now comes the bill. $2500.00! We are on Medicare so why didn't they pay. Oh! You didn't know? Patient was admitted for OBSERVATION not as an overnight patient. There's the rub. We went through all the same procedures, documents, life giveaway requirements that a patient being admitted overnight goes through. He got all the same treatment that overnight patients go through. Same nurses, same everything. (Had we know we were going to have to pay for all of it, we would have demanded royal service.) But whop knows, maybe that would cost more.

I was in the hospital for 7 days and paid a fraction of that much. So we called the doctor's office to ask questions. No they can't change the criteria the hospital uses to determine if a patient is in for observation or is, in fact, more deserving and therefore rated differently so the insurance pays for it.

Apparently doctor's do not have control over there patients as much as they lead us to believe. Hospitals have more control than doctors and insurance companies have the most control.

Here is a short history, as told to me by a billing person in the field for 20 years. It used to be that a doctor would place a patient in the hospital and had total control over everything on the patient. How much treatment, procedures, meds, etc. It all determined the price of everything. Along come insurance companies that are in business to make money, not disburse it in claims as they lead you and all others to believe. Somewhere along the line, not long ago, insurance companies refused to pay the high bills they received for two reasons, only one of which was given to the hospitals and passed onto everyone else. 1. The patient had to fall into a certain criteria for admission or observation. Since most patients are admitted for observation, based on their risk assessments (and as we all know are grossly out of line), they would only pay for the ones that were withing those certain criteria. The patient had to pay the bills for any admittance that did not fall into that criteria. This left the hospitals with huge unpaid bills through no fault of theirs and they had to recoup it somehow so; answer: Bill the patient!

So now we have Heart Institutes billing their heart patients thousands of dollars that they had no idea was coming. Heart attack region as far as I can see. That makes the Heart Institute the Heart Crusher!

So - for anyone that is in the situation of being admitted to the hospital for any reason - beware. Apparently even doctor's have no control over the criteria as set down by the insurance companies with employees that have no idea of what is good or bad in judgement because they are not doctors.

When I worked for an (undisclosed) insurance company, I was told a woman that had just given birth to a baby with all kinds of health problems was being denied any compensation for baby. Never mind she was looking at way over $50,000.00 yearly (many years ago) and this would continue for as long as baby lived and didn't even cover other expenses related to issues.

My first question surprised the big bosses - "Did we have a doctor on staff that would determine if baby would receive or be denied benefits?" Answer: "No! What do you think we are? We can't afford to put a doctor on staff to answer questions like these. Any moron would see this baby is a huge risk to a company like ours!"

"Who makes the determinations?: I asked. "Risk Assessors in underwriting!"

Who pays those Risk Assessors in Underwriting? The Insurance company out of your paid premiums. Now are they going to assess anything that would cause the insurance company (their personal money suppliers) to have to pay out money? I wouldn't think so based on the fact that I was basically called a moron for asking my first question.

So had I been sitting in the right desk, I could have been the one to deny the benefits to this baby, had I been also of a lot more negative attitude and hate and anger in my heart than I already have. I, unfortunately, love people, especially children, and animals. Therefore, I am never going to be at a underwriter's desk. And you guessed it, I would never be able to push the button on a weapon of md or anything on that line. I'm a peace lover, but more than that, I am a survivalist.

I love watching disaster movies - really don't know why, but I analyze every part of it. "If I were in that situation, how would I get out of it?" I guess it's what makes me strong, mentally and emotionally. I never breakdown until after the thing is over so at that point, I would be either dead or standing on the edge of the disaster crying my eyes out in shock.


At least you'll be able to utilize that insurance agent that came along with your premiums a few questions and get some information to help defray the heart attack that may come later.

Yes! Right now I hate Insurance Companies, the medical profession in part, and the fact that we have all been apathetic and uneducated on what has happened to our medical industry. Is Obama Care better? I believe it is in the fact that preexisting issues cannot be denied, there is some kind of standard being set up to resolve a lot of these issues, and everyone has a right to medical help. Without Obama Care, we will continue to fee the insurance companies unleashed greed and domination of a once good profession, but one we all still need. I also believe there is a lot of fixing to do with rules coming from the law of Obama Care, but anything is better than nothing and I believe it is up to us to communicate with those that are making the rules and sorting out the problems of Obama Care in order to make it better for all of us.

As I used to say about the banking system and their huge overhead of empty houses being vandalized and taken over by squatters; rent them out, make a deal with the people who are losing them due to inability to pay the mortgage (that the banks knew would happen in the first place), because something coming in is better than nothing.

I don't know about any other area than the one I am living in, but the housing market is building again like crazy. They are currently putting in over 6000 houses (no mistake on those zeros) across the street from where I live. I didn't know there was enough land over there to put that many house on. There are other developments going in, too. Unfortunately, the roads already in place can't handle all the extra cars and our commutes, even without the retirees getting into it for no reason at all, is obnoxious. I'm all for flex time, but here, flex time would just make the commute an all-day affair.

Okay! I releasing the soapbox for the next person! Have a great day!
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Member Comments About This Blog Post
    Update: We fought and lost this case. Apparently the doctors in the local hospital do not have the final say as to "observation" or what other choice they have - the hospital has that right and the doctors have to toe the line or find somewhere else to practice. Since most of the people here go to the local hospital, the doctors have little choice than to do as told in this case. It's a little scary to think some pencil whipper at the top has the final say on your medical attention. Sounds a little like the VA crap and I certainly hope that it scares all the hospitals where it needs to scare them.

    Thanks for all your comments. We have to pay and we are, but it sure irks us.
    1409 days ago
  • JANET552
    Thanks for posting!! I hope you can fight this.
    1409 days ago
    Yes you need to fight the bill. Hope it works out for you.
    1409 days ago
    That is terrible. Thanks for the info. Are you going to fight the bill?
    Hugs and Prayers Constance
    1441 days ago
    You can try to contest the bill. Doctors don't work for the hospital, they are a separate entity with hospital privileges. You need to deal with the hospital.
    1442 days ago
  • 123ELAINE456
    You need to fight the bill. This is not right. I read about things like this happening to other people. Yes this is Dangerous Grounds for Everyone. Let us know if you get the Bill reduced and paid for. God Blessings Always. Have a Wonderful Happy Mother Weekend. Hugs!!!!!!!!!!!!!! Take Care.
    1442 days ago
    You need to fight the bill. Lots of people do and get an adjustment.

    I worked at a time when all of these changes were occurring. Some of it had to to do with abuse in the system. We had people bring in their special need children so they could go on vacation. It happened way too often. And people would bring in their senile older relatives and rather than make arrangements to stay with them or make the hard decision to put them in a nursing home they would disappear. The claims were didn't qualify and the hospitals were picking up the tab. Unfortunately it caused things to swing the other direction. Where as a patient who had open surgery could stay in the hospital a reasonable amount of time until they were back on their feet now they send them home the next day even if they can't move and are all alone.
    1443 days ago
  • KERRYG155
    I read an article just a few weeks ago about this same thing. Before they put you in a room or keep you in ER for any length of time you need to make sure your doctor writes it up as inpatient and not observation. The doctor is supposed to be the one who says it isn't just observation. As for the insurance company not having a doctor to determine the necessity of things-that is unbelievable!!!! I would think that would leave them open for lawsuits. I had one doctor who quit private practice in order to work for an insurance company so I know some of them do have them on staff. Now as for the money you owe-my friend who is on medicare and had her hip replaced two weeks before me had an outrageous bill and she called the hospital and talked them down to just a small portion of what the original charge was. Maybe you can do that no matter what medicare decided. Good luck!
    1443 days ago
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