When you get a hospital step-in surgeon suddenly

IrishEyes

IrishEyes

Sharon
Location
Midwest
Does it occur to you to make sure he is covered by your health network?
I was just at the Blood lab this morning and had a conversation with the lab tech
brought on by my remaining puncture marks in my arm.
The conversation came round to the many different doctors I encountered and all wanting me do
follow ups with them.
She said that happened to her and she asked them right away "Is he covered by my insurance?"
She said the nurse was confused why she was asked that and told her he is your doctors associate.
The tech replied back, "I will not sign consent until I know he is covered by my insurance".
I have to admit, thinking back to the several doctors I encountered I never thought to ask that.
Has this ever occurred to you to be sure also?
 
That hasn't happened since I've been on a Medicare Advantage plan, but when I worked it did. The company had a plan requiring us to use doctors in their network. I made sure the surgeon was, but the day before surgery, the anesthesiologist called to go over allergies, other concerns, and I asked him if he was in my insurance company's network. I don't think he was going to bring that up. Turned out he was not, and another anesthesiologist had to be found. I never forgot that, and always check.
 
IrishEyes said:
Does it occur to you to make sure he is covered by your health network?
I was just at the Blood lab this morning and had a conversation with the lab tech
brought on by my remaining puncture marks in my arm.
The conversation came round to the many different doctors I encountered and all wanting me do
follow ups with them.
She said that happened to her and she asked them right away "Is he covered by my insurance?"
She said the nurse was confused why she was asked that and told her he is your doctors associate.
The tech replied back, "I will not sign consent until I know he is covered by my insurance".
I have to admit, thinking back to the several doctors I encountered I never thought to ask that.
Has this ever occurred to you to be sure also?
Click to expand...
That would never be a question, here in Canada, as every Doctor is a part of the Provincial medical care program in that Province. And of course, all citizens, and permanent Residents are ALSO covered by the Provincial health care program. That is why it's called a Universal care program.

JIMB>
 
MACKTEXAS said:
That hasn't happened since I've been on a Medicare Advantage plan, but when I worked it did. The company had a plan requiring us to use doctors in their network. I made sure the surgeon was, but the day before surgery, the anesthesiologist called to go over allergies, other concerns, and I asked him if he was in my insurance company's network. I don't think he was going to bring that up. Turned out he was not, and another anesthesiologist had to be found. I never forgot that, and always check.
Click to expand...
I am trying to wrack my brain remembering who and how many doctors had a dent in my care in those two days. Some I can't even
remember their names. I do have one of the major used Insurances in this area I am pretty sure I am good but... now I have that
ummm are you sure thing going on. You think that would be part of the job of the hospital wouldn't you? You are so drugged up and
sleep depredated how do you know up from down in there?
Thought I would post this so others are aware, I sure wasn't.
 
IrishEyes said:
I am trying to wrack my brain remembering who and how many doctors had a dent in my care in those two days.
Click to expand...
Yes, I understand. And suppose someone had a heart attack and went to the ER room, then out of the ER room into a regular room and various procedures had to be done by all sorts of providers. The patient would have no way to keep up with all that or ask questions.
IrishEyes said:
You think that would be part of the job of the hospital wouldn't you?
Click to expand...
But I don't think it is. Their focus is on care, and they may not (just as the surgeon in my case selected an anesthesiologist who was not in my network.)

That was the best part of having traditional Medicare and a supplement, which bypassed those in-network requirements. That was the main reason I preferred traditional Medicare, but the cost went up a huge amount each year on my supplement, until I finally decided to switch to an Advantage plan.

On Humana, if I see an out-of-network provider, it will still be covered, only I'll have a higher co-pay. I figure if I end up in that situation, I'll still come out cheaper since I will have saved those high supplement payments. If it doesn't work out that way, then I lose - it' a gamble I take, but life is full of many chances; we do the best we can.
 
StarSong said:
I'm with Kaiser Advantage. If an outside doctor or testing facility is used, that's because Kaiser contracts with them and orders it, therefore Kaiser picks up the tab. No worries for me.
Click to expand...
Thanks for that input - it relieves some concern. I did an AI inquiry and got the below response - and now I recall that a few years ago, "no balance billing" laws went into effect which apparently covers this very scenario, in addition to it's other provisions.


network.jpg
 
Last October I went to the ER and was admitted into the hospital for 2 days. They wanted to keep me longer but I insisted on going home because I didn't have any real health insurance. I had been severely dehydrated from an intestinal infection in spite of drinking copious amounts of fluids. After plenty of intravenous fluids and antibiotics I obviously felt much better and could simply finish the antibiotic regimen at home.

Of course I got a ridiculous hospital bill, but at least I only had to pay 40% with a self pay rate. The following month I then received several separate bills from different physicians. I had to pay an additional $1900 for that. Over the next several months I received several more bills, even one from a nurse practitioner.

After receiving several liters of intravenous fluids in the ER I had my wits about me and asked about every medication and procedure they wanted to give me and what each doctors name was that talked to me. I could tell they didn't appreciate that very much. They tried to give me an injection to prevent bed sores? WTF??? I wasn't even there for 48 hours and was getting out of bed to use the bathroom and going for walks up and down the hall by the second day. They didn't like that much either but I was pretty uncomfortable just laying in bed.

Anyhow there were several charges by a couple of doctors I never saw, including a radiologist that did not see me. I was given a CT scan of the lower abdomen and the ER doctor that first evening told me that my guts appeared normal. I had one bill where I called to inquire and they told me they didn't have any record of the account number? After about 3 calls they gave me a different phone number to call and they had no record of it either. Yet I am still receiving bills for this? The hospital gave me an additional 10% off for paying in full, but then a month later sent me a bill for the balance of that same 10%? Took several phone calls to correct that.

So yes, you cannot simply trust and accept what the hospital charges you. I don't know if it is incompetence or actual fraud/scamming, probably both. It is so sad, and think of all the patients that are admitted to the ER unable to perceive what is being done to them. I have no qualms about calling the whole medical process in the USA corrupt and full of criminals.
 
outlander said:
Last October I went to the ER and was admitted into the hospital for 2 days. They wanted to keep me longer but I insisted on going home because I didn't have any real health insurance. I had been severely dehydrated from an intestinal infection in spite of drinking copious amounts of fluids. After plenty of intravenous fluids and antibiotics I obviously felt much better and could simply finish the antibiotic regimen at home.

Of course I got a ridiculous hospital bill, but at least I only had to pay 40% with a self pay rate. The following month I then received several separate bills from different physicians. I had to pay an additional $1900 for that. Over the next several months I received several more bills, even one from a nurse practitioner.

After receiving several liters of intravenous fluids in the ER I had my wits about me and asked about every medication and procedure they wanted to give me and what each doctors name was that talked to me. I could tell they didn't appreciate that very much. They tried to give me an injection to prevent bed sores? WTF??? I wasn't even there for 48 hours and was getting out of bed to use the bathroom and going for walks up and down the hall by the second day. They didn't like that much either but I was pretty uncomfortable just laying in bed.

Anyhow there were several charges by a couple of doctors I never saw, including a radiologist that did not see me. I was given a CT scan of the lower abdomen and the ER doctor that first evening told me that my guts appeared normal. I had one bill where I called to inquire and they told me they didn't have any record of the account number? After about 3 calls they gave me a different phone number to call and they had no record of it either. Yet I am still receiving bills for this? The hospital gave me an additional 10% off for paying in full, but then a month later sent me a bill for the balance of that same 10%? Took several phone calls to correct that.

So yes, you cannot simply trust and accept what the hospital charges you. I don't know if it is incompetence or actual fraud/scamming, probably both. It is so sad, and think of all the patients that are admitted to the ER unable to perceive what is being done to them. I have no qualms about calling the whole medical process in the USA corrupt and full of criminals.
Click to expand...
I read your post, and I was shaking my head at the situation you Americans find yourself in. I just spent a total of 8 months in 3 different Toronto hospitals. I am 79 years old. At no time in my life have I ever received a "hospital bill " . Our system is universal, meaning everyone, citizen, or Permanent Resident is 100 percent covered.

Doctors in Canada are able to practice medicine, without being a bill collector, for medical insurance companies. They know that they will get PAID for what they do, from the Provincial Government, without having to employ "billing clerks " or collection agencies.

In my Province, Ontario, seniors over age 65 pay a flat rate of $4 for each prescription they need. How can that be ? The Provincial Government buys medical drugs in bulk, so the suppliers prices are limited to a set fee schedule. Hospitals in Canada are public entities, that are "non profit" based.

JIMB>
 
Thinking back to when my husband died I distinctly remember getting the final bill from the
hospital with a Total owed, showing all the charges that had occurred from the time he was admitted,
all his treatments and hospital staff listed that had fees, the total of what we had paid and the remaining.

I didn't have all the separate charges hitting me out of no where. He was only hospitalized once, one surgery,
numerous Chemo treatments, then the hospital bed when he needed it the last 4 months.
He was on Disability so that covered some of it.

They pretty much demanded that after a year of his passing they needed it be be paid upfront by whatever means
I could engage, personal loan, 2nd mortgage on the house or sell properties. They would no longer take payments.

I called a lawyer and he wanted to see the original admitting papers. He said it sounds like they are backed into a corner.
I took them to him and he looked it over. "Here it is, when he was admitted where were you?"

I said they took him straight from the Dr. Office to admission. I quickly drove home to get the boys from school to my friends
house since I had no idea how long it would take and to call my step kids"

He then said.. "Your name is not on the Responsible Financial Payer list. They can't demand nothing from you. When you came back
they forgot to have you sign the agreement. You have been making payments. So stop paying Now. You owe them nothing".
If they would have left me alone I would have paid off that bill and never realized it.
 
jimintoronto said:
That would never be a question, here in Canada, as every Doctor is a part of the Provincial medical care program in that Province. And of course, all citizens, and permanent Residents are ALSO covered by the Provincial health care program. That is why it's called a Universal care program.

JIMB>
Click to expand...
It is not a problem in Australia either. Private insurance or not, there is no difference.
 
IrishEyes said:
He then said.. "Your name is not on the Responsible Financial Payer list. They can't demand nothing from you. When you came back
they forgot to have you sign the agreement. You have been making payments. So stop paying Now. You owe them nothing".
If they would have left me alone I would have paid off that bill and never realized it.
Click to expand...
That must have been quite a relief. I googled if it was true everywhere, and in 'most' states it is true, but some states have laws that a spouse does owe the money even if they didn't sign a financial responsibility form (Arizona, California, Texas and maybe some other states).
 
HoneyNut said:
That must have been quite a relief. I googled if it was true everywhere, and in 'most' states it is true, but some states have laws that a spouse does owe the money even if they didn't sign a financial responsibility form (Arizona, California, Texas and maybe some other states).
Click to expand...
Yes, I looked it up some time ago, many have both responsible now. It began changing a few years after that happened to me.
That lawyer was so tickled he had them in a spot he filed the papers with copies of the agreement himself, no charge.
I was even paying them double the amount we agreed upon to begin with to get it down, they should have just let it ride.
Was never late in payments, they should have taken that into consideration.
 
There was a recent podcast where a man demanded a complete list and coding for every single thing he was being charged for. He then used AI (no identifying names included) and had it analyzed. Saved tens of thousands of dollars.
 
I have regular Medicare so I don’t have to worry about a doctor being in network. If my supplement plan gets too expensive as I age, I will just stay on regular Medicare and get a high deductible supplement plan. By the time Medicare reduces the charges you would have to have a serious illness like cancer, etc. to ever have to pay the entire deductible.
 
IrishEyes said:
He then said.. "Your name is not on the Responsible Financial Payer list. They can't demand nothing from you. When you came back
they forgot to have you sign the agreement. You have been making payments. So stop paying Now. You owe them nothing".
Click to expand...
Yes, that worked out well in your case, but it can, or does depend on the state. Texas is a community property state - so bills incurred during a marriage are considered joint debts. When my wife died, her outstanding medical bills had to be settled before probate of her Will could be finalized.

Edited: Sorry - never mind - I see this was already addressed by another member.
 
MACKTEXAS said:
Yes, that worked out well in your case, but it can, or does depend on the state. Texas is a community property state - so bills incurred during a marriage are considered joint debts. When my wife died, her outstanding medical bills had to be settled before probate of her Will could be finalized.

Edited: Sorry - never mind - I see this was already addressed by another member.
Click to expand...
Those first 8 years in Missouri was one big What's next? era. All we went through, stuck by each other and the boys doing without.
Then him with cancer just as he had his business booming, you better believe when the lawyer told me that, my head was bent, my heart
was throbbing and the most heart felt Thank You was whispered in nothing but love. It wasn't a gift to me but to each of us, because all
that man ever wanted was to take care of his family. I know where it came from.
 
IrishEyes said:
Does it occur to you to make sure he is covered by your health network?
I was just at the Blood lab this morning and had a conversation with the lab tech
brought on by my remaining puncture marks in my arm.
The conversation came round to the many different doctors I encountered and all wanting me do
follow ups with them.
She said that happened to her and she asked them right away "Is he covered by my insurance?"
She said the nurse was confused why she was asked that and told her he is your doctors associate.
The tech replied back, "I will not sign consent until I know he is covered by my insurance".
I have to admit, thinking back to the several doctors I encountered I never thought to ask that.
Has this ever occurred to you to be sure also?
Click to expand...
When your primary care physician makes a referral, they usually choose one they know is covered by your insurance; usually one in their group or clinic.

If your PCP's group doesn't have the specialist you need, they just pick one that isn't too far from you, and then it goes like this:

Your PCP sends your referral to a cardiac specialist of their choice; a guy named Doctor Hart. Dr. Hart's office calls your insurance company to see if he is on their list of approved cardiac specialists. If he isn't, his office notifies your PCP, and the PCP either just chooses a different specialist, or calls your insurance company and asks for their list of approved cardiac specialists.

But I don't know what a "step-in surgeon" is. Do you mean a walk-in surgeon?

I believe all surgeons need a referral from a patient's PCP before they go cutting on them or whatever.
 
Murrmurr said:
When your primary care physician makes a referral, they usually choose one they know is covered by your insurance; usually one in their group or clinic.

If your PCP's group doesn't have the specialist you need, they just pick one that isn't too far from you, and then it goes like this:

Your PCP sends your referral to a cardiac specialist of their choice; a guy named Doctor Hart. Dr. Hart's office calls your insurance company to see if he is on their list of approved cardiac specialists. If he isn't, his office notifies your PCP, and the PCP either just chooses a different specialist, or calls your insurance company and asks for their list of approved cardiac specialists.

But I don't know what a "step-in surgeon" is. Do you mean a walk-in surgeon?

I believe all surgeons need a referral from a patient's PCP before they go cutting on them or whatever.
Click to expand...
I was 1st told a Dr. Greco was going to do the procedure, then for some unknown reason to me, he couldn't and another in the hospital
did it instead, then that one's associate came in after and told me what all happened and then that associate wanted me to schedule
an appointment with him after I was released. Hot Potato game is what I felt like.
 
IrishEyes said:
I was 1st told a Dr. Greco was going to do the procedure, then for some unknown reason to me, he couldn't and another in the hospital
did it instead, then that one's associate came in after and told me what all happened and then that associate wanted me to schedule
an appointment with him after I was released. Hot Potato game is what I felt like.
Click to expand...
If the one who did the procedure was covering for Dr Greco because Dr Greco had an emergency or was sick, your insurance will cover the procedure. It might take longer than usual, though...if he's not on their list.
 
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