Owe St. Joesph's over $9,300 thanks to Code Mistake

Discuss here about Medical Disability claims and Insurance possibilities for PN treatment options

Owe St. Joesph's over $9,300 thanks to Code Mistake

Postby rea » Thu Jul 25, 2013 2:10 am

I had the perineal nerve block and vein scerolaztion with Dr. Hibner June 10th. I paid a flat fee of $334 and was told they were billing my insurance to see if they could collect any more. I was told before going up for the block that if Dr. Hibner did anything else that was not coded on my bill, it would be null and void and I would be responsible for what insurance didn't pay. I told the anesthesiologist and nurse to tell Hibner, "Stick to the script and don't do anything else but what was on the paper." That is the God's honest truth but it doesn't matter what I said to them.
I got a bill for over $9,300 so I called. Today I was informed that I was responsible for that amount because Hibner did other things and coded them on my bill. I have no idea what I'm going to do. I have 3 more months of extra insurance money but that is for more medical trips I'm going to have to make. I have 90 days to turn in my bank statements, income tax forms, and whatever else they request for their financial assistance forms. They only go back 90 days but I have money in my account that will be used for future medical use but since I have it the lady said I'd be denied and would have to pay $312.00 a month. In November my monthly income will decrease dramatically. I didn't ask if I could redo the application in the future.
I don't have a clue what else Hibner did to me. What else could he have done using ultrasound? This is so unfair and I'm a nervous wreck. I've cried so much and had an anxiety attack. I know the Dignity Health lady thought I was crazy...I was hysterical on the phone. I was just getting on my feet and finally going to have something to show for working and then the nerve struck. It took so much from me and is still taking. I don't have a shoulder to cry on but I know I have you guys to tell this to because you understand the life of pn and all the other disorders that can come with it that wreck our lives.
What do I do? Ride it out until I can file bankruptcy I guess. My credit was all I had left from my marriage. Now that''s going to be ruined too.
Last edited by rea on Mon Jul 29, 2013 2:26 am, edited 1 time in total.
rea
 
Posts: 123
Joined: Fri Sep 07, 2012 8:16 pm
Location: USA

Re: Owe St. Joesph's over $9,300 thanks to Hibner

Postby Karyn » Thu Jul 25, 2013 3:04 pm

:o OMG, Rea! :shock: I'm so very sorry this happened to you! Unfortunately, this isn't the first time I've heard of this type of situation in regards to that office, especially with the botox.
rea wrote:I don't have a clue what else Hibner did to me. What else could he have done using ultrasound?

I would start by contacting his office and asking for a copy of all your office/procedure notes, and EVERYTHING/ANYTHING you signed. You'll probably have to fill out a release form, which they can mail to you. This statement concerns me:
rea wrote: I paid a flat fee of $334 and was told they were billing my insurance to see if they could collect any more. I was told before going up for the block that if Dr. Hibner did anything else that was not coded on my bill, it would be null and void and I would be responsible for what insurance didn't pay.

I don't understand why they would tell you they would try to collect more from your insurance company? Did you actually get pre-approval for the block and scerolization?
I can only imagine how much anxiety this has caused you. I'm having heart palpitations just reading this. But, one step at a time. Get your records first, to see what you signed.
Hugs,
Karyn
Ultra Sound in 03/08 showed severely retroverted, detaching uterus with mulitple fibroids and ovarian cysts.
Pressure and pain in lower abdomen and groin area was unspeakable and devastating.
Total lap hysterectomy in 06/08, but damage was already done.
EMG testing in NH in 04/10 - bilateral PN and Ilioinguals
3T MRI at HSS, NY in 09/10
Bilateral TG surgery with Dr. Conway on 03/29/11. Bilat ilioinguinal & iliohypogastric neurectomy 03/12. TCD surgery 04/14.
User avatar
Karyn
 
Posts: 1668
Joined: Fri Sep 17, 2010 12:59 pm
Location: Lowell, MA

Re: Owe St. Joesph's over $9,300 thanks to Hibner

Postby rea » Thu Jul 25, 2013 6:41 pm

Thanks Karyn. I called my insurance today and the first rep found a code for the neck. Hospital says they see no codes for that that they billed. That my claim was reviewed and the doctor did other things (they cant tell me over the phone) that makes me responsible. The lady i spike with in billing yesterday rattled off 2 codes like it was nothing. I've called twice to speak with Cathleen in Hibner's office and waiting to hear from her. Will go to doc tomorrow to have my medical records from hospital and hibner sent to her. She'll give me a copy. I have my papers from Hospital and it covers them 100% and makes me totally responsible. I TOLD HIBNER TO NOT DO ANYTHING ELSE WHEN HE TOLD ME IT WOULD BE ABOUT 30 MINUTES BEFORE THEY TOOK ME BACK.
When the hospital told me I would have to pay 334 as a flat rate, they said my insurance had denied the pre approval. Insurance didn't have anything about that.
I had a waiver to have St Joesph's as in network but they put a code of J49999 which is an unlisted code. That did not match the codes on the insurance claim so it was treated as out of network. And the codes for the block and screlazation was NOWHERE on the claim Humana received. ???? Also showing the provider as "Methodist of Sacremento, Ca" Talk about incompetent. I remember Earl said their paperwork could be improved. He wasn't kidding.
The hospital is sending me an itemized list of my bill. My insurance faxed them the waiver to be corrected and resubmit the claim. Don't know how that will work out. In the meantime I'm to fill out their form for assistance and send back. The hospital won't talk with me now. They say the claim was reviewed, found codes not listed on the pay agreement and blah, blah, blah. At least I didn't lose it on them today.
Another odd thing is when I called a couple weeks ago the rep said they billed insurance 12,000. This bill is for 10,085. Doesn't match either. Maybe we need to start taping our conversations with them like they do us. Make sure it is allowed in your state first ;)
I have to wait now but how do I not think of anything else? I'm a nervous wreck. As for $312 month minimum payments, don't they have to accept less? I can only send them 100 for example. I heard the law has changed on that. My sister said send them $5 a month. I pay my bills but this is ridiculous.
Last edited by rea on Mon Jul 29, 2013 6:43 pm, edited 2 times in total.
rea
 
Posts: 123
Joined: Fri Sep 07, 2012 8:16 pm
Location: USA

Re: Owe St. Joesph's over $9,300 thanks to Hibner

Postby Karyn » Thu Jul 25, 2013 8:00 pm

Rea,
My heart goes out to you. What a nightmare!
rea wrote:I called my insurance today and the first rep found a code for the neck.

What? Neck? I thought you had a perineal block and vein scerolization? Did I miss something?
rea wrote:Will go to doc tomorrow to have my medical records from hospital and hibner sent to her. She'll give me a copy.

Oh, good! :)
rea wrote: I have my papers from Hospital and it covers them 100%.

rea wrote:When the hospital told me I would have to pay 334 as a flat rate, they said my insurance had denied the pre approval. Insurance didn't have anything about that.

I'm very confused. And I don't blame you for being a nervous wreck. I would be, too. This shouldn't be so difficult!
Rea, just a suggestion: Maybe you could hold off filing for that financial assistance form, until you can get more definitive answers and have everything in front of you? I understand how upsetting this is, but it appears some one dropped the ball on you somewhere. Because this is so badly screwed up, I'm holding out hope that you really don't owe the money they're saying you do.
Hugs,
Karyn
Ultra Sound in 03/08 showed severely retroverted, detaching uterus with mulitple fibroids and ovarian cysts.
Pressure and pain in lower abdomen and groin area was unspeakable and devastating.
Total lap hysterectomy in 06/08, but damage was already done.
EMG testing in NH in 04/10 - bilateral PN and Ilioinguals
3T MRI at HSS, NY in 09/10
Bilateral TG surgery with Dr. Conway on 03/29/11. Bilat ilioinguinal & iliohypogastric neurectomy 03/12. TCD surgery 04/14.
User avatar
Karyn
 
Posts: 1668
Joined: Fri Sep 17, 2010 12:59 pm
Location: Lowell, MA

Re: Owe St. Joesph's over $9,300 thanks to Hibner

Postby Emily B » Fri Jul 26, 2013 4:37 am

Rea,

So sorry to hear about your stress over the bill. Karyn gave you good advice to get copies of your paperwork.

Could the $9300 be the facility fee from Dignity Health?

Usually when you have a procedure, you'll receive separate bills from: (1) The Facility, (2) The Physician/Physician's Group, (3) Anesthesiologist (4) Radiologist. You’ll need to look over the bill and figure out if it’s just one of these, or a combination of these on the same bill.

In any case, you have a few options:

(1) Negotiate the amount of the bill. Why should you pay full price when insurance companies don’t? You can ask to talk to someone to negotiate a reduction in the bill. In that case, they’ll usually want you to pay the negotiated amount in full.

(2) Pay a monthly amount just to keep the account active so it won’t be sent to collections. Maybe pay $25 a month. Then when you’re financial circumstances change in November, you can apply for financial assistance at that time.

(3) Dignity Health’s new slogan is “Hello Human Kindness”. If you were misled with regard to billing, tell them you’d like to escalate your case within the organization because you feel you weren’t receiving human kindness. Speak with a manager. The president of the entire Dignity Health organization’s name is Lloyd Dean, President and CEO, 1-415-438-5500 x 2704. Tell them if you don’t receive satisfaction with your case, you’ll contact Mr. Dean in regard to your bill.

I sure hope this helps,

Emily B.
Emily B
 
Posts: 191
Joined: Sat Sep 18, 2010 1:21 am

Re: Owe St. Joesph's over $9,300 thanks to Hibner

Postby Karyn » Fri Jul 26, 2013 3:10 pm

Wow! Awesome suggestions, Em! :D
Please let us know how you make out with this mess, Rea. We're thinking of you!
Ultra Sound in 03/08 showed severely retroverted, detaching uterus with mulitple fibroids and ovarian cysts.
Pressure and pain in lower abdomen and groin area was unspeakable and devastating.
Total lap hysterectomy in 06/08, but damage was already done.
EMG testing in NH in 04/10 - bilateral PN and Ilioinguals
3T MRI at HSS, NY in 09/10
Bilateral TG surgery with Dr. Conway on 03/29/11. Bilat ilioinguinal & iliohypogastric neurectomy 03/12. TCD surgery 04/14.
User avatar
Karyn
 
Posts: 1668
Joined: Fri Sep 17, 2010 12:59 pm
Location: Lowell, MA

Re: Owe St. Joesph's over $9,300 thanks to Hibner

Postby HerMajesty » Fri Jul 26, 2013 8:04 pm

All good suggestions so far. Emily was spot-on correct: My husband was in an accident when we were uninsured (somebody else's fault) and had $60,000 in medical bills. I called every provider who billed us and asked what the minimum amount they would accept per month was. I wound up with about $600 worth of monthly bills I had to pay until our settlement came in. Most of the providers wanted $50 or less per month though, it was the life flight helicopter company that wanted something like $375 per month minimum. After I got the settlement I did negotiate down the hospital bills in return for the lump sum payment.

Billing / coding is notoriously innacurate. My son went to get an EMG as an outpatient once and was billed by the hospital for 2 IV bags of antibiotics. I went to the E.R. once and my insurance was billed for a $600 lab test which was ordered but never run (as I found out when I tried to get a copy of the results). I notified my insurance but they didn't care, they are very complacent about these things.

Get your medical chart with all the notes about what Hibner claims to have done, get the itemized bill, and write the office with your narrative story of what you said and what you experienced. Then compare that to the bill. And now for my favorite tactic: If there is a discrepancy between what your requested and/or what was done, vs. what you were billed for, state in no uncertain terms that you will not pay and why. Then state that if it goes to collections and onto your credit report, you will sue for defamation of credit. This can be done in small claims without a lawyer, up to whatever the small claims cap is in your State, probably around $10,000. I have never had to sue anybody for defamation of credit. Once I provide clear documentation as to why I should not pay and follow it up with that threat, they cease trying to collect.
pelvic pain started 1985 age 14 interstitial cystitis. Refused medical care from age 17, did GREAT with self care for years.
2004 PN started gradually, disabled by 2009. Underlying cause SIJD & Tarlov cysts
improved with PT & meds: neurontin, valium, nortriptyline, propanolol. (off nortriptyline & propanolol now, yay!)
Tarlov cyst surgery with Dr. Frank Feigenbaum March 20, 2012.
Results have been excellent so far; but I won't know my final functional level for a couple of years.
HerMajesty
 
Posts: 1151
Joined: Sat Sep 18, 2010 12:41 am
Location: North Las Vegas, Nevada

Re: Owe St. Joesph's over $9,300 thanks to Hibner

Postby Violet M » Sun Jul 28, 2013 12:40 am

A couple of other ideas. Ask your insurance company for a case manager to help you wade through this. Or if your insurance is through an employer, see if the employer has a case manager that works with its employees on their insurance problems.

It appears this was not submitted correctly to your insurance company so personally, I would not pay anything until the provider straightens this out, submits it to your insurance properly and explains your bill to you in a way that is understandable. I have never had to pay on a medical bill while it was being resubmitted (due to not being billed properly the first time.) Once you pay it, it might be a huge hassle to get it back even if you don't owe it.

You should receive an explanation of benefits (EOB) from your insurance company stating what was covered and what was denied and why it was denied. If you haven't received the EOB yet then you can request it from your insurance company. Of course, if it was never billed properly there won't be an EOB so you will have to wait until the provider resubmits the claim.

Once the claim gets submitted by the provider to the insurance company properly and you receive the explanation of benefits, you should then have an opportunity to appeal to the insurance company if benefits were denied.

I strongly doubt Hibner did anything wrong personally -- it's most likely the billing people who have messed up and never got it submitted properly.

If all else fails call your state insurance commissioner (do you live in Arizona?) to see what else you can do.

Best,

Violet
PNE since 2002. Started from weightlifting. PNE surgery from Dr. Bautrant, Oct 2004. Pain now is usually a 0 and I can sit for hours on certain chairs. No longer take medication for PNE. Can work full time and do "The Firm" exercise program. 99% cured from PGAD. PNE surgery was right for me but it might not be for you. Do your research.
User avatar
Violet M
 
Posts: 5467
Joined: Mon Sep 06, 2010 6:04 am
Location: United States

Re: Owe St. Joesph's over $9,300 thanks to Code Mistake

Postby rea » Mon Jul 29, 2013 7:35 pm

WOW! Thanks ladies for all the helpful information. I'm so touched by your support. Sorry I didn't even get online after posting here until today. Trying to hold it together.

Violet: I agree with you. The hosp. led me to believe that he did more things.I haven't seen Hibner's notes yet, but I don't think he did anything else to me. And a lady called me from Humana yesterday to check on me. They said to let them know if this doesn't get worked out and they would help me. And like you, I have never had to start paying on a bill until decision on re-submission is completed. My 45 day countdown to get this assistance form to them has already started. They said the sooner the better but I'm waiting on sending it back. Don't live in Arizona.

Karyn: When went to hospital they told me my insurance had denied the claim. I think they got that messed up too. I think they meant the "waiver for in-network" and not pre-approval claim. Norma, in their billing, did give me a flat rate. She didn't have to do that but if not for that then I wouldn't have went and had the block. The admittance person and the financial counselor both told me 1) vein sclerazation and ultrasound guided nerve block was procedures to be done and 2) Insurance was being billed to see if they would pay. This leads me to believe that, like my insurance said, they never received a claim (or pre-approval) until after procedure was done. July 3rd to be exact. So, a lot of mistakes that I have to pay for.

Emily, I'm waiting on itemized bill from hospital and insurance. I saw the Humana claim online and it had code for surgery, or, recovery, labs, and supplies. I did receive claim for anesthesiologist that said was not covered because panel deemed procedures experimental/investigational and harmful (my take on their explanation).
Great information and thank you. I'll use that "Kindness" slogan on my form.

Her Majesty You've really went through it. I'll see about a negotiation when I get the decision on this assistance form. I'll be paying over 1,500 before I can resubmit or negotiate...just have to wait. Wish I could just pay them 25 a month. Wonder if they can do anything to me legally or if they would not negotiate later with me?

The assistance form asks for a brief explanation but "brief" is far from what I've written. I'm waiting to hear back from Kathleen (Hibner's office). She called me Thursday evening. I'm sick to my stomach, trying to wait and hope that this gets worked out. Hope I made sense on all this. I'm messed up like my bill is :) Can't say it enough, thank you all...
Rea
Last edited by rea on Tue Jul 30, 2013 6:26 pm, edited 1 time in total.
rea
 
Posts: 123
Joined: Fri Sep 07, 2012 8:16 pm
Location: USA

Re: Owe St. Joesph's over $9,300 thanks to Code Mistake

Postby rea » Tue Jul 30, 2013 5:56 pm

OMG It just keeps getting more confusing. After being told last week couldn't give procedure codes over phone (after another rep did) I called today about questions on repeating charges- they charged twice for pregnancy urine test- I was given the code " 33427" which is Valvuloplasty, mitral valve, with cardiopulmonary bypass; radical reconstruction, with or without ring. They're sending the bill for audit of procedure codes. The bill I recieved after insurance processed lacked the charge of 1,272 which is the ultrasound guided intravenous injection. So when this goes through my insurance again, I'll owe more. I'm honest, even when it costs me. My ex always got mad because I was like that.
Another odd thing is the hosp. billing knew I had insurance before flat rate told to me. Since I gave them my insurance card and ins. processed the claim and insurance pd. some, by law, I'm responsible. I was told by a financial counselor that by law, if I have insurance, I must use it and that i'd be responsible for what ins. didn't cover. Told them I couldn't afford that so I got the flat rate, went, and was told as long as only 2 procedures done, they would just try to collect more from ins. and I'd be in the clear. I'm totally confused :shock: In the end, I'm guessing this will cost me between 2,800 to 3,800. I'm not going forward with anything on my nerve right now. Just deal with it and work on my hip.

I hope this helps someone else to dot their i's and cross their t's if they go to an out-of-network provider. I never had before. A very costly lesson.

Bless you all,
Rea
Last edited by rea on Thu Aug 01, 2013 5:28 am, edited 2 times in total.
rea
 
Posts: 123
Joined: Fri Sep 07, 2012 8:16 pm
Location: USA

Next

Return to INSURANCE & DISABILITY ISSUES

Who is online

Users browsing this forum: No registered users and 2 guests