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

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

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

Postby Karyn » Wed Jul 31, 2013 3:57 pm

Oh, Rea ...
I'm so sorry you have to deal with this. You're right - very confusing!!!!
Hoping things will sort out once you've got everything in front of you. Please let us know how you're coming along.
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.
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Re: Owe St. Joesph's over $9,300 thanks to Code Mistake

Postby rea » Wed Jul 31, 2013 5:11 pm

Yesterday I called to check the date for assistance form and explained why I was having to do one. She called me back and now the story is that I was told if insurance billed I'm responsible for what ins. doesn't pay. Since ins. pd. some on account, the balance is mine. Also told that if they had denied it, the flat rate would be it. She said they had a self pay plan, like I had the choice of using ins. Contradicts what Norma had told me in May. Cathleen from Hib's office checked on the mistake of procedures yesterday. Maybe that got lined out so now their using this story. I wasn't asked during check in if I wanted ins. billed. they asked for my id and insurance card. I questioned them about what would happened. I was told they were billing again to see if more could be collected. That raised a red flag with me but I trusted the 2 employess that assured me I was ok as long as only 2 procedures done. I think I've figured what happened with that double billing. When Norma sent it the 1st time it had the charges for the coded procedures and ins. denied them. The 2nd time had the hospital charges included of which my ins. pd. the minimum out of network total. TA-Da: A balance left over for me. The balance will be more when the audit is done and rebilled to Humana.
Humana has told me to go ahead and write an appeal letter and send to them. The hospital is telling me to get the assistnace form in asap. I pay what I owe but I don't owe this.
Symptoms began 6/27/12. Diagnosed with Vulvodynia.Estrace and Lidocane with no relief.
Uretha enlarged Aug. 2012. MRI of Lumbar in Sept. 2012.Normal. Did MRI 3 Tesla of ischial spine to Sacro Spin- Normal. Houston-Nerve Block 10-31-12 & MRI (MRN) entrapment of perineal branch, more on right side. Dr. Hibner- block of perineal branches and sclerozation w/relief over 1 month. SIJD/Piriformis Syndrome Left Side. Gabapentin 2400 mg.
rea
 
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Re: Owe St. Joesph's over $9,300 thanks to Code Mistake

Postby nyt » Thu Aug 01, 2013 4:17 am

Rea, I am so sorry to hear that you are dealing with all these insurance issues. It is such a pain in the neck. One person says one thing and another person tells you something else. I am also dealing with insurance problems with the last time I saw Dr. Hibner. I owe almost $6500.00. I have had both of these procedures before and the insurance has always paid. Insurance company is looking into the problem. Dr. Hibner is in-network for me and still have not gotten reimbursed for the upfront payment of botox to him, the hospital bill is another story. Called the physicians billing service yesterday and it was like no one had any idea that I should get reimbursed. They said they would look into the reimbursement and if I didn't get it in 30 days to call again. Do they think we are made of money?! Most of us scrape and safe to go have procedures done by him. I really don't think his office staff nor the billing department for his office and the hospital have any clue what we deal with and the lack of doctors who can treat us. Keep the faith and keep plugging away at this until it gets resolved. Worse case scenario, if all else fails, you write a letter to the agency at the state level that overseas health insurance in the state of your insurance company and in AZ. I have done that twice in my life and both times the insurance companies paid.
2/07 LAVH and TOT 7/07 TOT right side removed 9/07 IL, IH and GN neuropathy 11/07 PN - Dr. Howard
6/08 Obturator neuralgia - Dr. Conway 11/08 Disability, piriformis syndrome - Dr. Howard
4/09 Bilateral obturator decompression surgery, BLL RSD - Dr. Howard
9/10 Removed left side TOT, botox, re-evaluate obturator nerve - Dr. Hibner
2/11 LFCN and saphenous neuralgia - Dr. Dellon 2/11 MRI with Dr. Potter - confirmed entrapment
5/11 Right side TG - Dr. Hibner 2012 Left side TG - Dr. Hibner
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Re: Owe St. Joesph's over $9,300 thanks to Code Mistake

Postby rea » Thu Aug 01, 2013 6:13 am

I too am sorry for you. It so frustrating and stressful. I'm working on a letter of appeal to send to my insurance. They're out of network and they're not paying any more on this. They encouraged me to write the letter and send to them asap. I had already started I guess they'll send it to Dignity Health. If Loretta had suggested botox for me, I shiver to think what my bill would be. I've done nothing but think about this. It seems dignity health's employees need a retraining session. They are polite but like you said, one tells you this another tells you that.
I had written a lot more but lost it. Typing in the dark is a bad idea.
Since you are in network, if your insurance doesn't pay, I think the hospital can't make you pay for the charges since they have a contract. That happened to me at pain management. The charge was over 2,000 and ins. denied. Ins. told me PM couldn't make me pay for it. Never received a bill from PM.
Symptoms began 6/27/12. Diagnosed with Vulvodynia.Estrace and Lidocane with no relief.
Uretha enlarged Aug. 2012. MRI of Lumbar in Sept. 2012.Normal. Did MRI 3 Tesla of ischial spine to Sacro Spin- Normal. Houston-Nerve Block 10-31-12 & MRI (MRN) entrapment of perineal branch, more on right side. Dr. Hibner- block of perineal branches and sclerozation w/relief over 1 month. SIJD/Piriformis Syndrome Left Side. Gabapentin 2400 mg.
rea
 
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Re: Owe St. Joesph's over $9,300 thanks to Code Mistake

Postby nyt » Thu Aug 01, 2013 2:02 pm

My insurance has decided that botox and ketamine are experimental so the hospital can make me pay. My insurance company had requested additional records but never got them and that was their verdict without the records. They have requested the records again. I know I can easily fight the Ketamine charge because it is a known treatment for CRPS and Medicare will cover it.

Dr. Hibner now has a case manager that works for his office. I forget her full name, Mary something. You might want to contact her and see if there is something she can do to help.
2/07 LAVH and TOT 7/07 TOT right side removed 9/07 IL, IH and GN neuropathy 11/07 PN - Dr. Howard
6/08 Obturator neuralgia - Dr. Conway 11/08 Disability, piriformis syndrome - Dr. Howard
4/09 Bilateral obturator decompression surgery, BLL RSD - Dr. Howard
9/10 Removed left side TOT, botox, re-evaluate obturator nerve - Dr. Hibner
2/11 LFCN and saphenous neuralgia - Dr. Dellon 2/11 MRI with Dr. Potter - confirmed entrapment
5/11 Right side TG - Dr. Hibner 2012 Left side TG - Dr. Hibner
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Re: Owe St. Joesph's over $9,300 thanks to Code Mistake

Postby rea » Thu Aug 01, 2013 6:03 pm

Mary is actually the one that reviewed by claim and gave the decision that more procedures had been done so I was responsible. I sure hope you get your bill lined out. it will be months before my payment will be lowered.
Symptoms began 6/27/12. Diagnosed with Vulvodynia.Estrace and Lidocane with no relief.
Uretha enlarged Aug. 2012. MRI of Lumbar in Sept. 2012.Normal. Did MRI 3 Tesla of ischial spine to Sacro Spin- Normal. Houston-Nerve Block 10-31-12 & MRI (MRN) entrapment of perineal branch, more on right side. Dr. Hibner- block of perineal branches and sclerozation w/relief over 1 month. SIJD/Piriformis Syndrome Left Side. Gabapentin 2400 mg.
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 nyt » Fri Aug 02, 2013 9:08 pm

Rea, so sorry to hear all of this. wish there was something I could do that would fix all of this for you.
2/07 LAVH and TOT 7/07 TOT right side removed 9/07 IL, IH and GN neuropathy 11/07 PN - Dr. Howard
6/08 Obturator neuralgia - Dr. Conway 11/08 Disability, piriformis syndrome - Dr. Howard
4/09 Bilateral obturator decompression surgery, BLL RSD - Dr. Howard
9/10 Removed left side TOT, botox, re-evaluate obturator nerve - Dr. Hibner
2/11 LFCN and saphenous neuralgia - Dr. Dellon 2/11 MRI with Dr. Potter - confirmed entrapment
5/11 Right side TG - Dr. Hibner 2012 Left side TG - Dr. Hibner
nyt
 
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Re: Owe St. Joesph's over $9,300 thanks to Code Mistake

Postby rea » Tue Aug 13, 2013 12:47 am

nyt wrote:Rea, so sorry to hear all of this. wish there was something I could do that would fix all of this for you.


Thanks...same for you. Maybe one of us will win the lottery ;)
Symptoms began 6/27/12. Diagnosed with Vulvodynia.Estrace and Lidocane with no relief.
Uretha enlarged Aug. 2012. MRI of Lumbar in Sept. 2012.Normal. Did MRI 3 Tesla of ischial spine to Sacro Spin- Normal. Houston-Nerve Block 10-31-12 & MRI (MRN) entrapment of perineal branch, more on right side. Dr. Hibner- block of perineal branches and sclerozation w/relief over 1 month. SIJD/Piriformis Syndrome Left Side. Gabapentin 2400 mg.
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 » Thu Dec 19, 2013 4:32 am

Wrote a letter so appeal to ins. They pushed it through and paid over 8,000. Hospital had took off 75% but guess they're happy with payment. Thought I owed about 1,700 instead of the 2,400 and was told I had to do another assistance form but then got letter saying balance of 634.00 minus 400 & something, leaving me 164.00. So I paid it and think I'm all done. Hibner's office kept their word and did not bill for more than what they told me I'd be billed. Well, it was $10 higher. Now I've got Dr. Weiss's out of pocket bill to deal with.. :)
Symptoms began 6/27/12. Diagnosed with Vulvodynia.Estrace and Lidocane with no relief.
Uretha enlarged Aug. 2012. MRI of Lumbar in Sept. 2012.Normal. Did MRI 3 Tesla of ischial spine to Sacro Spin- Normal. Houston-Nerve Block 10-31-12 & MRI (MRN) entrapment of perineal branch, more on right side. Dr. Hibner- block of perineal branches and sclerozation w/relief over 1 month. SIJD/Piriformis Syndrome Left Side. Gabapentin 2400 mg.
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 Ray P. » Thu Dec 19, 2013 2:49 pm

What has DR Weiss done for you?
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