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Surprise medical bills

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lnich

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A recent New York Times article describes extravagant billing from out-of-network providers that the patient never knew:

http://www.nytimes.com/2014/09/21/us/drive-by-doctoring-surprise-medical-bills.html?_r=0

I also recall an article in the LA Times several months ago about a patient being handed a post-op icing machine as he was leaving the hospital, and then later being charged $15,000 for it because it wasn't covered by his inurance.

Has anyone had similar experiences with your knee surgeries? Are there things I should watch for or ask about before or after surgery?

I'm on Medicare, and I understand that I'm supposed to be informed in advance about things that Medicare won't cover with an "Advance Beneficiary Notice." However, I don't want to be handed an ABN to sign as I'm being wheeled into the OR.

Thanks for any information.....
 

jeano

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I'd believe 150.00 for the ice machine. Much more than that and I'm calling foul. That's comparable to the notorious case of the exorbitant sling someone got charged a ton of money for when the same item can be purchased anywhere for 7.99.

If you are concerned about this a frank conversation with your OS's office manager and the hospital's billing office may be in order.

Although we didn't note any ridiculous charges related to my knee surgeries, Mr Jeano spotted a whopper in the foot high stack of billing statements that accumulated during his hospitalization for mitral valve replacement. Our insurance covered all but a fraction of the cool third of a million it cost. However, Mr jeano, even though still considerably addled by weeks of section and being on the heart lung machine, smelled a rat when he noticed a bill for a visit during his last weekend in the hospital from a kidney resident. All fine and good, but not only hadn't Mr Jeano seen this doc, he knew darned well that the doc who was in charge of kidney stuff had signed off on the case some days previously. Either accidentally (or more likely deliberately) this resident had wandered onto the floor, picked up the chart, made an entry, and supplemented his on-call pay.

Except Mr Jeano, very correctly and respectfully declined to pay THAT couple hundred dollar fee. Hospital screamed blue murder, Mr Jeano stood firm, and the Gates of Hell did not prevail. I'm afraid little skimming schemes like this happen all the time.
 

Pumpkln

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I agree with jeano, I would ask your surgeon and hospital admissions directly about the NYT article and your concerns.
Hopefully with a good secondary you will have very little if any out of pocket.
You do not have to sign an ABN, and they should not be giving you one on the way into surgery in any case. At least one would hope.
 

Jamie

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Improper billing does occur. But it's not anything you should worry about going into surgery. It doesn't happen all that often and you have plenty of opportunities to resolve thing IF they occur once the surgery is complete. Pleae don't worry about this!

With Medicare, you won't see the paperwork for the charges until months after your surgery anyway. When you get the Medicare statement, just review it then for correctness. They usually send out a form with the statement so you can dispute any charges that need review. If you have supplemental insurance, you may never even see the itemized billing as it can go directly to your insurance company for their review.
 

Josephine

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Not only in the US! I had a private appoinment with an ENT surgeon earlier this year. Made it clear to the hospital and his secretary that I just wanted a consultation, no tests or anything. During the interview, he picked up with tiny weeny little fibre optic thing and peered into my nose. Took him about 6 mins tops. When I got my bill I found a charge of £650 for an endoscopy! I disputed it and was shown an accompanying letter with my letter of appointment, citing all the additional charges that could be made. But since I'd made my requirements clear, I figured I could ignore that! I pursued my complaint that no-one had pointed out this teensy tiny thing was actually an endoscope (I was used to much bigger ones!) I maintained it was an invalid charge and eventually they let me off the charge.

I'm seeing another surgeon privately about something else in a couple of weeks and have made sure they wrote me a letter confirming that my appointment would only be for a discussion and no tests or examinations!
 

Shortie

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I know lots of people complain about the NHS but at least we don't have to worry about any charges and if protocols are followed correctly any clinical need is completed without the patient worrying about the cost.

Shortie x
 

Knitter4444

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Technically you only have to get an ABN if the procedure is over $500 for US Medicare. Have had 15 surgeries in last 5 yrs (including 7 joint replacements) and with Original Medicare (not HMO) and a Medigap policy and 6 yrs of PT I have never paid a dime. Please be sure you have that 2nd policy.
 
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