How can I dispute hapital’s predatory billing?

[Anonymous]

Anonymous wrote:This is bananas. Shouldn't it be done in a dermatologist's office?

She’s getting it for headaches, so no.

The fee is outrageous. Does it fall under the No Suprises Act? also agree with others to go through your insurance. I’ve never seen a facilities fee that high even when my DS was inpatient.

[Anonymous]

Everything is negotiable. You need to call the billing department at the hospital and negotiate the bill.

I got a $70,000 hospital bill down to $12,000 but you need to call the accounts receivable department and see what they are willing to take to zero out the bill.

Everything is negotiable on medical charges. See what monies they will accept for payment to close out the invoice.

[Anonymous]

Also, be aware that academic hospitals will gouge with fees.

I learned the hard way. I went to Occupational Therapy (once) at the academic hospital and had to pay $300 copay for 5 minutes with OT.

My copay for an OT visit not associated with an academic hospital was $70.00

Both OTs were in my plan network.

[Anonymous]

Anonymous wrote:

Anonymous wrote:This is bananas. Shouldn't it be done in a dermatologist's office?

She’s getting it for headaches, so no.

The fee is outrageous. Does it fall under the No Suprises Act? also agree with others to go through your insurance. I’ve never seen a facilities fee that high even when my DS was inpatient.

Agree not a dermatologist
But also not a hospital. I work in a field where I see lots of Botox do migraines and never see it done in a hospital.

[Anonymous]

Some people who aren’t fully familiar with medical billing practices are weighing in with uninformed advice here.

Botox is billed as a “procedure,” and procedure charges are high—much more so than a regular doctor’s visit. Also, some physician offices and practices are very aggressive with their billing. They have some latitude about which billing codes to use and how to itemize billing.

Yes, hospital campuses can and usually do charge a facility fee on top of the provider’s fee. Don’t go to physician offices on hospital
campuses if you can avoid it; it’s always more expensive. For the uninitiated, this isn’t booking an OR for a minor procedure or going to the emergency department: Many hospitals have outpatient physician services on their grounds; MedStar Washington Hospital Center and Georgetown among them. Facility fees are poorly regulated and an attempt to make up for some reimbursement rates being lower than the cost of care. Medicare will not pay a facility fee that is not disclosed in advance. You could try arguing that same standard should apply to all patients.

OP should also log on to her insurance’s website. There will be an explanation of benefits for the date of service. If the insurance company has disallowed the facility fee, or if it was never billed through to insurance in the first place, then OP does not owe the co-insurance on the fee. In some cases, your insurer will help you negotiate with the provider, as they hate high fees as much as you do. You can get a representative on the phone and ask for a three-way call with a hospital billing representative.

Hospitals often have an ombudsman. Among other duties, they can help with incorrect charges. While some sort of facilities fee may apply here, this fee is excessive for a 15-minute out-patient procedure in a physician’s
office. If the hospital or hospital system does not have an ombudsman, your state or city may have one. In DC, the attorney general’s office also does a great job of connecting residents to appropriate resources for consumer protection.

[Anonymous]

Ask for an itemized bill, which they are required by law to provide to you. They should be able to provide you the revenue codes and room and board used to justify a facility bill of that size. Call and tell them you want to see the itemized bill and charges for facility based services. Based on this you can see what exactly composed that 11K charge and then dispute that specifically. The amount they are charging you is equivalent to a one day inpatient stay and extraordinarily high. If they uphold the charge take it to your insurance company as potential fraud, because that charge is completely inappropriate for an outpatient , non-skilled setting with no admission.

[Anonymous]

Anonymous wrote:Some people who aren’t fully familiar with medical billing practices are weighing in with uninformed advice here.

Botox is billed as a “procedure,” and procedure charges are high—much more so than a regular doctor’s visit. Also, some physician offices and practices are very aggressive with their billing. They have some latitude about which billing codes to use and how to itemize billing.

Yes, hospital campuses can and usually do charge a facility fee on top of the provider’s fee. Don’t go to physician offices on hospital
campuses if you can avoid it; it’s always more expensive. For the uninitiated, this isn’t booking an OR for a minor procedure or going to the emergency department: Many hospitals have outpatient physician services on their grounds; MedStar Washington Hospital Center and Georgetown among them. Facility fees are poorly regulated and an attempt to make up for some reimbursement rates being lower than the cost of care. Medicare will not pay a facility fee that is not disclosed in advance. You could try arguing that same standard should apply to all patients.

OP should also log on to her insurance’s website. There will be an explanation of benefits for the date of service. If the insurance company has disallowed the facility fee, or if it was never billed through to insurance in the first place, then OP does not owe the co-insurance on the fee. In some cases, your insurer will help you negotiate with the provider, as they hate high fees as much as you do. You can get a representative on the phone and ask for a three-way call with a hospital billing representative.

Hospitals often have an ombudsman. Among other duties, they can help with incorrect charges. While some sort of facilities fee may apply here, this fee is excessive for a 15-minute out-patient procedure in a physician’s
office. If the hospital or hospital system does not have an ombudsman, your state or city may have one. In DC, the attorney general’s office also does a great job of connecting residents to appropriate resources for consumer protection.

This statement is partially correct. The 'procedure' as you are referring to it is the 2K physician charges which correlate to the procedure being performed. Technically everything a physician performs is a procedure in medical nomenclature. They do not have latitude on billing, each code has prescribed requirements that can be audited if requested.

What OP has an issue with is the 13K facility charge. Facilities charge for the 'location' not necessarily the procedure being performed. You are assuming that is being correctly billed, which is something the facility would be able to support. The first step is not an ombudsman or an EOB, it is to request an itemized bill from the facility that outlines specific charges to specific codes. An EOB does not have this level of detail and an ombudsmen won't do anything if you don't know what you are challenging, since you can't just say 'that bill is too high.'

It is also not correct to say that if the insurance company doesn't have a bill you may not owe the facility. They could be out of network which would not go through your insurance, and you are absolutely still responsible. A lot of this information is wrong and you should be careful about telling people to just ignore bills.

[Anonymous]

OP checking in quickly. Thanks for the very helpful advice. The physician and facility are in network.

[Anonymous]

Anonymous wrote:Some people who aren’t fully familiar with medical billing practices are weighing in with uninformed advice here.

Botox is billed as a “procedure,” and procedure charges are high—much more so than a regular doctor’s visit. Also, some physician offices and practices are very aggressive with their billing. They have some latitude about which billing codes to use and how to itemize billing.

Yes, hospital campuses can and usually do charge a facility fee on top of the provider’s fee. Don’t go to physician offices on hospital
campuses if you can avoid it; it’s always more expensive. For the uninitiated, this isn’t booking an OR for a minor procedure or going to the emergency department: Many hospitals have outpatient physician services on their grounds; MedStar Washington Hospital Center and Georgetown among them. Facility fees are poorly regulated and an attempt to make up for some reimbursement rates being lower than the cost of care. Medicare will not pay a facility fee that is not disclosed in advance. You could try arguing that same standard should apply to all patients.

OP should also log on to her insurance’s website. There will be an explanation of benefits for the date of service. If the insurance company has disallowed the facility fee, or if it was never billed through to insurance in the first place, then OP does not owe the co-insurance on the fee. In some cases, your insurer will help you negotiate with the provider, as they hate high fees as much as you do. You can get a representative on the phone and ask for a three-way call with a hospital billing representative.

Hospitals often have an ombudsman. Among other duties, they can help with incorrect charges. While some sort of facilities fee may apply here, this fee is excessive for a 15-minute out-patient procedure in a physician’s
office. If the hospital or hospital system does not have an ombudsman, your state or city may have one. In DC, the attorney general’s office also does a great job of connecting residents to appropriate resources for consumer protection.

OP. You sound extremely knowledgeable. Thanks so much for this helpful advice. I’m aware of facility fees, but this is the first one I’ve had at this order of magnitude. This hospital had a contracts disputevwith BCBS months ago but ended up contracting with them again. As you said, this aggressive billing for facility fees is probably to r\compensate for low reimbursement rates they agreed to.

I will check the EOB soon. From the hospital’s statement, BCBS paid out around $900 total, presumably for the physician fee and medication. They definitely didn't;t cover any major part of the $13,000 facility fee. How would you convince an average BCBS rep get on the phone with the hospital’s billing? I imagine they most would tell me it;s a billing issue and that I should take it up with them.

Also, the hospital did not give me a superbill with codes. Should I ask for that first before i go to insurance?

Thank you again, PP.

[Anonymous]

Anonymous wrote:

Anonymous wrote:This is bananas. Shouldn't it be done in a dermatologist's office?

She’s getting it for headaches, so no.

The fee is outrageous. Does it fall under the No Suprises Act? also agree with others to go through your insurance. I’ve never seen a facilities fee that high even when my DS was inpatient.

OP again. It really should fakk No Surprises Act but unfortunately it doesn't. The NSA mainly covers care in the emergency dept and/or OON physicians at in network facilities.

[Anonymous]

I am shocked that your insurance approved you getting those shots at a hospital.

[Anonymous]

Anonymous wrote:Ask for an itemized bill, which they are required by law to provide to you. They should be able to provide you the revenue codes and room and board used to justify a facility bill of that size. Call and tell them you want to see the itemized bill and charges for facility based services. Based on this you can see what exactly composed that 11K charge and then dispute that specifically. The amount they are charging you is equivalent to a one day inpatient stay and extraordinarily high. If they uphold the charge take it to your insurance company as potential fraud, because that charge is completely inappropriate for an outpatient , non-skilled setting with no admission.

They gave me an itemized bill that didn’t break out the facility fee. Would I ask for a superbill or something else?

[Anonymous]

Anonymous wrote:This is bananas. Shouldn't it be done in a dermatologist's office?

This is done by a neurologist for migraine headaches. This is not cosmetic Botox! (NP)

[Anonymous]

Anonymous wrote:

Anonymous wrote:Some people who aren’t fully familiar with medical billing practices are weighing in with uninformed advice here.

Botox is billed as a “procedure,” and procedure charges are high—much more so than a regular doctor’s visit. Also, some physician offices and practices are very aggressive with their billing. They have some latitude about which billing codes to use and how to itemize billing.

Yes, hospital campuses can and usually do charge a facility fee on top of the provider’s fee. Don’t go to physician offices on hospital
campuses if you can avoid it; it’s always more expensive. For the uninitiated, this isn’t booking an OR for a minor procedure or going to the emergency department: Many hospitals have outpatient physician services on their grounds; MedStar Washington Hospital Center and Georgetown among them. Facility fees are poorly regulated and an attempt to make up for some reimbursement rates being lower than the cost of care. Medicare will not pay a facility fee that is not disclosed in advance. You could try arguing that same standard should apply to all patients.

OP should also log on to her insurance’s website. There will be an explanation of benefits for the date of service. If the insurance company has disallowed the facility fee, or if it was never billed through to insurance in the first place, then OP does not owe the co-insurance on the fee. In some cases, your insurer will help you negotiate with the provider, as they hate high fees as much as you do. You can get a representative on the phone and ask for a three-way call with a hospital billing representative.

Hospitals often have an ombudsman. Among other duties, they can help with incorrect charges. While some sort of facilities fee may apply here, this fee is excessive for a 15-minute out-patient procedure in a physician’s
office. If the hospital or hospital system does not have an ombudsman, your state or city may have one. In DC, the attorney general’s office also does a great job of connecting residents to appropriate resources for consumer protection.

OP. You sound extremely knowledgeable. Thanks so much for this helpful advice. I’m aware of facility fees, but this is the first one I’ve had at this order of magnitude. This hospital had a contracts disputevwith BCBS months ago but ended up contracting with them again. As you said, this aggressive billing for facility fees is probably to r\compensate for low reimbursement rates they agreed to.

I will check the EOB soon. From the hospital’s statement, BCBS paid out around $900 total, presumably for the physician fee and medication. They definitely didn't;t cover any major part of the $13,000 facility fee. How would you convince an average BCBS rep get on the phone with the hospital’s billing? I imagine they most would tell me it;s a billing issue and that I should take it up with them.

Also, the hospital did not give me a superbill with codes. Should I ask for that first before i go to insurance?

Thank you again, PP.

My experience is they do it very easily. My problem was not the same as yours, but I call and explain my issues and they are always happy to call billing for me.

I suggest you call first, as your insurance may already have those codes. Tell the insurance rep what you said here, that you don't understand what your benefits are, and how much you should are supposed to be paying. In my experience with BCBS basic, the hospital facility fee is part of the copay, not coinsurance. The insurance rep should consult the handbook to determine if you have to pay coinsurance on facility and if they are allowed to charge you for that.

[Anonymous]

Call your insurance company. If this is a participating provider, they are violating their contract with the insurer.

If they're not a PP, switch to a provider that is.