Reply to How can I dispute hapital’s predatory billing?

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[quote=Anonymous][quote=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.

[/quote]

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. [/quote]

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