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

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[quote=Anonymous][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]

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. [b]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. [/b]

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. 
[/quote]

If this is a participating provider, BCBS absolutely will care. The last time I had this issue, the insurer's customer service rep called the provider's billing office with me on the line and politely reminded them of their terms and told them to knock it off, then said,  "Ms. Smith is on the line, so can you assure her that she won't be receiving any more bills for this service?" It was delightful TBH.[/quote]

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