Whelp. I'm going to sue U of U healthcare, and United Healthcare.

[neufox47]

May be an old trick. But it's going to cost them this time. I am going to make noise about it. Post about it on social media. Sue em. Call the news. Tell everyone the story until they are sick of hearing it. People need to make noise about this shit when it happens.

File a complaint to your state’s department of insurance. Also consumer affairs or some other consumer organization in your state. You can also file suit in small claims, if it qualifies, and that’s a huge pain in the ass for them, not so bad for you.

[stfu&gbtw]

This thread pertains to my interests... So to speak.

Had another version of this unfold earlier this year. Was released from UCMed after a medical procedure with insufficient pain meds, because obviously if they gave me three days worth of percocet it would either turn me into a heroin addict or I'd sell it to my next door neighbor's 4th grader. Anyway, I needed a nerve injection the following weekend, so I dove past a UCMed ER to go to go to a facility listed on the UCMed website as an Urgent Care to get the procedure done... It's pretty straightforward... Needle goes into a gap in the base of my skull.. dig around a bit, inject a little bupivacaine, all done - NBD. Takes 5 mins.

Upon arriving, I see a sign (a print out scotch taped to the wall) saying the facility is actually an ER. Realizing what that meant, I asked if there is an Urgent Care nearby.. sure, 65 miles away. Of course, they couldn't say how much the procedure would cost... But the injection worked great and it only cost me $1,250 more (out of pocket) than it would have cost without that stupid piece of paper taped to the wall.

After having spent most of 2018 (and the better part of $40k) working with the medical community in Denver trying to determine the cause an unusual neurological issue (I'm sure you guys saw that coming), I've come to the conclusion that I'd rather have the problem than the cure.

Good luck BasinBeater... your case sounds pretty well established. Hard to imagine someone keeping a straight face while they try to explain that one even to an arbiter - let alone a judge or jury.

[basinbeater]

Suing may not be what I'll do. I just got the initial exam on the knee. Not too bad an injury. But annoying. So I was all fired up. I will make sure that whatever happens, they do not get an out of network fee without a fight. There are some good ideas in the last few posts that I will take into consideration. I have beat all my arrests for drunken youth behavior, as well as loud exhaust tickets, and took BMW to court to pay for a very expensive repair that I was not going to do, as it was a known problem.
Working on the car this evening, (finished reupholstering a seat, and got the seat 95% reassembled) has calmed my head, but my resolve is strong.

Also, how can they sue me for dragging their name though the mud when this has mud all over it? If a jury saw this, based on the responses here, 2/3 of them have had the same shit happen to them, and feel like I do. Fuck em.

sent from Utah.

[Skidog]

Suing may not be what I'll do. I just got the initial exam on the knee. Not too bad an injury. But annoying. So I was all fired up. I will make sure that whatever happens, they do not get an out of network fee without a fight. There are some good ideas in the last few posts that I will take into consideration. I have beat all my arrests for drunken youth behavior, as well as loud exhaust tickets, and took BMW to court to pay for a very expensive repair that I was not going to do, as it was a known problem.
Working on the car this evening, (finished reupholstering a seat, and got the seat 95% reassembled) has calmed my head, but my resolve is strong.

Also, how can they sue me for dragging their name though the mud when this has mud all over it? If a jury saw this, based on the responses here, 2/3 of them have had the same shit happen to them, and feel like I do. Fuck em.

sent from Utah.

people who have had this happen to them won't be sitting on your jury.

Good luck with the fight. My resolve wanes too easily after the initial burst of anger. I find its usually not worth it. I wouldnt pay and fight the charge, but thats as far as I would go personally. I know a few, like you, that would fight it to the end, and some might win. I hope you prevail.

[Marshall Tucker]

I went ballistic many years ago over United treating a visit to a doc-in-the-box at the beach for a kid as an ER visit. They eventually levied my bank account, put a mark on my credit. Didn't much care as I have plenty.

Ultimately didn't accomplish shit. So have at it.

[Bunion 2020]

Give 'em hell, basin!!! Screw those guys. They know what they're doing. We had a similar thing happen but it wasn't an insurance claim, just a "Free consult."

Wife called this butthole doctor's office in Bozeman to inquire about a deviated septum. They said it would be a free consultation. Went in for the consult but they said that she'd have to go to his OTHER office since they had some better equipment to take an initial look. She follows their advice. The "special equipment" was simply the doc shoving a little camera up her nose to take a look. Was like a 30 minute visit if that and never ended up doing a surgery with him since our spidey sense was tingling and we didn't quite trust him. Wanted another opinion perhaps. Imagine our surprise when we got like a thousand dollar bill with some fancy name for the so-called "medical procedure." We fought it over and over, and ultimately just let them send us to collections as we refused to pay them for their "free consultation." Their reason? "Oh, the free consultations are only at the doc's OTHER office. The doctor's office you saw him at is considered a different network." WTF?

We shoulda sued too. Doctors with practices like these need to be held accountable. Good luck, bro!

Dodson?

[MontuckyFried]

Dodson?

I honestly don't remember. Would have to dig through old bills to find his name. BUT, now that I've tried jogging my memory a little bit, I remember that they didn't actually label it as a "medical procedure," but rather a "surgical procedure"! That's what got my blood so boiling at the time. It was a nasal endoscopy. Probably like a minute of taking a look. Which again, we were told at the beginning it was all supposed to be a free consultation. ...only at his OTHER office apparently, though.

I'm no medical expert (obviously), but apparently I'm just another layman who doesn't understand the difference between a diagnostic look-see and a "surgical prodecure," and am apparently not the only one confused when getting the outrageous bill: https://www.entinstitute.com/nasal-e...y-explanation/ It has something to do with medical bill coding and insurance.
What a freaking racket. So by that standard, I guess when you're in for a physical and the doc checks your ears with the otoscope or check your breathing with the stethoscope, or check your blood pressure with the sphygmomanometer, I guess those are all surgeries too, eh? "Woops! Forgot to check your weight! Hop on the scale, bud. Nurse, tell the front desk we just bagged us another surgery! Just code it CPT-91234. Muahaha." "Uhh, doc. How much is all this gonna cost?" "Oh, that? Don't worry about it. It's all just routine."

[TBS]

May be an old trick. But it's going to cost them this time. I am going to make noise about it. Post about it on social media. Sue em. Call the news. Tell everyone the story until they are sick of hearing it. People need to make noise about this shit when it happens.

Calling the news may be your best bet.

I don’t think UofU wants any adverse publicity after that dustup with the nurse who wouldn’t do a blood draw for cops without a warrant. And I doubt the doc wants this publicized.

[Kinnikinnick]

Similar shit been happening in Colorado at least re Urgent Care

https://www.9news.com/mobile/article...s/73-438635946

I found out the hard way about urgent care and hospitals.
My kid had strep and high fever at 10pm on a Saturday on a long weekend. We went to the new neighborhood Urgent care owned by a hospital system. A streptococcus test and a prescription later, we get a bill from the facility weeks later for $1000. WTF. I had been to another urgent facility earlier in the year for $100.

When I inquired and asked for a price reduction they said that the facility was affiliated with a hospital so price was higher and the facility was technically an emergency room so the price was further higher.

Fuck heads. We need to cull the private health care system from the insurance companies to ACA to hospitals and doctors. Obscene prices and tricks and games that cost Americans tens of thousands of dollars a year.




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[k2skier112]

File a complaint to your state’s department of insurance. Also consumer affairs or some other consumer organization in your state. You can also file suit in small claims, if it qualifies, and that’s a huge pain in the ass for them, not so bad for you.

File a BBB complaint, businesses take that seriously.

[DBdude]

As someone who works in hospital consulting, would you be surprised if I told you they employ professional social media watchers and may actually counter sue you for saying bad things on social media.
Your situation sucks for sure though.

if he is factually correct they would file a nuisance suit? i don't think so

[old goat]

Re urgent care centers that call themselves ER's--every state has regulations as to what facilities and available staff an ER has to have. Might be worth looking them up and if they facility doesn't meet the requirements telling them that calling themselves an ER is fraud.

Upcoding on medical bills--charging for more care than was provided is very common. Orthopedist in Reno charged Kaiser for 2 extensive hospital visits concerning the acetabular fracture I had when I broke my back and ribs. The guy only saw me once, never examined me, never asked me questions, just told me it wasn't a problem, neglected to tell me not to weight bear on it--the PT told me that after I had been walking on it, total visit less than 1 minute. I told Kaiser, I don't know what they did about it. Billing codes require certain documentation to justify the level of care charged--it's not just whatever the doc or hospital feels like. For example--the physical exam must document so many organ systems examined, depending on the level. If you ever think you've been overcharged because of upcoding ask the doc or facility to provide you with the documentation for that level of care. You might see that the doc claims to have examined parts of you he never examined, for example.

To reemphasize a point I made earlier--the people making these billing decisions at hospitals, doctors offices, and insurance companies are not big, bad, greedy executives. They're the people those executives or doctors hired to do the dirty work--20 something poorly trained people with no medical knowledge who are trying to keep their jobs. A lot of their decisions don't stand up to scrutiny.

I got tossed from a jury panel for a personal injury case when I was asked if I knew anyone who would be testifying and I said that the UCDavis Med Center billing department was a bunch of crooks. That definitely got me the evil eye from the judge.

We'll all be better off when we get rid of fee for service medical care.

[DBdude]

i am somebody who has worked on the billing side once the data is entered. the only way i know a procedure can be billed if it is in the electronic health record. if there are procedures or contacts in the ehr that didn't occur then fraud occurred.

all the mistakes I was made aware of were mistakes made by the billing staff working their queues in the billing system. As i understood it they had visits assigned to their work queue and then read the visit in the emr. billing is a dreary, tedious gig

in my eighteen months working on the billings of a large ambulatory practice for a large teaching hospital, I have never heard of fraudulent entries in the emr

i have been called out on billing before by those that know the business better. My gig was to get the data into some other database for reporting or data sharing

again the location of the visit and calling it an emergency room visit or a hospital visit is the oldest scam in the book and hard to fight. the other of course is care providers not in your network - for example a radiologist reading your imaging result

[Kinnikinnick]

i am somebody who has worked on the billing side once the data is entered. the only way i know a procedure can be billed if it is in the electronic health record. if there are procedures or contacts in the ehr that didn't occur then fraud occurred.

all the mistakes I was made aware of was mistakes made by the billing staff working their queues in the billing system. As i understood it they had visits assigned to their work queue and then read the visit in the emr.

in my eighteen months working on the billings of a large ambulatory practice for a large teaching hospital, I have never heard of fraudulent entries in the emr

i have been called out on billing before by those that know the business better. My gig was to get the data into some other database for reporting or data sharing

It’s not fraud if there isn’t an explicit law banning the fleecing of consumers in that particular way.

Is there a real benefit to a kid with strep throat that the urgent care facility is associated with a hospital or that it technically qualifies as an ER? No but the hospital gets more $, as does the DR who works there, as does the billing staff. So fuck the rest of us so you can buy a Tesla and go on vacation to the Virgin Islands.

The banality of evil.


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[DBdude]

fraudulent entries in an emr is very much against federal law. I can't name them, but they drill it into you when you work at a hospital

again, I have never heard of it. i also worked a smaller regional hospital in vermont. it would be very much against the culture to create false billings through the emr. they did have hospital locations at ambulatory facilities. it stank, and I was shocked when it was stated very matter of fact like

the people i meet in healthcare work hard and are doing the best work possible

i do know horror stories. especially on the rehab side and how care is billed. it is really complicated and it is difficult not to get screwed. the rules are arcane and people don't understand what the care providers are telling them. the common problem in rehab is the patient is not progressing. if the patient isn't progressing, CMS or the private insurer will stop paying but the patien can't come home because they need care the family can't provide or they don't know that CMS or the private insurer has stopped paying

[splat]

Oh this is sick. United headquarters minutes from my home. They employ countless paper pushing self entitled rats

Your mission, should you decide to accept it....

[MontuckyFried]

Your mission, should you decide to accept it....

Dog poop under their door handles? That would be legit.

[old goat]

fraudulent entries in an emr is very much against federal law. I can't name them, but they drill it into you when you work at a hospital

again, I have never heard of it. i also worked a smaller regional hospital in vermont. it would be very much against the culture to create false billings through the emr. they did have hospital locations at ambulatory facilities. it stank, and I was shocked when it was stated very matter of fact like

the people i meet in healthcare work hard and are doing the best work possible

i do know horror stories. especially on the rehab side and how care is billed. it is really complicated and it is difficult not to get screwed. the rules are arcane and people don't understand what the care providers are telling them. the common problem in rehab is the patient is not progressing. if the patient isn't progressing, CMS or the private insurer will stop paying but the patien can't come home because they need care the family can't provide or they don't know that CMS or the private insurer has stopped paying

How would you know if fraudulent information was entered in the EMR. A doctor goes into a room with a patient, looks at his sprained ankle, and records that he looked at pupils, listened to lungs and heart, examined abdomen, and a few other things. It happens. Try reading the quarterly California Medical Board Bulletin, which includes a list of disciplined doctors and what they did. A lot of very shady stuff going on. Most upcoding isn't deliberate fraud though, just unsophisticated billers not understanding the EMR. The way the EMR works a lot of stuff gets autopopulated, some of which is inaccurate, and most docs don't check everything their name is under.

[east or bust]

It's bullshit that you can stand in an office and they can't tell you what the billing will be for a procedure or whether every med person involved is on the insurance plan

this x1000

I hope you stick it to them good. What other industry gets away with this kind of bullshit?

[Skidog]

this x1000

I hope you stick it to them good. What other industry gets away with this kind of bullshit?

Banks? Wall Street? Fortune 500 companies? Trump?

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[Svengali]

At least you didn't get an unnecessary bypass!
82 patients

[Cono Este]

I love how everyone just jumps on the insurance company that wasn’t even there.

Sounds like the fool that checked him in took his insurance, and did not check if his facility accepted it.

That’s on the them.




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[east or bust]

Banks? Wall Street? Fortune 500 companies? Trump?

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Not talking about corporate greed, that’s everywhere. More along the lines of what other service industries get away with no indication of what the service will cost? Medical procedures would be trickier to estimate than getting a freckle checked out but that could be solved with some sort of hourly surcharge. Just like a mechanic.

Bottom line is someone should be able to walk into a doctors office and know the cost of what they’re there for on the spot, not get a surprise bill 3 months later.

[Cono Este]

Not talking about corporate greed, that’s everywhere. More along the lines of what other service industries get away with no indication of what the service will cost? Medical procedures would be trickier to estimate than getting a freckle checked out but that could be solved with some sort of hourly surcharge. Just like a mechanic.

Bottom line is someone should be able to walk into a doctors office and know the cost of what they’re there for on the spot, not get a surprise bill 3 months later.

Doctors have no interest in how you pay, they just want to practice medicine. Ha, that’s a joke. They’ll send the bill collectors right after you.

If they meant that, they’d be the biggest proponents of a single payer system. Instead they get to be poor business people, employee DMV quality admins, and just Jam everyone with bills.


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[cycology1]

Once/if u get thru the BS in the billing side, always make sure to get a letter (in writing) that you have paid in full. heard cases that the debt can be sold and or firms buying the practices will research written off debt and pursue collections.