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View Diary: First Doctor Visit in Five Years: Why Repubs Want Us Broke or Dead (224 comments)

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  •  that wrangling between providers and insurers (14+ / 0-)

    got exposed in Ohio a few years ago, and it took down one of the largest insurance companies in the state.

    For years the company now known as Medical Mutual of Ohio got away with using its negotiated discount as all or part of its "payment" for services. In practical terms, it meant that patients were paying all of their medical bills.

    There was quite an uproar in the late 90s when it came to light. The company was forced to drop its use of the Blue Cross/Blue Shield name by the national BC/BS association and there was a big shakeup in the executive suite. It was quite a soap opera, actually. Wish I could find links to it but this was well before the Plain Dealer was online.

    But as far as I know, other than the slightly more honest practice by the company, no policy holders ever got anything out of it.

    Reforms come from below. No man with four aces howls for a new deal.
    Keystone XL will raise gas prices!

    by Turbonerd on Wed Mar 26, 2014 at 01:01:27 PM PDT

    [ Parent ]

    •  You just reminded me of something (24+ / 0-)

      Many years ago, it would have been in the early 90s, my girlfriend at the time broke her leg.  The hospital said it was sprained, but admitted that they didn't have a radiologist on hand to confirm the diagnosis.  They sent her home and told her to walk on it and see an orthopedic doctor in a few days.  She did.  She was then told that it was broken and now required surgery.  Had it been handled immediately, it could have been set and allowed to heal without it.

      What's more is that the doctor said, "I concur with the hospital diagnosis that it was broken".  Apparently a radiologist later reviewed the case, but at NO time was she notified.

      She had surgery to fix her leg and insurance, which was BCBS (but I can't recall which flavor) paid for it.  Some time later, the reneged the payment and she got stuck with the entire bill and wound up with serious debt collections for several thousands of dollars.  Her parents ultimately put it on a credit card.  

      Apparently they had a practice of doing this type of illicit behavior.  If I recall, they tried claiming that it should have been a workman's comp claim, even though it happened at home, and therefore the insurance wasn't liable.  Several months after her parents finally paid the bill, she got a legal settlement from a class action lawsuit against them for the grand sum of $100.  What a stinking rip off!

      "It's not surveillance, it's data collection to keep you safe"

      by blackhand on Wed Mar 26, 2014 at 01:18:01 PM PDT

      [ Parent ]

      •  wow that's crazy (5+ / 0-)

        I didn't think that kind of cost-shifting was going on that far back.

        It was actually refreshing, looking back through some of that reporting, to find Republicans (Betty Montgomery) acting in good faith.

        Reforms come from below. No man with four aces howls for a new deal.
        Keystone XL will raise gas prices!

        by Turbonerd on Wed Mar 26, 2014 at 01:43:37 PM PDT

        [ Parent ]

      •  The billing for medical care is literally insane (13+ / 0-)

        A couple years ago, I had some PT for my foot. I received a bill for $89 (my share, after insurance), along with about 30 other bills for things like x-ray, radiologist, etc. - each of which is not only in its own department, but bills completely separately. To make it worse, the hospital itself is two separate legal entities, and some departments were in one entity and some in the other. Anyway, I paid the bill after the second reminder.

        A few weeks later, I got the same bill in the mail. I asked what the deal was and was told they'd applied the money to a different bill, so it was still due. Fine, what a nuisance. next time I went in, I had the secretary look up the total owed from 2012 (this was Jan of 2013), and apply a single payment to pay everything off. She did ... for the wrong legal entity. So, now I still owed the $89, but had used up the flexible spending account balance on bills that weren't due, yet, from a different department. Of course, I found this out when I received another bill a month later for the same $89. Gaaaah! So, I went down to the hospital's central billing office and made the person show me the computer monitor as she credited the payment for that bill (which was, by then, several months overdue).

        Cut to September - I get another bill for the same $89! The bill had been queued up to be sent to a collection agency sometime during that whole saga. So this version was from their in-house collection agency (I guess that's more efficient than an independent one?). It was an automated process, but apparently a very slow one, so 3 months after it was finally paid, I was being billed, again!

        I called and told them the bill was paid and they needed to check their records. Since this was the collection agency arm, and not the regular office, they did the normal collection agency BS of not believing the bill was paid. They sent more bills w/nastier wording, started calling, all the fun stuff. Finally, I took one of the dunning notices, changed the sending address to the regular billing department, and paid it by mail, certified, with return receipt, so someone had to sign for it. I know I didn't have to, but I wanted something to take to court if they continued harassing me. That was in December.

        On Saturday (it's now March), I received a check from the hospital ... for $89 ... for overpayment.



        On the plus side, the collection arm stopped annoying me in January, and I did get my money back (though I had written it off as a lost cause - a human response that I assume collection agencies rely on). I'm guessing whoever had to sign for it in billing figured out what the deal was, and their very, very slow processing eventually led to the refund.

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