Billing Vent!!! Did this happen to you?

[mlfsandiego 0]

I was banded 5/18 as a self pay and had my procedure done in a surgery center. I paid the surgery center $8,500.00 and my surgeon $6,800 before the surgery as my band wasn't covered because I am low BMI. Today I received from my insurance company an explanation of benefits stating they have been billed for "supplies" at the rate of $9,500.00 from the surgery center. I then called the surgery center to ask what this charge was for? I was told that since I had a hiatal hernia repair (which I didn't even know I had until my post op check up) that they billed my insurance for that and I will be getting a separate bill from my surgeon for his part to repair it. I understand the part about my surgeon being paid to repair it, but how could the surgery center possibly rack up $9,500 in supplies for a 2 stitch repair? I am livid!! They are double dipping. I already paid to be operated on with anesthesia included and they billed my insurance company for a whole other surgery and expect me to pay the $1.532.00 of unpaid ins. deductible plus a $1500, co pay! I told them that this is a scam and double dipping and flat out insurance fraud. I told them I wanted a detailed list of "supplies" and was told that they bill globally for a procedure and don't count up each bandaid used. I am awaiting a call from their administration and flat out refuse to pay them for a whole other surgery! Unfortunately my insurance has already paid them their portion to the tune of $3,900. I intend to fight this all the way and let a judge decide if need be. This is the reason healthcare is so expensive. These kind of people bill and overbill as much as possible and get away with it. I also, plan to talk to my insurance company today to dispute this claim and hopefully they will investigate them. Sorry for the vent, but I cannot believe the greed in this situation.:thumbup:

[jalomum 1]

Don't let them get away with it. Make a lot of noise about this...it is not acceptable.

[ashleyw889 0]

I had something similar happen to me. I was self pay and paid everything up front. After the surgery, I got a bill for 19,000 for "supplies" and some other stuff. I asked for a detailed bill too and received one. Once I got it in the mail, I kept calling the billing office to explain that I was self pay. It took four calls and me asking for a supervisor to understand that I was self pay. After talking to the supervisor, she said she would clear out the bill. It really upset me that had I used insurance, they would have billed the insurance company that outrageous amount.

[sharcorb 0]

I was self pay also, and when I found out I had the hernia repair, I asked the doctors to bill the insurance for that part. They did that, and that amount was refunded to me. Maybe that $3900 is what they are trying to get for you? I was not successful getting the hospital to bill the insurance, unfortunately. The just didn't want the extra work.

Right after surgery I also got a couple bills I wasn't expecting, one for the chest x-ray and another for the stress test. Both of those were submitted to the insurance, then when not paid they were both dropped by the doctors office. Believe me, I called and raised a fuss!

Good luck, Sharon

[shelley1057 0]

Being as you had hiatal hernia repair I can see your insurance paying for this. $3900 sounds reasonable. but they are definitely inflating their prices! Hospitals will charge unreasonable fees to make up for the pts. that don't have insurance and don't pay. If you ever look at an itemized bill and see $5.00 charged for a small box of tissues or $15.00 for an aspirin then you get the idea. You are entitled to an itemized statement of every single thing used and charged to your acct. Demand to see it and then scrutinize it and argue every single fee you disagree with.

[crzytchr 3]

My dad told me this about his 2 hour outpatient surgery (not lapband) he had last year. He is on medicare and the hospital made the BIG mistake on sending him a bill to the tune of over 60k. He called them and told them it was 2 hours in an operating room and not only was he not going to pay it, he was going to see that medicare didn't pay it either since it was ridiculous. Then, the next bill came that was around 30K. He called and told them the same thing. When it was all said and done, medicare and his humana only paid around 8K. It is a crock of crap that our insurance companies are billed exorbitant amounts of money for procedures.

[mlfsandiego 0]

Update:

Thanks for all of your replies!

I called my surgeons biller today to ask her if this is normal for the surgery center to do this and she didn't know, but what she did say is that my surgeon wasn't going to even bill me or insurance for hernia repair as he just fixes them as an accomodation to his patients:biggrin: How nice is that? I then promptly called the surgery center and asked once again to speak to the administrator and was stoned walled. I got her voice mail and once again said that it was insurance fraud and that I don't see how they can charge for a whole other surgery when my own surgeon isn't charging for it? Also, I demanded a phone call back to resolve this issue. Unfortunately, they did not call me back, so I called blueshield my insurance company and explained exactly what happend and they are investigating this and will be fighting this claim. I hope they stick it to them!

What a bunch of greedy bxstards!

[IAmJacksLapBand 5]

I was afraid this would happen to me. During my consult I asked about the hernia to ensure if it was present that it would be included and that I would not receive additional bills.

What did happen was a few bills here and there from providers who were involved in my surgery that I did not know about. Luckily my surgeon's office is helping me get them all cleared up. I am getting bills for a test here, and a pill there, and a blanket over there... but none of it was to be billed to me.

[agiudice 0]

wow, I was banded over a month ago now and have received zero bills. I figured I'd get something.....

[jensmallwood 0]

How frustrating! I was self-pay also, but at my surgeon's own surgery center. He fixed a hiatal hernia that I didn't know I had, and it was just considered part of the procedure. No extra cost at all.

I did receive a bill from the anaesthesiologist by mistake. The surgery center had given them my check, but they didn't record it or something. We gave them a call and they took care of it right away.

I'm sure that BCBS will fight this-- provided the amount they paid is more than the cost of fixing the mistake.

[June 2010 0]

I too am FURIOUS!! Just received additional $13,000 hospital bill. My doctor quoted me the price of the hospital outpatient (in writing), which I paid. She also didn't charge for the Hernia repair.....Not sure what direction to go....will call hospital to clear up and if not....will definately take a legal route!

[Murpel 0]

I was an insurance pay, and had to pay my co-pays the day before the surgery. I paid my Dr. his portion, then went to the hospital and paid their portion. A month or so after the surgery I got a bill from the hospital stating that I owed $0, Now three months out they are billing me $2,000 for non covered costs. Hello! they are contracted through my insurance, they CAN'T charge any more, AND I have a bill stating that I don't owe anything. What the heck?

[JMinDallas 1]

You're comments worry me. I too was self-pay and have insurance, but they don't cover WLS. I had a hernia repaired that I didn't know about beforehand. My deductible is a whopping $5K, so I'm hoping they don't bill me or my insurance, cause I can't come up with more money for that too.

Hospitals are usually behind, so I figure in the next month or so I'll know if they billed it out.

[HappyMom 1]

You might also want to watch out for billing for fills also.

My insurance company paid for the surgery, minus my deductible....they were great.

I had my first fill at 4 weeks and my second at 8 weeks. Just after my second fill I finally received the bill for the first fill. The hospital charged $1710 and the doctor $295 for the first fill. My insurance company got the total reduced to $1300 and they paid $600 leaving me with $700........for each of the first two fills!

I called the hospital asking them how in the heck can a 3 minute procedure be billed at $2005! They said that is the standard billing charge for a fill under flouro. They also stated that most people's insurance only requires them to pay a $20-$50 doctor copay for each fill visit. I informed them that my insurance obviously didn't work that way! My insurance stated that the fills were not a covered benefit and I would have to assume a greater responsibility for the billing....not just the usual 10% of the charge.

The hospital stated that I can self-pay for the fills for a total of $350 each, or go through my insurance. I asked why do you charge one person $350 for a self-pay and then turn around and charge another persons insurance company $2005 for the same procedure?

I asked them to back out the insurance charge for the first two fills and allow me just to pay the self-pay charge of $350 each......the hospital wouldn't go for it. Probably because they were scoring $600 from the insurance company and $700 from me for each of the fills.

Either way....my third fill I self-paid for. Chalk it up to a lesson learned about hospital and doctors billing practices. No wonder health insurance costs so much!

[davidsj 0]

I had my lap band surgery on April 4th, 2011 as a "cash upfront" customer.. I was warned upfront that if I have a hiatal hernia, that it would be repaired, and that my insurance would be billed, and that if insurance did not pay up, that I wouldn't have to pay for the hiatal hernia repair. I just received an "Explanation of Benefits" from my insurance company, and it appears that the Doctor/Surgery Center billed my insurance company over $20,000 for the hiatal hernia repair (I confirmed this with the billing office). It appears that my insurance company has already paid approximately $8800, which is in addition to the $9900 I paid upfront. And from what I understand, the repair of the hiatal hernia did not require any additional supplies or extended stay. I can understand them billing for some additional charges, but these charges seem excessive, and possibly "double dipping", i.e. billing the insurance company for things that I already paid for when I paid cash for the surgery itself. I'm concerned that my insurance company may raise my rates or even possibly drop me as a client. I'm not sure if I should contact them about this. But I think I understand now why lap band surgery is growing, and there are billboards everywhere. The ability to add several thousand dollars of profit to every transaction makes this an extremely lucrative practice..