Getting money back from surgery

[liveaboard15 1,293]

So i had my surgery last month. I am self pay as insurance will not cover. I paid around $18-19K. I had to pay before i could have the surgery. A couple weeks after surgery i notice there was a claim from the hospital on my insurance for that same surgery for around $40K. Which they denied since its not covered. I called the hospital to find out what the heck is going on. So i gave them my receipts showing i paid the Surgeons fee, Surgeon assistant fee, Anesthesiologist fee, Hospital facility fee, complication coverage fee, Pathology, psychological exam, and nutritional evaluation. all coming out to about $19K. So they told me they would figure out what happened and why my they did my insurance instead of self pay. Today i get a email from the hospital that they switched me to self pay and that i am owed a refund of over $3,000 which was odd because i am not owed anything. So i called and they checked and checked and said they gave me a discount since I paid cash lol. So i was like... ARE YOU SURE... Because once i get this money i am paying off my credit cards and you wont be getting that money back... and they checked and said i am good. So i should be getting some moolah back here in the next couple days lol. So thanks for that mistake haha.

[Spinoza 1,452]

Oh wow what a stroke of luck! Maybe they charge less for self-funding patients? No idea how things work in the US.

[liveaboard15 1,293]

27 minutes ago, Spinoza said:

Oh wow what a stroke of luck! Maybe they charge less for self-funding patients? No idea how things work in the US.

So for self pay patients we get a self pay rate. The money must be paid before surgery. which i paid everything on this list. To me its a mistake that they are refunded. but they said they checked and the phone call to the hospital was recorded and they have it in their notes so if something comes up later its not my problem lol.

[copley95 5]

They do often give discounts for self pay, robbery that they bill insurance 40k but less than 20k if not…

[ShoppGirl 5,004]

Well at least if they do come back and ask for it you can make small payments and take your time paying it cause there is no interest. I once paid a medical bill off at like $15 a month. I talked to the girl in billing and told her I was going through tough times financially and she said as long as I sent something she didn’t care how much it was.

[liveaboard15 1,293]

2 hours ago, ShoppGirl said:

Well at least if they do come back and ask for it you can make small payments and take your time paying it cause there is no interest. I once paid a medical bill off at like $15 a month. I talked to the girl in billing and told her I was going through tough times financially and she said as long as I sent something she didn’t care how much it was.

Yea thats with any bill to keep it from collections pay something. Even 5 bucks lol. I use to be a debt collector and we had people do that all the time to keep it from going onto their credit. They would mail in a 5 dollar check every month. remember one guy sending a dollar (he could afford more but didnt want to pay it lol)

[ShoppGirl 5,004]

6 minutes ago, liveaboard15 said:

Yea thats with any bill to keep it from collections pay something. Even 5 bucks lol. I use to be a debt collector and we had people do that all the time to keep it from going onto their credit. They would mail in a 5 dollar check every month. remember one guy sending a dollar (he could afford more but didnt want to pay it lol)

OMG, a dollar. Nowadays it wouldn’t be worth it to cover the check and the stamp. Lol

[kcuster83 1,504]

woohooo NICE SURPRISE!

[catwoman7 11,220]

15 hours ago, Spinoza said:

Oh wow what a stroke of luck! Maybe they charge less for self-funding patients? No idea how things work in the US.

they often charge insurance companies way more than they charge self-pays. My plastic surgery was self-pay. I originally got a statement that my surgery (which I'd already paid for) was like three times more than what i paid for it. When I called, they said it was just a statement and to ignore it since I'd already paid. I'm pretty sure that was the amount that would have been billed to the insurance company if insurance would have covered it.

[acopas 104]

I do insurance billing and the fees we charge when we bill to insurance are pretty arbitrary.

In my specialty, Medicare used to pay us based on groups. So group 1 codes would be allowed $400, but group 2 would pay $800. Instead of having a different charge amount for every procedure, we took the highest paying group and round it up to the next $100. At the time that the fees were entered (2004), we charged around $1000. Then work comp changed their manual and allowed at $1593 for one procedure, so all of our charges became $1600. The fees haven't changed since.

If we add a new procedure to our services, we take the current MCR fee schedule and times it by 2.4 to get our charge rate. We do this because 90% of our commercial health insurance plans are based on a percentage of Medicare allowed. Our highest is 200% of MCR.

[liveaboard15 1,293]

So i got an email this morning... Saying that the 3K refund was a mistake. That they would correct it... GO FIGURE... lmao

[kcuster83 1,504]

19 minutes ago, liveaboard15 said:

So i got an email this morning... Saying that the 3K refund was a mistake. That they would correct it... GO FIGURE... lmao

When it seems too good to be true, it usually is...

[liveaboard15 1,293]

1 minute ago, kcuster83 said:

When it seems too good to be true, it usually is...

SOOOO DAMN TRUE LMAO

[ShoppGirl 5,004]

47 minutes ago, liveaboard15 said:

So i got an email this morning... Saying that the 3K refund was a mistake. That they would correct it... GO FIGURE... lmao

Darn it. I had a sneaking suspicion that would happen.

[Forienthe 0]

On 5/24/2022 at 11:44 PM, liveaboard15 said:

So for self pay patients we get a self pay rate. The money must be paid before surgery. which i paid everything on this list. To me its a mistake that they are refunded. but they said they checked and the phone call to the hospital was recorded and they have it in their notes so if something comes up later its not my problem lol. Modern systems have even made casinos secure. For example, take a look at the https://casinosanalyzer.com/casino-bonuses/casinoadrenaline.com ere everything about Casino Adrenaline no deposit bonus is well explained. I found it very convenient. So, if anyone still has doubts, I recommend checking it out!

They denied me insurance for an absolutely unclear reason.

Edited September 17, 2024 by Forienthe