State agency I can talk to? Dr's staff lying and insurance issues.

[fitz19d]

So I had the back surgery posts. In january I got cortisone shot in my back that didnt help or even made it worse. At the time I'd had a few images done and other things and every step of the way I asked, is this covered by my insurance since these were outside people doing imaging etc. In the case of the office for the cortisone shot I was scheduled by the scheduler at my back doctor. Then when I went to the office I asked the front desk lady there again about insurance and they took a $45 payment which was my specialist O/V rate.

Fast foward 4-5 months and I get my EOB from Aetna saying none of it's covered. (Thought I had a approval letter like I had for MRI's but maybe not) Finally got the bill today. Charges of around a grand and change. (The EOB showed 2,500 so looks like they cut the charge already but not reflected on the bill.)

I was wondering what's the best recourse, is there usually a state agency I can complain to? The dr works out of an office with a few locations and doctors, so not sure to complain to him or who there as well as the office which did the cortisone shot. 9news has been running an interesting thing on medical billing you can submit your bs too.

If I can drop it to a few hundred that would be fine, though still more than I should have paid since my coinsurance is only 10%.




Unrelated but for the surgery they had at dr request a neuromonitor guy to help make sure they didnt mess w/ spine. They had twice a letter stating their services arnt balance billed and I wont get charged any extra. From my EOB they billed like 18,000 to insurance. Insurance paid next to nothing and gives an EOB for close to the 18k. An amount which dwarfs everything else billed by multiple times over. I havn't gotten anything from them so I may be fine but dreading that one.

[Gman]

I had something similar. I was told everything would be cleared through the insurance company. I went to the facility where they performed the injections. It appeared that the neurosurgeon may have been a part owner of the facility. My back felt better for a couple of days and then got much worse than it had ever been before. The neurosurgeon was also slow in getting me back into the office to discuss the excruciating pain I was in. I found another neurosurgeon that actually worked through the diagnostic process quickly and accurately.

I later received a denial from my insurance company for the injections and they had a significant cost associated to them. I never was billed for this unapproved procedure.

I also had a third party that worked with the surgeon to monitor my nerves during the procedure. Insurance kept bouncing the charges. I filled out a limited power of attorney for the claim and they were able to work with the insurance company to get it resolved.

Best of luck to you for a resolution and hope you heal up well!

[fitz19d]

I'm doing largely good but still some issues, it's that herniated disc. If I do anything much athletically/lifting it aches and hurts if I try to basically bend backwards. And certain chairs without enough cushy support allows the sciatic nerve in my leg to get squished a bit causing a sharp pain when I stand. But not doing anything with it until bills get figured out. Can't let them dick me more.

[bczandm]

Fitz19d:

1) NEVER take an offices word for coverage, they really don't have anything to do with YOUR insurance.

2) Dr's invest in surgery centers, its common.

3) In the industry balance billing means the service provider takes the math from the EOB and honors it. An $18,000 EOB may have coverage and may not, but there can be lots of approved charges that are not covered. If the EOB says $16,000 is allowable no balance billing means they won't bill you for the difference between the $16,000 (allowable) and $18,000 (total bill). They will try to collect on the $16,000 and in many cases they are required by law to make reasonable attempts to collect the full allowable amount.

4) how to proceed now can vary depending on the procedure, insurance coverage and the collection polices of the service provider(s). It gets very complex.

It's one of the many flaws in the system and a significant issue that more recent legislation has ignored.