Broken ankle and balance billing

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9/14/2018 10:24 AM

Will probably end up in non moto but I’ll start here.

I have a pretty decent med insurance plan but In an emergency situation I was brought to an out of network medical provider and once stabilized thransferred to an in network provider. Long story short after spending 3 nights in the non network hospital and am left with a pretty hefty bill. I have met all of my max out of pocket deductables for the year and appealed 3 times the remaining balance with my provider to only be denied. They said they have paid all they are going to pay for services rendered. (Reasonable amount for services). However, the hospital is charging what seems to be a pretty inflated rate and I am being told that I am resposible for the difference above and beyond my max out of pocket deductables. I have also read that balance billing is illegal in the state of California. If you have any info that you can share on how to handle it will be greatly appreciated.

Thanks,
Ryan Raiford

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9/14/2018 10:26 AM

sorry to hear that dude, I listened to this on NPR a few weeks ago. May be helpful.

https://www.npr.org/sections/health-shots/2018/08/27/640891882/life-threatening-heart-attack-leaves-teacher-with-108-951-bill

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I'm the dude, man.

9/14/2018 10:37 AM

Go talk to the hospital and explain your situation. Most hospitals are willing to work with you if you are up front with them.

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9/14/2018 10:47 AM

Read up on your contractual obligations with your insurance. There is often some kind of clause about "life- or limb-threatening" injuries treated in an out-of-network hospital. I'm assuming that since you spent 3 days at the other hospital it wasn't just a broken ankle. If it's in writing, you deserve to be treated until stabilized, then transferred back in-network.
Also, talk to a patient advocate at the hospital. They may be able to help you with this process.

I have a feeling that since you have met your max out of pocket, you can force your insurance to pay the hospital. It's up to them to hash out how much the fees should be; not your problem anymore.
Don't just "appeal." That's like asking, "pretty please?" If they are contractually obligated to pay, don't give them one inch.
I am 100% convinced that insurance companies have people whose entire job it is to deny perfectly legitimate claims so the company earns more margin.

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Braaapin' aint easy.

9/14/2018 10:49 AM
Edited Date/Time: 9/14/2018 10:50 AM

For sure go to the hospital with a good attitude and speak to them in person, if they won't help you I'd spend that money on a laywer.

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9/14/2018 11:55 AM

brocster wrote:

Will probably end up in non moto but I’ll start here.

I have a pretty decent med insurance plan but In an emergency situation I was brought to an out of network medical provider and once stabilized thransferred to an in network provider. Long story short after spending 3 nights in the non network hospital and am left with a pretty hefty bill. I have met all of my max out of pocket deductables for the year and appealed 3 times the remaining balance with my provider to only be denied. They said they have paid all they are going to pay for services rendered. (Reasonable amount for services). However, the hospital is charging what seems to be a pretty inflated rate and I am being told that I am resposible for the difference above and beyond my max out of pocket deductables. I have also read that balance billing is illegal in the state of California. If you have any info that you can share on how to handle it will be greatly appreciated.

Thanks,
Ryan Raiford

http://www.sandiegouniontribune.com/news/health/sd-me-balance-billing-20170731-story.html#

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9/14/2018 12:46 PM

Man I’m glad I live in Canada. Health care is not even a thought up here. I know you guys down there have something against taxes, but it’s mind boggling that you could loose everything because of a accident? I had a bad crash up in the mountains a few years back(busted pelvis/broken thumb) cost me $80 for the ambulance ride.

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9/14/2018 3:58 PM

Falcon wrote:

Read up on your contractual obligations with your insurance. There is often some kind of clause about "life- or limb-threatening" injuries treated in an out-of-network hospital. I'm assuming that since you spent 3 days at the other hospital it wasn't just a broken ankle. If it's in writing, you deserve to be treated until stabilized, then transferred back in-network.
Also, talk to a patient advocate at the hospital. They may be able to help you with this process.

I have a feeling that since you have met your max out of pocket, you can force your insurance to pay the hospital. It's up to them to hash out how much the fees should be; not your problem anymore.
Don't just "appeal." That's like asking, "pretty please?" If they are contractually obligated to pay, don't give them one inch.
I am 100% convinced that insurance companies have people whose entire job it is to deny perfectly legitimate claims so the company earns more margin.

I was hopped up on morphine upon arriving and insurance coverage was the last thing on my mind. Had a pilon fracture to the ankle, broken radius in my wrist and two broken metacarples in my hand. Kept me the first night to do surgery on my arm and hand the following day. Kept me that night to put external fix on the following day. Kept that night for observation from surgery. Transported the next day. Through all of this I was highly medicated. In hindsight had I known I would get jammed with the bill from it being an emergency and NOT life threatening I surely would have been asked to be transported if I was in my right state of mind. Who the faq takes advantage of people like this other than dirty ass insurance companies.

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9/14/2018 4:23 PM

brocster wrote:

I was hopped up on morphine upon arriving and insurance coverage was the last thing on my mind. Had a pilon fracture to the ankle, broken radius in my wrist and two broken metacarples in my hand. Kept me the first night to do surgery on my arm and hand the following day. Kept me that night to put external fix on the following day. Kept that night for observation from surgery. Transported the next day. Through all of this I was highly medicated. In hindsight had I known I would get jammed with the bill from it being an emergency and NOT life threatening I surely would have been asked to be transported if I was in my right state of mind. Who the faq takes advantage of people like this other than dirty ass insurance companies.

Not much in this world I hate more than insurance companies. Good luck man, and sorry to hear about your injuries.

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9/14/2018 5:17 PM

Falcon wrote:

Read up on your contractual obligations with your insurance. There is often some kind of clause about "life- or limb-threatening" injuries treated in an out-of-network hospital. I'm assuming that since you spent 3 days at the other hospital it wasn't just a broken ankle. If it's in writing, you deserve to be treated until stabilized, then transferred back in-network.
Also, talk to a patient advocate at the hospital. They may be able to help you with this process.

I have a feeling that since you have met your max out of pocket, you can force your insurance to pay the hospital. It's up to them to hash out how much the fees should be; not your problem anymore.
Don't just "appeal." That's like asking, "pretty please?" If they are contractually obligated to pay, don't give them one inch.
I am 100% convinced that insurance companies have people whose entire job it is to deny perfectly legitimate claims so the company earns more margin.

brocster wrote:

I was hopped up on morphine upon arriving and insurance coverage was the last thing on my mind. Had a pilon fracture to the ankle, broken radius in my wrist and two broken metacarples in my hand. Kept me the first night to do surgery on my arm and hand the following day. Kept me that night to put external fix on the following day. Kept that night for observation from surgery. Transported the next day. Through all of this I was highly medicated. In hindsight had I known I would get jammed with the bill from it being an emergency and NOT life threatening I surely would have been asked to be transported if I was in my right state of mind. Who the faq takes advantage of people like this other than dirty ass insurance companies.

Squirrelings wrote:

Not much in this world I hate more than insurance companies. Good luck man, and sorry to hear about your injuries.

Yep, I put them on the same rung as lawyers, politicians, car salesmen and mega preachers. If you are reading this and are in one of these professions....and can truthfully say you DO NOT take advantage of people...I apologise to you...and you only.

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If it ain't yer's don't take it, If it ain't the truth dont say it, If it ain't right don't do it...Marcus Aurelius

9/14/2018 5:26 PM

Falcon wrote:

Read up on your contractual obligations with your insurance. There is often some kind of clause about "life- or limb-threatening" injuries treated in an out-of-network hospital. I'm assuming that since you spent 3 days at the other hospital it wasn't just a broken ankle. If it's in writing, you deserve to be treated until stabilized, then transferred back in-network.
Also, talk to a patient advocate at the hospital. They may be able to help you with this process.

I have a feeling that since you have met your max out of pocket, you can force your insurance to pay the hospital. It's up to them to hash out how much the fees should be; not your problem anymore.
Don't just "appeal." That's like asking, "pretty please?" If they are contractually obligated to pay, don't give them one inch.
I am 100% convinced that insurance companies have people whose entire job it is to deny perfectly legitimate claims so the company earns more margin.

brocster wrote:

I was hopped up on morphine upon arriving and insurance coverage was the last thing on my mind. Had a pilon fracture to the ankle, broken radius in my wrist and two broken metacarples in my hand. Kept me the first night to do surgery on my arm and hand the following day. Kept me that night to put external fix on the following day. Kept that night for observation from surgery. Transported the next day. Through all of this I was highly medicated. In hindsight had I known I would get jammed with the bill from it being an emergency and NOT life threatening I surely would have been asked to be transported if I was in my right state of mind. Who the faq takes advantage of people like this other than dirty ass insurance companies.

Exactly.

I hope this doesn't sound callous, but I'm actually glad you were on drugs when they took advantage of you.... this is an ace up your lawyer's sleeve, should it come to that. I think you have a good case. Don't feel bad about going toe to toe with the insurance company; they truly do not have your best interests at heart, no matter what fluff goes out in their feel-good marketing.

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Braaapin' aint easy.

9/14/2018 6:03 PM

Falcon wrote:

Exactly.

I hope this doesn't sound callous, but I'm actually glad you were on drugs when they took advantage of you.... this is an ace up your lawyer's sleeve, should it come to that. I think you have a good case. Don't feel bad about going toe to toe with the insurance company; they truly do not have your best interests at heart, no matter what fluff goes out in their feel-good marketing.

They care about one thing...turning as much of your money into their money as possible.

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If it ain't yer's don't take it, If it ain't the truth dont say it, If it ain't right don't do it...Marcus Aurelius

9/14/2018 10:08 PM

I blew over a outboard drag boat and broke 5 vertebraes and pushed my femur through the back of my pelvis. My insurance covered everything but the $50,000 life flight helicopter ride. My wife called the company and asked them that if we put it on our credit card how much would they reduce it, or we would make $25 a month payments for the rest of our lives? They cut the bill to $15,000. I feel your pain. Good luck.

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9/15/2018 10:14 PM
Edited Date/Time: 9/15/2018 10:14 PM

Same thing happened to me when I shattered my elbow into 15 peices, like I cared what hospital I went to or if it was in my network!!! Tell them see you in bankruptcy court, they will drop the amount owed quick.

All those uninsured people waiting in then ER, that's how the hospitals make their money back... charging insurance exorbitant amounts and people like you and me that are trying to do the right thing and maintain a credit score.

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Don’t piss off the old people - the older they get the less “life in prison” is a deterrent for them!

2020.5 KTM 450 SXF FE
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9/15/2018 10:44 PM
Edited Date/Time: 9/15/2018 10:48 PM

This is soft request for the folks at vital, maybe a medical section could be beneficial for everyone . imo

I am having arhtroscopic Procedure and my neighbor warned me that watch out for the anesthesiologist and make sure he is in network also . If not I would be paying for it . Just an example.

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9/15/2018 10:44 PM

jjavaman wrote:

Man I’m glad I live in Canada. Health care is not even a thought up here. I know you guys down there have something against taxes, but it’s mind boggling that you could loose everything because of a accident? I had a bad crash up in the mountains a few years back(busted pelvis/broken thumb) cost me $80 for the ambulance ride.

Yep. Insurance companies arent in the business of paying bills. They are in the business of collecting premiums. Dude is lucky they paid anything at all!
Until they figure out health insurance isnt about healthcare, nothing will change.
Their welfare people have 100% coverage and never see a bill. Not even for 1 cent. Their system is ass backwards.

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My post is my opinion. If you don't agree with it, I'm OK with it.

9/15/2018 10:46 PM

wreckers wrote:

For sure go to the hospital with a good attitude and speak to them in person, if they won't help you I'd spend that money on a laywer.

Why? So he owes two places money?

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My post is my opinion. If you don't agree with it, I'm OK with it.

9/16/2018 12:35 AM

jjavaman wrote:

Man I’m glad I live in Canada. Health care is not even a thought up here. I know you guys down there have something against taxes, but it’s mind boggling that you could loose everything because of a accident? I had a bad crash up in the mountains a few years back(busted pelvis/broken thumb) cost me $80 for the ambulance ride.

If he was in Canada he would have been handed crutches, told to come back in 8 months to get his ankle fixed, but died of a staff infection 2 weeks later

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9/16/2018 12:36 AM

wreckers wrote:

For sure go to the hospital with a good attitude and speak to them in person, if they won't help you I'd spend that money on a laywer.

So ne can owe a hospital and attorney? Great advice.

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9/16/2018 7:33 AM

jjavaman wrote:

Man I’m glad I live in Canada. Health care is not even a thought up here. I know you guys down there have something against taxes, but it’s mind boggling that you could loose everything because of a accident? I had a bad crash up in the mountains a few years back(busted pelvis/broken thumb) cost me $80 for the ambulance ride.

Texas Built wrote:

If he was in Canada he would have been handed crutches, told to come back in 8 months to get his ankle fixed, but died of a staff infection 2 weeks later

Thats false. The only thing that gets postponed are non immediate or non life threatening things.
You also have to understand, there arent many hospitals that can handle major things, so travel may be necessary. The whole country has less people than California, so there isn't major centers on every corner filled with snot nosed welfare kids billing the hell out of the government. I went to the local hospital with a compound clean break Tib/Fib and was out in 3 hours total. Good to go.

I have relatives in the US that have surguries scheduled for 6 months out. Soonest they can get in within a 12 hour drive. Oh, and the closest doc to them that takes their insurance is 6 hours away, which will take new patients.
Their regular doc is booked out.

So for all the medical centers in the US and urgent care facilities on every corner, your system is probably worse

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My post is my opinion. If you don't agree with it, I'm OK with it.

9/16/2018 8:18 AM

jjavaman wrote:

Man I’m glad I live in Canada. Health care is not even a thought up here. I know you guys down there have something against taxes, but it’s mind boggling that you could loose everything because of a accident? I had a bad crash up in the mountains a few years back(busted pelvis/broken thumb) cost me $80 for the ambulance ride.

Texas Built wrote:

If he was in Canada he would have been handed crutches, told to come back in 8 months to get his ankle fixed, but died of a staff infection 2 weeks later

Um ya - bullshit.

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HAF

9/16/2018 8:35 AM
Edited Date/Time: 9/16/2018 8:36 AM

lesson learned here:

First question you ask is...is this in network? And I need to speak with a social worker before I agree to receive treatment.

You need a letter from the treating physicians to state it wasn’t feasible to transport you. They’ll write this letter, you gotta ask them.

I’d go hard at that insurance company. But go through your plan with a fine toothed comb. Or a highlighter. All 50 pages of course....

If All else fails.....you call the hospital and start negotiating. They might wipe majority of the bill and set you up with an interest free payment plan.

If you’re still not happy lawyer up. But....you’re probably more apt to beating it with physician letters, not subpoenas.

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GP740
Since 1987

9/16/2018 9:00 AM

jjavaman wrote:

Man I’m glad I live in Canada. Health care is not even a thought up here. I know you guys down there have something against taxes, but it’s mind boggling that you could loose everything because of a accident? I had a bad crash up in the mountains a few years back(busted pelvis/broken thumb) cost me $80 for the ambulance ride.

Moto96 wrote:

Yep. Insurance companies arent in the business of paying bills. They are in the business of collecting premiums. Dude is lucky they paid anything at all!
Until they figure out health insurance isnt about healthcare, nothing will change.
Their welfare people have 100% coverage and never see a bill. Not even for 1 cent. Their system is ass backwards.

Paul, why are you pretending to be Canadian?

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9/16/2018 10:00 AM

Texas Built wrote:

If he was in Canada he would have been handed crutches, told to come back in 8 months to get his ankle fixed, but died of a staff infection 2 weeks later

You’ve drank the kool-aid of Fox News, and that’s a sad thing.

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9/16/2018 10:12 AM

jjavaman wrote:

Man I’m glad I live in Canada. Health care is not even a thought up here. I know you guys down there have something against taxes, but it’s mind boggling that you could loose everything because of a accident? I had a bad crash up in the mountains a few years back(busted pelvis/broken thumb) cost me $80 for the ambulance ride.

Texas Built wrote:

If he was in Canada he would have been handed crutches, told to come back in 8 months to get his ankle fixed, but died of a staff infection 2 weeks later

Fake news

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9/16/2018 12:16 PM
Edited Date/Time: 9/16/2018 12:21 PM

Physician and hospital rates in the US are inflated and most Americans would be shocked to know how much lower they are in other countries. I remember I told a back surgeon that I was going to use an in network doctor for my surgery.. he said he will bill the usual rate to the insurance companies and not to worry about paying the rest. this is how doctors and hospitals game the system. Talk to the hospital.. The probability is very high that they will work out an agreement with you. the US system is way out of control and it is time for universal healthcare like the rest of the world has. Most Americans really don't know what this means because of the negative propaganda people/ politicians spew. Actually my job for the past 30 years is to know the pros and cons of healthcare systems all around the world and I have experienced the systems intimately in other countries where I have lived since I raced motocross wherever I lived. Time to switch off Fox news and enter the real world and fix the country for real!

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9/16/2018 12:20 PM

jjavaman wrote:

Man I’m glad I live in Canada. Health care is not even a thought up here. I know you guys down there have something against taxes, but it’s mind boggling that you could loose everything because of a accident? I had a bad crash up in the mountains a few years back(busted pelvis/broken thumb) cost me $80 for the ambulance ride.

Let’s not pretend your healthcare is “free” or only costs you $80 dollars after a serious injury..laughing

You are paying plenty for your healthcare via taxes..far more than you’re getting benefit from. In fact, I’d be willing to bet the OPs bill for his ankle ( plus his premiums ) are going to be significantly less than you paid for your health insurance this year..

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9/16/2018 12:46 PM

Tokyo_Tiddler wrote:

Physician and hospital rates in the US are inflated and most Americans would be shocked to know how much lower they are in other countries. I remember I told a back surgeon that I was going to use an in network doctor for my surgery.. he said he will bill the usual rate to the insurance companies and not to worry about paying the rest. this is how doctors and hospitals game the system. Talk to the hospital.. The probability is very high that they will work out an agreement with you. the US system is way out of control and it is time for universal healthcare like the rest of the world has. Most Americans really don't know what this means because of the negative propaganda people/ politicians spew. Actually my job for the past 30 years is to know the pros and cons of healthcare systems all around the world and I have experienced the systems intimately in other countries where I have lived since I raced motocross wherever I lived. Time to switch off Fox news and enter the real world and fix the country for real!

Yes to all of this. Sad part is, had I showed up to the same hospital in the same emergency case with NO insurance my bill would look a hell of a lot different (less). Fortunately, but unfortunately, I have insurance so they try and milk us for the max to subsidize the payments for those that don’t. Coincidentally, they amounts between the two would be nearly the same. It’s a fuggin game and its sad that it’s peoples health and livelyhood that they are jockeying around with.

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9/16/2018 12:48 PM



Best of luck man. The out of network thing is bullshit. Nothing like getting an extra expense because you needed immediate treatment.
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