My experience involved a PPO surgeon who used a non-PPO anesthesiologist. The surgeon's fees were limited to his agreement with my insurance company - but the anesthesiologists were not. I had to pay the difference between what my insurer paid and the actual, much higher fee billed by the anesthesiologist. I was pretty upset and said so. I have since noticed a sign at the check-in window at the surgeon's office that says it is the patient's responsibility to be sure all providers are covered by their insurance.

My husband was in the Trauma Unit for 2 weeks last year due to a motorcycle accident.  Happily the surgeon saved his leg, but life wasn't so fun for months trying to sort out the medical bills.  Many of the "providers" sent by the hospital to care for my husband were nonparticipating providers which meant they came to us for large amounts of money even though we have what is supposed to be an excellent Blue Cross PPO.  In the hospital you are held hostage to this system and I am thinking of getting my first tattoo - it will be:  "Are you a BCBS participating provider?"  

In addition, the wheelchair rental company Apria sent us to a collection agency although we constantly told them that our insurance stated they had never been billed by Apria.  After months of my phonecalls and letters begging Apria to re-file to insurance I finally got a supervisor on the line.  Her first question:  what is your policy number?  Turns out Apria had been one digit off...

My husband had another hospitalization a few days ago and lucky him, he can now go to the VA.  They are fabulous.  Who would have guessed that the government could do something so much better than private industry.

When our fifth child was born three years ago, we had a new $500 copay for anytime you are admitted, so we planned ahead for it for my delivery.  What we never considered was a copay for the baby too! Ouch

I happened to be on-call as an obstetrician one night when I cam home and found my 18 yr old on the bathroom floor, doubled over in pain.  I rushed  her to my own hospital's ER and told them she more than likely had appendicitis.  The teaching staff still requested a pelvic ultrasound, and abdominal ultrasound, an abdominopelvic CT scan, and 12 hours later, she finally got her laparoscopic appendectomy.  The physician and lab bills arrived within 3 months.  The hospital bill took 6 months and I promptly paid my portion of the insurance company/hospital  negotiated bill.  (Original charges were 48 thousand dollars for the 12 hour ER, surgery and one night stay)  A full 8 months after the hospitalization,  I got the radiolgist bill that included a charge for a chest CT scan.  After speaking with the patient advocate office, I got the charge investigated and removed.  As a divorced parent still paying off 130 K in medical school loans, I was relieved to find my daughter was still covered under her dad's insurance since her surgery happened the day before her 19th birthday.

You have an auto accident.  In our case it was a single car weather related one, in which our son was driven off the road with the offender leaving the scene.  We have very good health insurance with only a 100.00 deductible for emergency room treatment and we carry the optional med pay on our automobile insurance also. The ambulance charges are covered by health insurance at 80-20.  All toll, paying for the two insurances, and this only being a 3 hour ER experience, we should have had NO out of pocket cost.  WRONG.  Not with manner in which hospitals try every which way to gleen money from patients and insurances despite the contractual agreements they have entered with the health insurance providers.   Our optional med pay that we pay additinal premiums to have, was designed to cover deductibles, copays, and any out of pocket expense beyond what our health insurance paid to the hospital.  On our EOB it specifically states that the only amount owed by the patient was 100.00.  Yet, the hospital took the auto insurance policy number off the acdident report, and simultaneously billed both health insurance and auto for the FULL retail amount of the hospital charges as if we had no medical insurance at all!  They sent a "notice of lien" to our son!  TWO insurances.  Health insurance with a contracted agreement and a hospital that is an IN NETWORK provider to boot!  We had always carried 25,000 in med pay but our agent screwed up and lowered it to 2,000 when this vehicle was purchased and we didn't catch it.  The hospital was paid the full amount available on the med pay, 2,000.00 plus the capitated coverage from our health insurance as well.  We were stuck paying the 20% remaining balance on the ambulance charges since our health insurance covered only 80% of that bill.  Had we had larger limits on the med pay, the hospital would have billed our auto insurance for the FULL retail amount of the bill as if we were "uninsured" without a health insurance plan.  Bottom line, when they do this, the amount that your auto insurance pays out, is added to the losses they also pay for the wreck itself, and this whole sum amount is reported as a percentage of loss on you CLUE report. The hospital is double dipping and enriching themselves beyond what they are entitled to receive, and totally ignoring the contracts they have with your health insurance provider!  You, wind up with increased loss amounts on your CLUE report as well as out of pocket expenses you should NOT have had to pay!  Call the billing department, and they will snottily tell you that they have no intention of returning any monies they double billed for, even though they knew that they were treating a patient that had full medical coverage, in network, that should have only had to pay them 100.00.  

We did not give them the policy number of our auto insurance company.  They took if off the accident report.  So even if you don't give them the information, they will remove it themselves and find ways to get additional monies at a retail level for a bill you do not owe!  

Most people do not understand their coverages and I'm sure this practice is more rampant than most people realize.  It enlightened us on the lacivious practices of hospitals in their quest to make up for lsoses on the backs of those of us that have been fortunate enough to carry necessary insurance.  They have devised a way to do this because they know that most insurance companies will not subdrogate to get monies back when the amount taken are not of huge proporiton; it is too costly.  Multiply this practice by how many people and the retail monies they are getting likely amount to a very tidy sum.  

This particular hospital, book the entire sum of 2000.00 even though we owed only 100.00 deductible and gave us a "credit" of 100.00 of that money to the deductible we did owe them.  They gleened a nice profit of 1,900.00 above what they were owed.  Those remaining 1,900.00 were to be used for PATIENT out of pocket deductibles and expenses such as the remaining 20% ambulance charge. Nope.... it wound up in the pockets of the hospital.....nice profit, huh?

The larger amount on your CLUE paid out on losses, helps to set your future premiums on your auto polcy at renewal, too.  Bad enough to have a loss, but if it isn't owed because you pay premiums for health insurance why should you be penalized twice because a hospital has found a sneaky way to get money at a retail level from your auto insurance when they are NOT DUE the funds?  You pay and then pay again.

This little scam needs to be addressed.  It is prevailent because most people have a difficult time understanding what is covered  under what policy and for what percentage.  If you have a medical insurance that is self-insured as we do, the Illinois Department of Insurance can't help with the problem as they do not govern those types of health insurance you have to complain to the Attorney General.  

We as consumers, cannot double dip nad receive payouts from insurance beyond our losses.  Why are hospital allowed to double dip and bill for monies beyond the amount the patient legally owes them?  This little secret needs to be exposed for what it is.