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.  

My wife has Medicare part A (hospitalization) with NO part B (Doctors, Labs, etc.) because I have a private medical insurance policy by Guardian PPO for the both of us.

My wife has been admitted by her In-Network Doctor to a Guardian PPO (In-Network hospital) by the name of Orange County Memorial Medical Center, Fountain Valley, CA  on several occassions, because this is one of the hospials that he has privileges. We usually have  little or no problems during the time spent or with Billing and Insurance afterward. On an occassion Billing has not sent the hospitalization to Medicare part A first and this has caused several issues. Yes, you need to stay on top of your Insurance EOB's.

One evening she became very sick from an ongoing related disability and asked if I would take her to the same hospital for the ER to help and possibly admit. They did admit.

Months later I get a bill from an "ER Visit / Wong'. It turns out that even though the hospital is in-network not all of there ER Docs are. Now I ask you how would you know this in an Emergency situation? I assumed that any services that took place in that In-Network Hospital would be billed as In-Network becasue this has been the case many times over during my wifes disability and prior admits. But not at this hospital. We have tried at all levels to get this rectified and no one has really wanted to address a simple issue and it concerns me that this is probably happening to many people, other than ourselves. I believe this is referred to as 'Balanced Billing".

As you can see I am not going to let this slide even though I feel more than blessed with most of the medical care that my wife has received over the last 13 years.

Note: We feel so fortunate to be able to call ourselves Americans and native to  Southern Californian. God could of allowed us to be born in some third world country where we might not have the great medical system that we have.  May God continue to bless America.

I noticed this article a few minutes after again dealing with a medical service provider on related billing issues. I am so disgusted with insurance and medical billing systems I just had to say something, to somebody.  

During 2007 my 15 year-old daughter had her second liver transplant. Between transplants there were years of extensive medical issues that would take hours to fully explain.

To make a very long story a bit shorter…I recently had to submit one claim 5 times AND file a formal grievance with the insurance company (a popular Southern California organization) and with a State agency before finally receiving reimbursement 10 months later. Errors are very common in routine claim processing and getting them fixed normally requires a formal grievance during which time service providers seem more tham happy to seek the services of collection agenies. The only thing worse than dealing with a claims representative on the telephone is dealing with one on the insurance company website. The good thing about electronic communications is that you get a written record of their level of stupidity.

I could go on and one but just don’t have the time today…

This is why i think universal health care is a lot better.I come from Europe and many country,s have them,including mine.The is no such thing of getting bills in your mail from hospital stay's.You can choose any doctor,specialist or hospital where you like to be treated at.And that goes for everybody.No need to worry if you have major surgery,s.Medication is a lot cheaper.There is no thing as network provider book that HMO patient,s have to use to chose their doctor,s from,like i said same care for everybody.I find it sad in a country that is not poor,where people have to worry of maybe going bankrupt because of the exspensiv medical bills.And my country is not bigger then the size of Texas.If we can do it,why not this big country.And we had this system for many a years.

excuse me i meant we have this system for many year's.(Typing error):)

That is awful! but it is not new. I'm not sure of your premiums but the insurance from my previous job was also PPO but we had far higher copays, $25 to see docs, $50 specialists, $250 hospital, $3500 ded, and my Friend, try a 60/40 %  if you think 90/10 is bad. You read that right, they pay 60, you pay 40% and try nearly $200 a month in premiums for single. It was a group plan that was designed to benefit the company. However, if you tried to get the a decent plan on your own w/ dental, it'd cost you around $300 + single. Insurance is awful here.

I had a kidney stone at one point but I didnt even have insurance, it cost me nearly $1000, I was in the hospital for only a few hours, had some xrays, ink injected, several morphine injections and thats it. I like you, received multiple bills, one from the physician, the hospital, radiology etc. One thing to remember IF possible, NOT to go be admitted via the emergency room it seems. As odd as that sounds for the pain you're in, same symptoms of your wife, they charge almost $500 JUST for coming in through the emergency room. Its sickening, no wonder insurance premiums are high but in the end, insurance comps dont suffer, nor does the doc/ institution, its the patient & Family. Thank You for sharing your story.