Need help with excessive Medical insurance claim.

Joined
Oct 25, 2000
Messages
1,350
My GF recently noticed that she had developed a lump around her left hipbone so so went to the health dept. to get it checked out. The lady she went to determined it wasn't a female related health problem and advised her to see another doctor. The other doctor examines the lump but can't determine what it is, and refers her to go see a local surgeon that has more experience in lumps. Without running any tests, the surgeon advises that the lump needed to be surgically removed to determine what it was.

My GF decides to follow this advice and schedules a surgery date. On the morning of this date, I felt the lump before we went to the hospital. We spent a grand total of maye 2.5 hours at the hospital, an hour of that spent in the waiting room, at preop, and post op. It was an outpatient proceedure.

After performing the surgery, the surgeon approaches me and informs me that the surgery went well, but that she couldn't find any lump to remove, but did remove a little bit of fat that "could have possibly" been the lump. I was a bit astounded and started asking how it was possible that the lump wasn't there, and the surgeon tries to blame hormonal changes in the ovaries.

As soon as the swelling from surgery subsided, it was apparent the lump was still there, in the exact place it had been.

We receive a bill from the surgeon for around $200, but then we get the news from my GF's insurance company. The hospital charged OVER $11,000 for this OR visit. Thats right, Eleven THOUSAND dollars. The insurance covered their end, but it still left my GF with $1700 to pay out of pocket. How can it be possible that a very simple, outpatient proceedure taking less than an hour to perform, can cost $11,000?

We just moved into out Apartment and were struggling to make ends meet as it stands. The hospital is allowing 6 months to pay the $1700, which leaves her paying $300 a month. She doesn't want her credit ruined by missing payments, but she really can't afford this and I can't afford to help her.

Seeing as how the surgeon managed to miss a superball sized lump, this surgery accomplished nothing but draining money, taking time from work, and leaving a 3" scar on my GF's abdomen. All this while not doing what it was supposed to have.

She saw another OBGYN today and was told once again that it had nothing to do with the femal repro. system and it was DEFINATELY not her ovaries or anything hormonal. An ultrasound performed a few weeks after the surgery shows that there is a lump under the surface but that its of unknown origin.

We can't afford to hire a lawyer, and we really don't want to upset the medical personel in this town as long as she still has this lump. At the same time, we don't feel such excessive fees for the surgery were justified, nor can we understand how the head surgeon at this hospital could have not seen this lump once she began the proceedure.

Our main concern is my GF's health and getting rid of this lump, but the money is also a concern since if we have to pay such a rediculous amount, we won't be able to afford to live in our Apt. anymore.
 
This one is easy, though you might not like it:

First, you don't pay the bill. Yell at them or ignore them as you please, but don't pay it.

Then, they will probably keep sending you bills for a long time, adding interest charges, getting more and more insistent. Just ignore it. They might threaten to sue you and/or ruin your credit rating but they won't actually try it. If they did they would not be successful, and hospitals cannot afford that kind of publicity; they depend largely on donations and public funding.

You can get a lawyer but he'll just tell you the same thing I just did and charge you money for it.
 
Been there, done that. One time, I followed exactly what Cougar said, over an outrageously inflated charge. I tossed the dunning letters in the trash, suitably shredded. Their collection agency settled for an entirely reasonable 5 cents on the dollar.

Another time I told my insurance company that the charge was phony, they followed through and thanked me for telling them; so they weren't paying it. End of charge.

Have you gotten on the phone with her insurer and explained what happened? They don't like paying money any more than you do. And when they contest it, the bill will drop like a rock. If the doctor operated on nothing and missed the something he was supposed to operate on, he is in an ambiguous position. The hospital has no business backing him up by pretending you owe money.
 
Thank you for the advice. My GF is extremely worried about her credit, since I have very poor credit and we're just starting out. She is afraid that if she appeals the claim, the insurance company won't pay anything and she'll have the entire bill on her hands, which would end up turned over to a collections agency, thus ruining her credit.

I told her to call the hosp. and ask for an itemized bill explaining exactly how $12,000 is spent in less than 3 hours total visit time for a basic proceedure. This is a private hospital BTW, I don't know if that makes a difference.

I'm just really worried right now because we don't have a lawyer to fight this and can't afford one, but we also can't afford such an inflated bill. I know we could probably argue with the surgeon about the $170 she charged for the operation, and she might give in rather than deal with it, but the Hospital probably doesn't care if the operation was a success or not, it still happened and thats the bill we don't feel is justified.
 
Good point asking for itemization. Once you get it, your insurance company may be in a better position to refuse to pay all or a lot of it, and if they don't pay, that makes it hard for a collection agency to justify dunning you.

Don't worry about them ruining your credit, because if they succeed in getting you to pay an outrageous amount like that, you're ruined anyway. So relax -- and make them justify every nickel.
 
There is the other approach which is to threaten everyone in sight with a malpractice lawsuit for operating on the wrong spot. Find a malpractice attorney and have a single introductory consultation with him. Usually a lawyer will talk to you for a single session for somewhere around 1-2 hundred bucks. Ask if he would send a letter to the hospital on your behaf questioning the bill for incompetent service. The surgeon should have identified the spot with a marking pen while your friend was still conscious to confirm the location. Nurses and other staff should have been questioning what is going on. You should see if the malpractice attorney knows of problems this doctor has had before.
 
Welcome to The System! Stories like this drive me nuts because every insurance company in the country is sticking it to chiropractors because we're "overutilizers" of health care dollars. My average case costs a couple of hundred dollars to resolve. $11,000 for shoddy medical work? I don't think so!
 
I found out today that the Hospital billed the Insurance company in the range of $11,335, the Insurance company only allowed $7,119 and only paid $5,341. This left a total of $1777 for my GF to try to pay off in 6 months. I also found out that this bill of $11,335 doesn't include the bill for the Surgeon, Pathologist, Anesthesiologist. The surgeon charged $170, The Pathologist charged $200, the Anesthesiologist charged $450. I must say, that was the most expensive 3 hours I've even seen in person.

We don't want to go around screaming Malpractice, as my GF still has this lump and still needs to determine what it is and have it removed. We live in a small community and the doctors and lawyers here stick together You can't get one to go against another (lawyer vs. lawyer, doctor vs. doctor). If we throw around malpractice, we may have a hell of a time getting the lump taken care of as other practitioners might be leery of getting sued also.
 
Don't get the lump removed in town. With the cozy relationships you are talking about you are bound to get screwed. Find a more competitive non-community. If the lump is not within her abdominal cavity don't have the work done in a full-fledged hospital. Find an outpatient surgery center. That's the way I had my double hernia repaired.
 
Chiro75 said:
Welcome to The System! Stories like this drive me nuts because every insurance company in the country is sticking it to chiropractors because we're "overutilizers" of health care dollars. My average case costs a couple of hundred dollars to resolve. $11,000 for shoddy medical work? I don't think so!


I've had a couple of great Chiropractors who helped me and saved me a lot of pain. Thank God for them. But, I also had a Chiropractic "group" who, upon initial consultation, determined how much insurance money I had for Chiropractic care, and set me up immediately for enough visits to use it all up. What jokers. I dropped them like a rock and never went back. I hate thieves.
 
HAving been through something somewhat like this, first you should have a needle biopsy done before any surgery. secondly if she needs surgery darw a big circle in magic marker around the lump before surgery.

As far as the bill goes, and I migth be mistaken, as long as you are paying they can't bitch. SO send them a letter and tell them you can't afford the 300 a month and tell them you can afford $20 a month. Send them $20 a month.

In the mean time you need to appeal the bill. Also write down what the surgeon told you and that the lump is still there. and I agree with the advice that you may have to got out of town for further care.
 
Every hospital has a claims department. If you tell them what happened and they still insist you must pay, you have no choice but to get a lawyer. Not only should they cover the cost of this surgery, but they owe your girlfriend for scaring her up. Don't take this **** and do not pay a cent. This was medical malpractice pure and simple. The hospitals first tactic is ALWAYS to scare you into paying. Once they realize you are serious, they will back off.
 
Back
Top