By Eric Schoen
I had a wakeup call several weeks ago. As many of you know, I had two complete knee replacements last year. Thankfully, both went smoothly and recovery had none of the complications you frequently hear about.
These procedures are quite expensive and you receive doctor bills and bills for services from many companies. Some of these companies don’t have your doctor’s name as part of the corporate name the billing is under. Some of them are from doctors who might have stopped in on you one day and your sedation, nervousness or pain level didn’t put you in a frame of mind to ask their name, specialty, what they were there for, or the billing name of the company they go through.
Even if they did, these corporate names might not tell you that Dr. XYZ is part of the hypothetical Yonkers Doctor Billing Company.
Things can get a wee bit complicated and you have to stay on your toes to make sure the bills are correct. Thank God I am of sound mind and body (even though a few who read this column may question that) and can read and decipher and question my medical bills. Sadly, many cannot do that.
Let’s get back to the medical bill I received. It had on it a charge for Medicare evaluation and certification. In the $100 range. There’s only one big problem here: I am too young for Medicare. And not only did it have one charge for Medicare, but a second charge for Medicare evaluation and certification for a second month!
I called the billing service for the doctor and they realized their mistake and told me they would immediately cancel the charge and that I didn’t have to worry about it. But I said to myself: If there is one, there’s probably a thousand bills that go out every day for services people don’t receive.
How about the bills you receive from a stay at a hospital for doctors and other professional services that you receive in the hospital from individuals who not part of your health plan, but are on staff at the hospital to provide services you need? You receive the bill from the doctor saying all or part of the services are not covered, but you had no choice as to whether the doctor you needed to see was in your plan.
These are called surprise bills in New York State. If the state determines the insurance company has sufficiently compensated the doctor for the services, you will not be required to pay a co-payment or any part of the bill. There are procedures to follow that are different on many plans, but if the scenario is yours, call your insurance company and ask them what to do.
The decision about whether your condition requires you to go to a hospital or can be handled at an Urgent Care Center is also important, in terms of what your final bill will be. Obviously, if you are having a heart attack, a stroke or can’t breathe, you call 911 for an ambulance to take you to the hospital.
If there is any question as to the severity of a situation, you call your doctor’s office, your insurance company or the Nurseline 24-hour-a-day service most insurance companies offer. If the Nurseline or insurance company (and obviously if the doctor) tells you to call 911 or go to the hospital, you follow their direction. If they say an Urgent Care Center is fine, go there. You don’t want to be hit with a co-payment or fee for a higher level of service than you need to be.
It is important that you or a family member scrutinize every medical or hospital bill you receive. Believe me, many mistakes are made because the wrong key was punched or someone made a mistake or error with no intent to commit fraud. Most importantly, just because you received a bill, it doesn’t mean you have to pay it.
If it is determined that you have to pay the bill, ask for a discount or to allow the bill to be paid over a time period or via a payment plan. Let’s face it, if there is a $175 doctor bill you don’t believe you have to pay, but the medical facility is demanding payment, it will cost far more in legal fees than $175 to take this claim to court. So it is in the best interest of the facility to settle directly with you than to go to court.
Please note that every situation is different and my words today are just that, my words, and not professional advice. I bring this issue to your attention because I believe it is important that in this day and age, when so many of us have basic health issues (some quite complex), that there are rules out there and “off the record” negotiations that can occur so you aren’t bankrupt over medical expenses.
Let’s hope our legislators in Washington and Albany – just as they had when people were getting ready for Obamacare – would set up groups of professionally trained health care advisors throughout the country to assist you in understanding and paying your medical bills.
With all the changes in insurance, there are many concerned consumers out there who need a helping hand determining whether to pay a medical bill. Don’t be scared if they use tactics to attempt to coerce you to pay a medical bill. These methods, often illegal, are meant to scare you. Ask the caller for something in writing or tell them you are going to record the call. Don’t be surprised if you get “Mr. Click,” or the person who is calling hangs up and turns to play the same shenanigans on someone else!
More Health & Welfare News
Again, someone in Westchester was attempting to be scammed by a caller who told them their relative is in trouble and they need a source of payment to set them free. This is a longtime scam. If you get the call, hang up and call the police immediately.
We must have proof that anyone who sets foot on our shores has received proper vaccination. It is because this was not checked upon entry to this county that the measles is spreading to more than half of our states.
The World Health Organization has declared “video health addiction” an official mental health disorder. So why not go to the Yonkers Public Library, where they will lend you a telescope? Go outside on these beautiful spring and summer nights and look at the stars and the sky. You will realize there is so much more out there we need to explore!
What will the library lend out next? It’s not your grandparents’ or parents’ library, anymore. There’s so much to do and see and read!
Reach Eric Schoen at thistooisyonkers@aol.com. Follow him on Twitter @ericyonkers. Listen to Eric Schoen and Dan Murphy on the Westchester Rising Radio Show on Thursdays from 10 to 11 a.m. on WVOX 1460 AM, go to WVOX.com and click the arrow to listen to the live stream or download the WVOX app from the App Store free of charge.
