Panic for Profit

I, more than many, understand how mind-numbing the medical billing process can be.  That said, I feel like I’m in a position of slight competence where hospitals vs. insurance companies are concerned.  So I’ll give you a quick recap of what we’re dealing with, and I’ll endeavor to make it as entertaining as possible.

Insurance companies.  The debbil, right?  You pay all this money to them, and when it’s time for you to actually use their services they suddenly disappear in a cloud of red tape and denial letters.  That does indeed happen.  But let me assure you that hospitals are not downy innocents in this ongoing game of “Who Can Keep Your Money the Longest.”  And some of the reactions by insurance companies are direct results of how shady hospital billing can be.  And hospital billing is shady because…well, they can be.  You’re at the hospital because you need help, after all, and therefore you’re susceptible to doing whatever the hell the hospital asks.

evilhospitalYou look fine.  Would you kindly see the billing office on your way out? 

As an example, Jen and I have been going to the High Risk Pregnancy Imaging Center at Memorial Hermann Katy.  We’ve had several ultrasounds done there, and have (at least) a few more to go.  Yes, Daphne looks fine; we’re told these are for “monitoring purposes.”
The interesting bit is that they’ve been charging us a $500+ admission fee at the gate to ride Ultrasound Mountain.  Thing is, they’ve never bothered to bill Jen’s insurance.  They just kept the cash she was paying them and quietly went on their way.  Now let me tell you why.

Insurance companies have contracts with hospitals that essentially provide them a bulk discount.  So when a hospital sends a bill to Blue Cross/Blue Shield, the agreed upon discount kicks into effect and BC/BS gets roughly 40% off the total bill.  It’s much more complicated than that, but that’s the gist of it.  So, obviously, if a hospital can convince a patient to pay cash, they’d get to keep the full amount rather than suffer these “contractual adjustments.”  (There’s even more money on the back end because patients are responsible for their co-insurance up to a certain dollar amount annually, but let’s leave that alone for now.)

So hospitals don’t want to bill your insurance because they’d receive less money.  And your insurance, naturally, is just fine with this because they get to just keep your monthly payments without having to render any kind of service.  So you get people paying straight cash homie, for services that should already be covered.


Yes, it’s screwed all around.  (Although if it weren’t, I’d be out of a job.)

Anyway we started the process of correcting this little snafu yesterday and the suddenly the hospital has become very accommodating.

You know, you’re right!  You do seem to have a credit in our system.  Please don’t contact your insurer about this.  Call down to our billing office and we fix for you.  Oh!  And today is special deal, just for you.  Is $100 for treatment.  Is good deal, yes?

The real payoff to all this is that we get more of those strange, in-utero 3d images of my daughter.  So here you go:

daphne4Daphne’s profile pic.


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