Medical Debt Saga Part II : Anyone know anything about OR billing?

[1monster]

Part one is here: http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=1689369&mesg_id=1689369

I need to know if anyone knows what these are and if it is appropriate to bill them seperately or if the norm is to include these with the OR charge. Also, I need to know if the cost is out of line with the norm. (The medical verification person believes that it is tantamont to double billing. The hospital has not complied with my request to provide documentation for these two charges.

This was for a triple bypass:

Cell Saver: $1,221.70
Open Heart Perfusion: $5,200.00

I got a very frosty reception from the hospital billing clerk when I called. I asked her if I could speak to her boss, but she said the boss was busy.

I asked when I could see her at the hospital. She anwered that if I came in within the half hour, I could see the supervisor.

Twenty minutes later I was there. Talked to the same woman who had been very unfriendly over the phone.

She told me that the reason the medical verification rep said that there was a problem with the bill was that he and the insurance company made money that way...

She was extremely uncooperative acting as though I was in the wrong for asking for docuemntation via a letter instead of talking to them in person. She stated that I was in the wrong for talking to the insurance company and the medical review rep rather than them. And that I had done nothing to take care of the problem.

When I pointed out that I had sent them a letter requesting documentation, they did not answer me, and again when I replied to the collections law firm stating that the account was in dispute because the hospital did not supply the requested documentation, she stated that they did get in touch with us by sending a statement. She said they left a message on my home phone (I didn't have an answering machine until last week and I haven't hooked it up yet) and my husband's cell phone BEFORE I sent them the letter.

I asked to see her supervisor, the one she told me would see me if I came in within the half hour.

"She's not here. She has left for the afternoon," said the woman.

:grr:

The gave me a print out of all the charges both paid and unpaid. I asked for a separate print out of the charges that were not paid, but she said that was impossible. (Four years ago, it was not impossible...but maybe they got new software.)

I came home and got a call from the medical bill verification company. A new rep was handling this case.

He told me that he had spoken to the same woman I saw at the hospital an hour before I got there explaining that he was the new rep for this case. He said she was polite, but not cordial. (Please note that she did not tell me that the rep had been in touch.)

:grr: :grr:

The hospital billing clerk told me that insurance companies "never pay 100% of the hospital bills" and indicated that the over $7500.00 disallowed charges were due to "acceptable and customary charges" type thing.

The new medical review rep sent me via e-mail a print out of all the charges and why had not been paid and why. Of the $7500 plus outstanding balance, that charge was $21.20...

I'll be happy to write a check for that immediately.

In the meantime, the medical review rep is talking to the insurance company and said it is possible that if the hospital provide documentaion and a reasonable explanation for the above items being billed separately, the insurance company might pay up.

But the hospital is saying "PAY UP NOW OR WE WILL START COURT PROCEDINGS"

(My offer of $1,000 was turned down flat. She said nothing less than $5000 which is almost as bad as $7500... sigh.