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Insured Californians Getting Gouged by Out-of-Network Providers

Insured Californians Getting Gouged by Out-of-Network Providers June 16, 2020. By Jane Mundy.
Santa Clara, CA Back in 2017, a law was passed to protect Californians against surprise medical bills for non-emergency care. Before that, AB1611 was proposed: it was supposed to protect against emergency room overcharges but California consumers are still getting gouged by out-of-network providers.
Read [ Insured Californians Getting Gouged by Out-of-Network Providers ]

Getting Caught Can Reduce Emergency Room Overcharges

Getting Caught Can Reduce Emergency Room Overcharges May 14, 2020. By Jane Mundy.
San Francisco, CA Last year Zuckerberg San Francisco General Hospital reduced a patient’s emergency room charges from $20,243 bill down to $200—after the patient, Nina Dang, contacted the media. She broke her arm on the pavement in a bike accident. Can’t reach the media? Of course lawyers experienced with negotiating ER overcharges can also substantially reduce hospital costs, both for insured and uninsured patients. “It’s frustrating that I have to hire a lawyer, but so far it’s been worth it,” said another ER patient, Alexa Sulvetta.
Read [ Getting Caught Can Reduce Emergency Room Overcharges ]

Emergency Room Overcharges –Surprise!

Emergency Room Overcharges –Surprise! April 16, 2020. By Jane Mundy.
Santa Clara, CA Almost one-third of Americans with health insurance who wind up in an emergency room find out after the fact that their health plan doesn’t cover as much as they thought. Given that there are about 140 million ER visits each year, and “surprise” emergency room charges are so frequent that 59 percent of Americans have been contacted by a debt collector and 16 percent of Americans’ credit reports include medical debt due to overdue medical bills, it’s not such as surprise that this debt totals about $81 billion.
Read [ Emergency Room Overcharges –Surprise! ]

Emergency Room Overcharges with Coronavirus Test

Emergency Room Overcharges with Coronavirus Test April 5, 2020. By Jane Mundy.
Santa Clara, CA Despite the $2 trillion coronavirus aid package that includes over $100 billion for hospitals and medical needs, and despite a law signed by President Trump on March 18 that supposedly allows Americans to be tested for coronavirus free of charge, some patients now face emergency room overcharges. While the tests may be free, both insured and uninsured patients are still charged the ER visit to get the test.  And keep in mind that insured patients visiting an emergency room during this crisis could face huge ER costs.
Read [ Emergency Room Overcharges with Coronavirus Test ]

Patients Battle Surprise Emergency Room Charges

Patients Battle Surprise Emergency Room Charges February 20, 2019. By Anne Wallace.
Washington, DC Dr. Joaquin Lopez ‘s surprise emergency room bill came after he and his insurer had already paid $11,000 toward the cost of emergency gallbladder surgery. For dentist Brad Buckingham, who fell off his bicycle, the shock was a $70,000 bill to repair a broken hip. For Stacey Shapiro, it was a $6,720 emergency room fee to treat sudden spell of low blood sugar.
Read [ Patients Battle Surprise Emergency Room Charges ]

Discrepancies in Emergency Room Overcharges Cause Frustration and Financial Woes

Discrepancies in Emergency Room Overcharges Cause Frustration and Financial Woes February 11, 2019. By Jane Mundy.
Scottsdale, AZ: Emergency room care in the US is the highest-priced care a patient can receive. Even a minor condition can set you back thousands of dollars, which in itself can cause health issues—financial problems are stressful. It can get worse: one patient dinged with outrageous emergency room overcharges later discovered that another patient with similar treatment paid a lot less.
Read [ Discrepancies in Emergency Room Overcharges Cause Frustration and Financial Woes ]

ER Charges: Underserved and Over-Charged thanks to Upcoding

ER Charges: Underserved and Over-Charged thanks to Upcoding January 10, 2019. By Jane Mundy.

Los Angeles, CA: When a nine-year old accidentally had gasoline splashed in her eyes, her mother immediately drove her to the closest hospital emergency room. They were directed to the eyewash station but it was so dirty they couldn’t use it, so Brianna’s mom rinsed her daughter’s eyes at a regular sink. Turns out, they would have been better off using the gas station’s eyewash, which was free. The ER sink cost $1,400: the hospital charged $600 and the ER doctor fee was $800 (for walking into the room, saying Brianna needed an eyewash station and walking out). Upcoding has become common practice, resulting in emergency room overcharges and increased health costs for everyone.

Levels of Care




Brianna’s care was billed as “Level 3” which means a health problem--such as fractures or signs of infection--is significant but not life threatening. Most hospitals are based on a five level triage system, with five being the most severe. Dr Kathleen Handal explains that there are commonly three levels of ERs:


Level 1: Highest level ER, indicating the ability to give definitive, rapid care for all critical emergency situations; usually associated with a teaching hospital. Resources within the hospital (diagnostic and intensive care units) can continue to care for these patients. Level 1 trauma centers have an in-house trauma surgeon and on-call specialists available, as well as an open operating room.


Level 2: The ER can care for most emergencies. All specialties are on-call and available within 60 minutes; usually no residents on staff. Emergency medicine (EM) doctor cares for patient until back-up specialist responds to the request for assistance. In-hospital resources are limited.


Level 3: Treatment by EM doctors. Not all specialties available to come to ER to help. Patient will be stabilized and transported to an appropriate care facility. Trauma patients will be transferred to another hospital that is equipped to handle the trauma.


(If a hospital has a Level 3 trauma designation it can charge thousands of dollars more for trauma expertise. One hospital that is owned by the largest for-profit hospital chain in the United States, the Hospital Corporation of America, charges nearly $10,000 on top of regular medical treatment for trauma care. According to the Las Vegas Review Journal, money was the impetus for Centennial Hills –the hospital Brianna visited, to seek a level 3 trauma center.)

What is UpCoding?




“Upcoding” occurs when a healthcare provider, such as an ER doctor, submits codes on medical bills to patients for more serious (and more expensive) diagnoses or procedures than the provider actually diagnosed or performed. Just about any service or medical procedure can be up-coded, from billing a simple x-ray as more complex to having a nurse treat you but billing treatment by a doctor to using a sink as an eyewash station. Upcoding is illegal--it is fraud--but hospital ERs and healthcare providers are continually caught doing it. And it winds up costing everyone, including insured and uninsured patients. Insured patients wind up paying more because health insurance companies overpay, and their monetary loss is balanced by increasing the cost of healthcare premiums.

Upcoding Fraud– Complaints to LawyersandSettlements




Jose from Anaheim: “I went to ER one night and paid $1,500 for a CAT Scan so they could tell me I had a hernia, which I already knew and told them as much. They charged me another $900 for drugs and I agreed to make monthly payments, but I wasn’t able to pay it right away. About six months later I was mailed a bill for $14,000. WTF, how can they do that? Now my credit is ruined.”


Charlie from Virginia: “I was bitten by a bat, phoned my doctor’s office and was told to go to ER. I never saw a doctor. I was given Human Rabies Immune Globulin, a rabies shot, a Benadryl shot and a bill for $44,151.44. I was charged $33,168.04 for the immune globulin by itself. Then I did some research and the CDC estimates that it costs between $3,000 and $7,000.”


Jason from Alabama: “I went to the ER and was diagnosed with bronchitis after having blood tests and an x-ray. I was there for only two hours and was billed $3,710.30. As if that isn’t bad enough, it was adjusted (I have no idea why, it didn’t say) from $6,746.00. It was just bronchitis! And my insurance didn’t go into effect until a few months later. How on earth can they do this?”


Betty from Nashville: “I went to the closest ER for a stomach problem. (Our insurer never told us where or where not to go.) They ran some heart tests and other tests, even though I was complaining about a stomach ache. I am also a runner and very healthy. What a surprise to get a bill for $4,000 after they already got $2,000 from our insurance company! This is outrageous. We have been emotionally and financially drained: my husband is a retiree and we both work part time. What can we do?”

What You Can Do – Be Proactive




Whenever possible, don’t go to ER. Call your doctor first or call your insurer’s nurse triage hot line. Go over your bill, read the small print. If you think the charge looks wrong, call the hospital’s billing department. Mistakes can and do happen. You can negotiate a bill, even when you have insurance. The majority of hospitals will discount private paying patients’ bills. But act sooner than later as unpaid ER bills are forwarded to collection agencies. If that happens, you should consider legal advice.
Read [ ER Charges: Underserved and Over-Charged thanks to Upcoding ]

Michigan Patient Billed Over $1,000 for Sitting in the Waiting Room

Michigan Patient Billed Over $1,000 for Sitting in the Waiting Room February 23, 2018. By Gordon Gibb.
Grand Rapids, MI:Judy Burton did what most people do when they begin suffering unexplained pains while at home on a Saturday evening: she proceeded to the nearest emergency room to get checked out. The Michigan resident told FOX 17 News (11/17/17) that she wound up not requiring treatment after her pains subsided and after about an hour simply left the waiting room and went home. Imagine her surprise when she received a bill about 2 weeks later for over $1,000 in emergency room charges.
Read [ Michigan Patient Billed Over $1,000 for Sitting in the Waiting Room ]

Medical Billing and Hospital Overcharges - What Happened to the Hippocratic Oath of "first, do no harm"?

Medical Billing and Hospital Overcharges - What Happened to the Hippocratic Oath of "first, do no harm"? February 19, 2018. By Jane Mundy.
Tampa, FL: Attorney Ben Stewart is seeing an increase in hospital overcharging, mostly to uninsured people. "Look carefully at your medical bills. If you have been overcharged and have either started a payment schedule or completed payment, you may be entitled to monetary damages," says Stewart.
Read [ Medical Billing and Hospital Overcharges - What Happened to the Hippocratic Oath of "first, do no harm"? ]

ER Bills and Hospital Overcharging: It’s Not Getting Any Better

ER Bills and Hospital Overcharging: It’s Not Getting Any Better October 30, 2017. By Gordon Gibb.
Boston, MA: Regardless of the machinations undertaken by the Trump Administration to replace the so-called ‘Obama Care’ with something that may, or may not be superior the fact remains that health care costs continue to balloon, with hospital billings and emergency room charges chronically higher than rates set by Medicare. With such hospital overcharging going on, it’s little wonder patients seek justice with an ER bill lawsuit, or similar.
Read [ ER Bills and Hospital Overcharging: It’s Not Getting Any Better ]


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