Scan Medical Insurance

Fighting with insurance and hospital?

In May of 2006 while on vacation in Denver, my husband's esophogus closed and after 7 hours in the ER he was wheeled in for an emergency EGD dialation and removal of the foreign object (in this case, chicken). They gave us the statement in early June after our health insurance (United Healthcare) paid for their 90%. That's fine. We don't mind. The bill was $330. Then we looked at the statement. This is what they were charging us for, among other things: 5/18 -- EGD W/ Savory Dilation (1 unit) $2581.70 5/18 -- EGD W/ Remov Foreign Body (1 unit) $2531.10 Basically, it looks like (to us and some medical professionals we've spoken with) that they are charging us twice for the same surgery. The professionals we have been speaking with have pointed out that they should have charged full price for one of the procedures and knocked it down to a $300-$500 fee for the other procedure. We called the insurance, and they said to call the hospital. We called the hospital and... ...and 3 weeks ago they said they would put our account on hold for 2 weeks while our account was audited. Obviously it's been more than 2 weeks. We called, and they said it had just been sent to the auditing department TODAY. We asked them if our account would still be on hold, and they said it depended on the circumstance. We have a message with the supervisor, but now we just don't know how to go foreward with this. Our insurance doesn't give a flying flip even though we think they made a mistake. Any advice?

Public Comments

1. they are trying to cover up a mistake by the sounds of things consider the bill paid for
2. Just stay on top of it, document who you speak with, what you talk about and when. I would also restate in every conversation that you are not paying the bill until it has been resolved, and that you want to make sure that they don't put your account into collections. If the insurance company doesn't care fine for them. Just make sure you aren't paying for it. The one time I had issues with a dentist billing me for things I didn't think were necessary the first thing I told them was I would report them to my insurance company for fraudulent billing. They turned around real fast!
3. The coding & billing look fine to me... "A balloon dilator passed through the endoscope is often inflated within the confines of the stricture, thus opening the area and relieving the patient's symptoms. (These are called Mallony or savory dilators in increasing sizes & break open the stricture. In either case, the patients are sedated.)" << (from www.gastromd.com)... So, this is the basic description for the EGD W/ savory dilation for $2581.70. The second EGD w/ extraction is self explanatory... So, they're different procedures. That's how much they cost. One is the dilation. One is the extraction. Because they can both be performed separately, they have separate medical procedure codes. The "fee or price cut" someone referred to is called a multiple surgery discount... Which, if your balance was $330.00, they applied. Usually multiple surgeries pay 100% for the first procedure. 50% for the second. and 25% for the third... So, your 10% is about right if the procedure allowable is about $3500.00, instead of $5000.00. This looks correct to me. I've coded & audited hospital and surgical claims for several years. They're not charging you twice or trying to rip you off. This is the way medical coding works. I know it may seem fraudulent or like double billing; however, it is not. If he indeed did have a dilation & extraction this appears to be valid. I'm not sure which "professionals" you were speaking with. I can assure you medical coding is tricky & not always intuative. Speak with a coder or a supervisor @ your insurance company or hospital if you have additional questions or concerns. They can try to explain more if you can find someone who knows what they're talking about. Call the gastroenterologists office.. They probably billed the same way. Maybe they'll offer a better explanation. Sorry to tell you, but the "audit" @ the hospital probably won't change anything. If they do write off the balance to satisfy an upset customer, they're probably doing it to make you happy. sorry you spent so much time on this...
4. sorry but unless you get a good lawyer your not going to win; as the hospital just cares about making money (in the end); not who is right
5. Don't stop until you get the situation resolved but the billing department may be charging because these are two different things. They should be considered one procedure but that is not how diagnosis codes work with billing sometimes. Seeing that they are considering one a dilation and the other a removal. These are two differnet things. It is rare that the cost of both are so close with just a few cents difference. In a diagnosis code the EGD would just stand for the area of the body that was affected and not the actual procedure done.
6. I stopped selling health insurance years ago because the system in our country is terribly flawed. Overbilling, denials for no just reason, corruption at every level. Please see MIchael Moore's new documentay " SickO". It should wake up all Americans( well probably not Bush)