Medical Insurance Billing Nightmare

It is a medical insurance nightmare that began with a physician simply trying to make things easier for a patient.

A simple favor turned into money seizures, bill collections, and a lawsuit that were spinning out of control.

So, it was time to Get Gephardt.

The doctor patient relationship can be very personal.

So personal that I know many kind doctors will go out of their way to provide special help to a patient who is in particular need.

In this case, such a personal favor turned into a medical insurance nightmare for the patient...

With the energy Tiffany Schoenfeld displays to supervise her children around her home, you wouldn't suspect that she has a heart condition.

But she does...

Back in February of 2007, Tiffany wound up here at the University of Utah Medical Center Adult Congenital Heart Clinic, where Tiffany's insurance covered treatment by only one of the doctors. Her insurance did not cover an electrocardiogram heart test.

But, in Tiffany's need, the doctors worked out a deal.

"They all came back in and said, oh, it's your lucky day," Tiffany says.

The doctors arranged that no matter what happened, all of her treatment would be billed through that one doctor who took her insurance.

But then someone filled out insurance forms that sent the bill through the wrong doctor. And that was the beginning of a 2-year medical insurance nightmare.

The first bill from University Healthcare rejected by the insurance company came to $978...And Tiffany sent in her appeals.

"None of it was supposed to be charged," she says.

But after Tiffany appealed to the University of Utah Medical Center, another bill came...with late charges.

So, this time, the nurse went to the billing department to tell them about the mistake.

But that didn't work, as Tiffany found out when the state of Utah seized her money.

That's right. The state of Utah with no trial, or even a hearing, can seize a citizen's tax refund. The Utah Attorney General acts as the collection agent if a state institution, like the University of Utah Medical Center simply says a citizen owes money

The state seizure was $500 dollars. But, by now, the bill had now grown to nearly $1400.

So, this time, the University of Utah Medical Center sent the bill to their collection agency, Express Recovery.

And that brought tiffany to Second District Court in Layton for mediation with Express Recovery's lawyer.

Tiffany was armed with a letter. It is from the nurse who tried to stand up for Tiffany once before. The nurse wrote that she "was personally present" when the doctor said he would be "waiving his fee." Tiffany gave the letter to the lawyer, but that didn't do any good.

The lawyer sent Tiffany back to mediation, and when she tried to explain again Experess Recovery Lawyer Edwin Parry sued Tiffany. Now Tiffany needed a lawyer. It cost her $130 an hour on a bill she never owed.

A court date was set, but Tiffany's lawyer got the trial postponed...and that's when she called me...nearly 2 years later.

I called Chris Nelson, the head of Public Affairs at University of Utah Healthcare. And over night, this medical insurance nightmare was over.

"You know, this went to the highest level of our hospital's administration. And as everyone looked at this, it was kind of an obvious thing. Yeah, this was not handled well...so we need to do what's right for the patient," Nelson says.

And within days, a check came from university hospital for $503. The amount seized so long ago from Tiffany's state tax refund.

And that lawsuit to collect the rest of the money is dropped...Tiffany got lumped into a collection system that sometimes doesn't look closely at individual cases.

“For every one Tiffany,” Nelson says, “unfortunately, there are probably 40 or 50 other cases where folks are trying to maybe not pay their bills. But we need to not be brushing everybody with the same stroke."

And University of Utah Healthcare is paying all of Tiffany's attorney fees.

So, the problem here stemmed from a doctor trying to do a patient in need a favor, but when the doctor did not carefully follow his own paperwork to have it properly billed, the favor wound up as a billing system medical insurance nightmare.

Source:http://www.kutv.com/content/news

Types of health insurance

There are many different types of health insurance programs, most of which can be divided into three basic areas of protection. The first type of protection is called a fee-for-service indemnity plan and generally provides for hospital, surgical and medical needs, including major medical, comprehensive, catastrophic, and dental plans. This insurance is provided by commercial insurance companies, independent organizations, and by Blue Cross and Blue Shield.

Rates depend on which plan you buy, the level of coverage your employer or you choose, and whether you purchase individual or family protection. The second basic type of health insurance protection is the prepaid health care plan. The major providers of prepaid care consist of HMO's or health maintenance organizations, and PPO's or preferred provider organizations.

These are groups of doctors, hospitals, and other health care professionals who have joined together to provide members with prepaid medical care. Instead of paying a premium, each member pays a flat monthly or quarterly fee. The last type of coverage available is governmental health insurance, including both Medicare and Medicaid. check
your local governmental offices to see if you qualify. For more information about health insurance, contact a local insurance professional in your area.

Source:http://www.abc15.com/guides