[apdakin]

Hi! I'm Adriana and am looking for some advice on a seemingly stuck problem after having birth control removed. Actually there are 2 parts of the issue.

1) I think the hospital may have overcharged for pulling out my IUD. Last spring I had an IUD removed at the hospital because the removal strings were tucked up a little and not accessible when clinic nurses tried. First I had an ultrasound that showed the device was right where it should be, though, and a doc was able to remove it easily in the hospital when I was under general anesthesia. The procedure took about 2 hours tops I think, including prep and recovery. They charged a bit over $17,000 for ultrasound + procedure, and didn't let me know ahead of time what it would cost or that insurance wasn't going to cover it. My IUD needed to be taken out at some point, but technically it still had 1.5 years of life left on it, so I could have fixed the insurance issue at my leisure and then gotten it removed. When I've asked the hospital how much this usually costs, they can't or don't say. I don't have the money to pay it, especially since it should have been covered by insurance or I wouldn't have done it then. By comparison, my cesarian deliveries for both children (with actual surgery, sedation, and 3 days of care in the hospital) each cost about $30,000.

2) My employer-provided insurance with UnitedHealthcare has declined to cover the $17k bill so far because it wasn't done in Washington DC. They mistakenly put me in a DC network since the company I work for has an office there. It seems like a type of fraud not to fix that issue since they had my home address on my insurance paperwork right from the start (and have sent insurance card etc to my home). The Washington DC network limitation wasn't clear to any of us at first -- even the biz manager at my company checked if any employees were mistakenly in this group after a similar problem occurred with another employee not living in DC, and didn't find me among that group.

Ex post facto, UnitedHealthcare just wrote in December that they would cover the claim if I had a primary care physician on file, but there's no doctor here in California who's in their DC network (2.5k miles away), and it's past the 6-month time frame to add someone. I can appeal to add a PCP if I have a Washington DC doctor, but wouldn't that be un-kosher to add a DC doc I've never seen? And that should be unnecessary since they've had my home address all along and were happy to be paid for my insurance by my employer. They initially said we have to prove that they made a mistake putting me in a DC network. That's hard since DC isn't mentioned on the paperwork as far as we can tell, and I applied with my CA address. I've had health insurance every year in the past and it was always valid in the region where I live!

Would like to have my no-deductible health insurance do whatever needed negotiations with the hospital to lower the bill and then pay it.

Not sure what to do to make this happen and it's been 4 months of on-and-off worry since I learned about this problem in September. Ready to lay this to rest somehow! Any tips from you all? I'd be so grateful!

Best, Adriana

[atskitty2]

without knowing the specifics of what the hospital did, type of anesthesia and so forth, it's hard to say if you may have been overcharged. Generally speaking, if it was done at the hospital it would be higher than done at ur docs office or other type clinic. I dont mean to overstate the obvious, it's very frustrating, I agree. Why were they removing it if you had time left? Were there complications? Did you ask the cost difference prior to consenting or arrival?

My insurance was charged $17000 for a night in an observation room. Just laying there...no monitors, not even a regular check in by nurses, which I could have done at home. But I was a stroke suspect...so I was kept. at the time I knew, but could barely speak and didn't have the presence of mind to ask for an AMA and cab to take me home. I knew I hadn't had a stroke, or had a pretty strong idea that wasn't what was wrong. the $17000 did not include the 2 MRI done, the CT, the ER visit, ambulance, medications which I mostly refused, the echo, 2 ultrasounds, xrays, and labwork....the $17000 was just my half of a room in gen pop. my portion after insurance was I think $2000?

I'm not complaining, just trying to point out that costs are generally much more expensive than we realize, as we are so accustomed to that cut taken out by insurance coverage.
Its a job, but you can push for an itemized bill. that is within your rights, last I looked into it. That's where I would start. if you are going to try to negotiate with them to lower cost, that's a good thing to have.

next I would push the benefits department at work for more information. it could be an error in communication on their end as well...I don't know. if their corporate office is in DC or their benefits division, that may be part of it.

keep in mind when those papers and cards go out, it's just by computer. There's no live human using their brain to compare the policy against where in the country their cards are mailed.
seems common sense, but there's really little sense used in most of those details

wish I had better info, and I hope you are able to get this straightened out.

[jns]

My general feeling is the medical industry is filled with crooks, thieves and liars. That is not to say that there aren't a lot of good and dedicated people, just that there are a lot of scoundrels.