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Suggestions on a insurance bill I received for an MRI

Rusty Shackelford

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#1
I have been having some severe shoulder pain since October. Was worried about a possible rotator cuff tear. Dr sent me in for so outpatient PT. Worked ok out of the gate but the progress stopped after 4-5 sessions. Still doing exercises but not getting much results. Take a 12 hr aleve every day but no help. So Dr order Xrays and MRI in his office. Got the pre approval from the insurance. Imagine says no damage but just severe tendonitis. Okay, but 6 weeks later it still hurts like a muther....but not ass bad as the bill I got this afternoon...as you all know I had multiple surgeries this spring so my deductible was not an issue (or so I thought)..had imagine done there in the past with same insurance company so when I got the pre approval letter I thought nothing of it...turns out that even though the dr and the facility are in network, the equipment is now being managed by a 3rd party who is out of network...should I have known? maybe...should the provider have informed me of this after running my insurance...IMO hell yes....long story short...my deductible doesnt matter when it was an out of network provider and I am now saddled with a $3300 MRI/Xray bill despite hitting my network out of pocket max back in Feb 2018.

Any suggestions on how to handle this once I can the billing department? I am effing furious right now.

Thanks,
RS
 

3glocks1stack

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#2
I'd be PO too. Definetly talk it over with the Dr who ordered the MRI, see if they can't gain you some leverage with the imaging place. Round here they're doing MRI's for $600 cash, and that's what I would offer. If they say no, let it go to collections and then offer the $600 to settle it. Bet they take it at that point.
 

GOLDBRIX

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#3
I'd make sure MRI people had filed their billing with your medical insurance first.
Second I'd want an Itemized Billing from both the MRI people and my health insurance company. What they charged, What the Insurance Allows and Disallows charges to be and what they paid the MRI Co.
Certain charges Insurance Disallows the MRI Co. just has to eat.
I'd also check to see if my state has an Ombudsman Agency to challenge cost.
Damn my CANCER CTs, MRI, Xray and surgery didn't hit my wallet like the costs you're facing for an MRI. ( I'm still paying on those)

If all else fails see if you can negotiate a discount for a one lump sum payment plan.

Best of Luck
 

3glocks1stack

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#4
Also, research the "allowed amount" that your ins co offers for the code. This is the amount they would have accepted if they had been in network. Another good place to start negotiations.
 

itsamess

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#5
Have you received your EOB which would show why it wasn't covered. Maybe coded incorrectly by office. Maybe Doc / Imaging can resubmit with "doctor required" code. Also make sure they Imaging folks aren't under contract with your insurance company without being in network since they would be required to honor contract and right off excess fees. This stuff is stupid but following up may save you money.
 

gnome

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#6

PhucilliJerry

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#7
I can't comment on the billing but have you tried eating keto/low carb for your tendonitis? Lots of people see great benefits from the reduced inflammation of the low carb diet.
 

Rusty Shackelford

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#8
Have you received your EOB which would show why it wasn't covered. Maybe coded incorrectly by office. Maybe Doc / Imaging can resubmit with "doctor required" code. Also make sure they Imaging folks aren't under contract with your insurance company without being in network since they would be required to honor contract and right off excess fees. This stuff is stupid but following up may save you money.
Yes...the EOB states that the 3rd party management team that handles the equipment is out of network. This despite everything else in the entire facility being in network.
 

TomD

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#9
The providers are often willing to negotiate. It would help if you knew what the going cost for independent MRI's cost. Where I live there's a indy that will provide a MRI (or any imaging) for a few hundred bucks that would cost 10-20 times that much at the local hospital. They are at least as professional about it as the local hospital too.

See if you can find one and get a quote for the MRI that you got and use that figure to negotiate your way down.
 

Rusty Shackelford

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#10
Regardless of the result, I will be dropping this dr and his facility and find me a new PCP....after being his patient and using the facility for 19 years...to have this nonNetwork BS happen is inexcusable. I mean what is the purpose of the dr calling my insurance to get authorization and approval and not know or tell me the equipment provider is out of network.
 

stAGgering

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#11
To further PJ's statement above...

Ruta Grav 30x Homeopathic Remedy from Hylands sold on Vitacost.
Homeopathic remedies do not work in a coffee or cola contaminated blood supply.

Reduce or eliminate sugar. Sugar expands, salt contracts, thus sugar in any form promotes or prolongs inflammation.

Gluten especially so in type O blood, is inflammatory. PJ says carb reduction; ditch wheat.

Post surgery Acupuncture, & Osteopathic treatment recommended, doctors reattach not realign.

This from a man who has been in more auto and motorcycle accidents on track and road than years alive.
Broke no bones until 19 and have done leg to cranium since.
Worked three of the most dangerous jobs and love adrenaline and endorphins.
Do not drink, take drugs or meds, and eat to live healthfully until dead from who knows what.
Hopefully not some texting 'tard while I am on the motorcycle, it is a war zone of The Driving Dead out there.

Hope your shoulder recovers.
I tore my right cuff @ 19, and keep in shape in order to avoid surgery which is inevitable but technically improving.
Makes great crunchy noise when reaching upward, like chewing rice crispy bar... man I wish I could eat one of those.
 

ErrosionOfAccord

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#12
Even in BFE Wyoming they only run about a grand.

Our radiology dept is separate from the hospital as well. Not a fan of the situation.
 

southfork

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#13
In the past Ive just let them go unpaid for months, eventually they call and I tell them Im a senion on fixed income cant pay, cant afford payment plans, they said how bout cc and i reply im still paying off the cc from last bills, eveventually they come down to about .25 on the dollar, in Fl they cant lien your home if its homesteaded, nor your 401 or retirement
 

Rusty Shackelford

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#14
Been of the phone with the billing department...I asked what the deal was with the MRI being out of network when all all aspects of the facility are in network and that the office had called and get everything authorized and pre-approved...the lady in billing responded """uuuhhhh they typically tell you all that before hand..did know one tell you? I am going to transfer you to an insurance patient advocate".....still waiting on that return call....sound like they fucked up and got in a hurry or withheld info....we will see
 

southfork

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Been of the phone with the billing department...I asked what the deal was with the MRI being out of network when all all aspects of the facility are in network and that the office had called and get everything authorized and pre-approved...the lady in billing responded """uuuhhhh they typically tell you all that before hand..did know one tell you? I am going to transfer you to an insurance patient advocate".....still waiting on that return call....sound like they fucked up and got in a hurry or withheld info....we will see
Also I would call the state insurance commision
 

Rusty Shackelford

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Dumbasses...just got off phone with higher up in the insurance billing department....seems the mri office is jointly owned and operated by 2 separate entities...one entity is in network and the other is out of network...she said the claim was filed on behalf of the wrong entity and that it would be corrected to be filed against the correct in network provider.
 

Joe King

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#19
The providers are often willing to negotiate. It would help if you knew what the going cost for independent MRI's cost. Where I live there's a indy that will provide a MRI (or any imaging) for a few hundred bucks that would cost 10-20 times that much at the local hospital. They are at least as professional about it as the local hospital too.
I had to get an mri once. Price with insurance was $2000. However, cash price was $500.
 

GOLDBRIX

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#20
Rusty I thought you had a gubbermint job, with full benefits.
Full Benefits does not mean 100% complete and total coverage. I'm in the same boat with this cancer incident.

Hell, the Dr. that did my emergency kidney stone operation that started all this whole thing. Told me the group does not accept my .gov insurance ( NOT Anthem BC/BS) and I'd have to find another practice to do follow-up with.
I have a Dr. friend I told of my predicament. He said he'd make a call for me. Later that day the nurse for the doctor that took my case and in the same practice w/ the On-Call kidney stone emergency doctor. Scheduled an appointment as a Professional Curtesy . My Dr. friend calls this kidney surgeon a "Rock Star in the Field", and he took it on.

I'm paying him what I can when I can. And I will not ask him to discount his work he did that has saved my life.
He is worth every penny and he will get paid.
If I'd hit the lottery he'd get a big tip.
 

lumpOgold

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#21
I have been having some severe shoulder pain since October. Was worried about a possible rotator cuff tear. Dr sent me in for so outpatient PT. Worked ok out of the gate but the progress stopped after 4-5 sessions. Still doing exercises but not getting much results. Take a 12 hr aleve every day but no help. So Dr order Xrays and MRI in his office. Got the pre approval from the insurance. Imagine says no damage but just severe tendonitis. Okay, but 6 weeks later it still hurts like a muther....but not ass bad as the bill I got this afternoon...as you all know I had multiple surgeries this spring so my deductible was not an issue (or so I thought)..had imagine done there in the past with same insurance company so when I got the pre approval letter I thought nothing of it...turns out that even though the dr and the facility are in network, the equipment is now being managed by a 3rd party who is out of network...should I have known? maybe...should the provider have informed me of this after running my insurance...IMO hell yes....long story short...my deductible doesnt matter when it was an out of network provider and I am now saddled with a $3300 MRI/Xray bill despite hitting my network out of pocket max back in Feb 2018.

Any suggestions on how to handle this once I can the billing department? I am effing furious right now.

Thanks,
RS
Hi Rusty, I had a very similar problem with my insurance. I wrote to them and explained the treatment I received was at an in-network facility and that any providers at that facility should be covered as in-network. After a bunch of back and forth, they finally agreed and covered the treatment as in-network.

Sounds like you really need that patient advocate from the insurance company to call.
 

southfork

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#22
I had to get an mri once. Price with insurance was $2000. However, cash price was $500.
I cant get a mri due to having a pacemaker/defibrallator, had to get a myelogram back in august, hospital charged 29,000, in network I paid 200 bucks. Next day my home health nurse came by, I could only sit for minutes the spine was leaking, she sent me to er again for blood patch, i paid 80.00 , came by next day and sent me to er again, my bill 80.00, took close to a month for it to heal
 

Goldhedge

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#25
I am going to transfer you to an insurance patient advocate".....still waiting on that return call....sound like they fucked up and got in a hurry or withheld info....we will see
Yeppers! They should tell you AND have you sign a release stating you were 'informed' to cover their assets!
 

TomD

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#26
In every case in which there is no discernable relationship between the cost to produce a product and the billing cost of that product, you know government is involved somewhere along the line.
 

Uglytruth

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#27
Now who's gunna pay for your ass aches dealing with these idiots? I swear they do this just to see if you will pay or even pay a portion.
I's all a F'ing game.

Ya think ruth is worried about her obalambacare covering her coma?
 

gnome

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#29
I forget how much you Yanks get raped when it comes to health care costs, even with health insurance.
Richest country in the world spends 19% of GDP on health care and we have health outcomes on par with shithole countries.
 

Rusty Shackelford

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Richest country in the world spends 19% of GDP on health care and we have health outcomes on par with shithole countries.
Our life expectancy is much higher then that of developing shithole countries
https://www.statista.com/statistics/274507/life-expectancy-in-industrial-and-developing-countries/

The infant mortality rate in the US is far superior to that of shithole developing coountries

Now compared to industrialized countries, yea the US is lagging...but when comparing countries ahead of us you tend to notice a rather homogeneous nature about their populations compared to thew US. I would like to see US rates when comparing similar population mixes.
 

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