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Cross-posted on MotherTalkers.

Update to the Update: The hospital's media affairs department called me today. Spokesman Dr. John Gentile let me know that all physicians at the hospital are independent contractors. When you receive a bill from the hospital, what you are paying for are the facilities and equipment. I didn't know that. Also, a couple things stood out about our conversation: the amount of time and money it takes the doctor's office to gain payment from insurance companies. A lot of health costs is simply bureaucracy. Oftentimes, a doctor will charge more for a service because he knows he will get only 80 percent of the fee via Medicare and/or it takes at least six weeks -- in the best circumstances -- for a doctor to receive his fee.

Dr. Gentile also singled out Blue Cross Blue Shield as the only insurance company that has no "in network" anesthesiologists anywhere in the country. The company feels that anesthesiologists are overpaid, although it is currently trying to strike a deal with the anesthesiology company that administered my epidural.

But Dr. Gentile agreed with me that health insurance companies are for-profit ventures whose interests are to pay the doctor as little as possible and offer the patient little care. Of course, this could simply be spin especially if the anesthesiologists are rolling in the dough. -Elisa

About three weeks ago, my husband wrote about our battle with our heath insurance company, Blue Shield of California. Even though we are paying $800 a month for insurance, the company refused to pay for an epidural I received seven months ago because the anesthesiologist was "out of network."

In the last seven months, I have waited on the line and spoken to BCBS customer service reps at least five times. I have documented an additional five phone calls with the anesthesiologist’s billing department, which threatened to report us to a collections agency. I was caught in the middle as each of the parties pointed fingers at the other, claiming I needed to speak to one more person at the other party to gain payment. A BCBS customer service rep even hung up on me as my tone was one of a frustrated customer who had been bounced around one too many times.

Thanks to the advice of gracious readers on Daily Kos, BCBS is now claiming it will pay the remainder of the balance, $753.90. The original bill was $1,032.

I did call a couple members of the media department at BCBS to let them know we were discussing the issue on Daily Kos and I wanted to update the readers on it. They sent a response via snail mail:

On November 2, 2007 an internet blog was discovered by Blue Shield of California’s Media Relations Department. The issues addressed in your blog were forwarded to Blue Shield of California’s Special Services Department for Executive inquiries to research your concerns.

The letter -- two pages total -- continued to give an accurate description of my phone calls with Blue Shield as well as one check that was sent to me and cashed (I forwarded it to the anesthesiologist). One of the checks for a total of $452.51 was never received by me nor cashed. Based on my final phone call with BCBS on November 1, the company cut me a check for $328.68, which I forwarded to East Bay Anesthesiology, the company that gave me the epidural.

Since East Bay Anesthesiology is a non participating provider with Blue Shield all reimbursements will issue to the primary subscriber on the policy (me). The total amount of reimbursement issued is $1,059.29. This total includes an interest payment in the amount of $27.29.

We at Blue Shield do understand that our members are not always given a choice of providers during certain situations. Emergency room visits and anesthesiology services are two examples of situations in which we try to make exceptions for our members based on their extenuating circumstances. If for some reason we are unable to make an exception, our members are given appeal rights through Blue Shield as well as the Department of Managed Health Care.

Please be advised that this situation has been addressed with the appropriate areas and that we are truly sorry for any inconvenience that this matter may have caused. We would like to take this opportunity to advise you that the service expectations of our members are extremely important to us and that the information we receive is used to continually improve the services we provide.

I should also let you know that based on the recommendations my husband received on Daily Kos, I wrote a letter to both East Bay Anesthesiology and the hospital. I actually hand-delivered the letter to the hospital’s billing department. In my letter, I demanded the hospital “write off” the remainder of this balance, for the reasons listed in this e-mail received by my husband (No worries -- we blotted out the name of the person who gave us this advice! We received others like it, BTW, so we do believe it is true.):

I think I know what happened to you, and where the "fault" lies…

Hospitals contract with BCBS to be in-network so that you can access them at the preferred rate (in-network with little or no deductible).  All of the services you receive at the hospital are provided by contractors who work out of the hospital, but are not paid through the hospital and bill you directly.  While you can choose an OB/GYN who is in network, you have no choice regarding your anesthesiologist who signs a contract to work at the hospital.

What is happening is that these anesthesiologists have a monopoly relationship with the hospital.  All patients at the hospital must use these anesthesiologists.  These providers are increasingly dropping out of networks and billing patients the maximum they can get.  Since the patient has no choice (you don't find out until after the fact), you are stuck with a large bill that doesn't seem right.  The insurance company recognizing that you have no choice but see an out of network provider has agreed to treat the provider as an in-network provider for deductible and coinsurance purposes.  However, BCBS will not pay more for the service than what the pre-established rates are for this procedure.  In fact, there are other hospitals where anesthesiologists have agreed to accept BCBS payment as payment in full for services.  It is just that the hospital you are using is allowing anesthesologists to rip off their patients.

The fault here lies with the hospital you selected and your OB/GYN who works out of that hospital.  They know what is going on here, yet are silent.  The hospital knows that every patient will get balance billed by their contracted anesthesiologists, but are silent.  Your OB/GYN knew that the anesthesiologists at the hospital you were using would rape you, but was silent.  You are not the first person who has gone through this trap.

What is happening is standard in the industry.  The insurers and medicare pay $400 for a procedure.  The doc wants $700, so they bill $1,400.  The person who has the cash and doesn't want to hassle with the bill pays the full $1,400. The person who tries to deal with the practice will negotiate down to $700 and will feel like they have won.  The person who aggresively goes after the scheme should be able to get a majority of the bill reduced.

When this happened to me, I complained as high as I could to the hospital that I used and they got the anesthesiologist practice to write off the excess balance.  If that doesn't work you could also deal directly with the anesthesologist practice to discount the bill.  Good luck on getting this reduced!!!

Initially, I was livid with BCBS for screwing over not only us, but the doctor, too. After reading this, my sympathy for the doctor who administered the epidural and the hospital staff completely diminished. These people aren’t working in the best interest of their patients. They are there to make money. Or, the system is set up that they actually bankroll when others -- especially those ignorant of how the system works -- are sick or in an emergency.

As for BCBS, the company is no victim. It continues to send me small checks in hope that the anesthesiologist will drop its bill. Also, I do understand that we received special treatment because of Daily Kos, and it is infuriating. Our system is so whacked. Can I hear a shout out for universal health care?

Thank you all for your good thoughts and advice. Let's march on for not only affordable healthcare, but guaranteed health care for all.

Originally posted to Elisa on Tue Nov 20, 2007 at 10:50 AM PST.

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