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Post by librarylady on Aug 25, 2024 12:42:13 GMT
Jamie Holmes of northwestern Washington state says a surgery center tried to make her pay for two operations when she only had one. Holmes had surgery in 2019 to have her fallopian tubes tied, a permanent birth-control procedure that her insurance company agreed to cover.
While under anesthesia, her surgeon noticed early signs of endometriosis, a common condition in which fibrous scar tissue grows around the uterus. The surgeon told her that he spent around 15 minutes cauterizing the troublesome tissue as a precaution and assured her the extra treatment would cost her little, if anything.
But when the bill came, it was a completely different story. Holmes was being charged for two separate operations, totaling up to almost $10,000. Her insurer would only cover a fraction of the cost.
Holmes figured the center’s billing department mistakenly thought she’d been on the operating table twice. Surely this could be explained, right? Here’s the story of how she ended up being sued by a collection agency and where things stand for her now.
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Post by jill8909 on Aug 25, 2024 13:04:00 GMT
nothing surprises me. I had the same thing happen to me in the 1980s. Had surgery for an ovarian cyst. they removed my appendix because why not and the surgeon charged me for that.
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Post by mikklynn on Aug 25, 2024 14:10:13 GMT
nothing surprises me. I had the same thing happen to me in the 1980s. Had surgery for an ovarian cyst. they removed my appendix because why not and the surgeon charged me for that. That is truly shocking! |
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peabay
Prolific Pea
Posts: 9,940
Jun 25, 2014 19:50:41 GMT
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Post by peabay on Aug 25, 2024 14:47:12 GMT
nothing surprises me. I had the same thing happen to me in the 1980s. Had surgery for an ovarian cyst. they removed my appendix because why not and the surgeon charged me for that.  What happened with the billing?!?!? |
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Post by bc2ca on Aug 25, 2024 16:18:05 GMT
Sadly, I don't find this shocking at all. I am so glad she refused to pay and fought the lawsuit.  |
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Post by crazy4scraps on Aug 25, 2024 17:47:39 GMT
When I was on the gurney being rolled in to the OR to have my kid via c-section, the doctor asked me and my DH if he should just tie my tubes while I was already opened up. I said no, fearing that very thing would happen and that because it wasn’t something the insurance company had pre authorized, it wouldn’t be covered.
It’s for that same reason I won’t do one of those at home colon cancer tests. They are known for having a good number of false positives, especially if you have certain conditions. My insurance will only cover one test for the recommended number of years so if I do that and it’s positive, the recommendation would be to have a standard colonoscopy as a followup. If that ends up being negative, guess who gets billed for the more expensive test? My last one was clear and the guy said see you in ten years, so yeah, that’s when they’re gonna see me next.
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Post by sabrinae on Aug 25, 2024 19:12:30 GMT
Not surprised at all. When I had my now 17 year old I was in labor for 12 hours and then had to have a c-section. They charged me for both a vaginal delivery and c-section. We did eventually get it charged correctly but it was a lot of work and phone calls on my end. When I had my 14 year old they went ahead and removed a ovarian cyst and cleaned up scar tissue from the first c-section- I didn’t get charged for that - but I’m pretty sure it’s bc the surgeon didn’t put it in the procedure list. Just noted it in the surgery description/notes.
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Post by MorellisCupcake on Aug 25, 2024 21:02:36 GMT
I’m a medical coder so I have a good guess why. If he documented a C-section and endometriosis removal, the coder would have to bill for both UNLESS the MD specifically states no charge. Or adds a modifier indicating reduced service or whatever.
That’s 2 separate CPT codes and we’re under scrutiny to capture everything documented to meet compliance standards. We can’t under bill or over bill but whatever is in the note should be captured if it’s not a bundled service.
I don’t necessarily agree but that’s how it works. We get audited for compliance standards monthly and can’t ignore something that is clearly there in writing.
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Post by AussieMeg on Aug 26, 2024 1:40:37 GMT
I’m a medical coder so I have a good guess why. If he documented a C-section and endometriosis removal, the coder would have to bill for both UNLESS the MD specifically states no charge. That's exactly what I would have thought. It was two separate procedures, so it makes sense to me that there would be a charge for each. 🤷♀️ I can't quite work out from the article how much each part cost. But the way I see it, if the tubal ligation cost, for example, $3000 and the anaesthetist fee was $1000 and the endometriosis treatment was $2000, and the hospital stay was $500, then why shouldn't she have to pay all that? Even if it all got done in the allotted time. The only thing that shouldn't be doubled up on is the anaesthetist fees and hospital stay. Or was her issue that he did it without her consent while she was under anaesthetic? In that case, I would be annoyed too. But chances are, she'd have to go back and get it done at a later stage, and it would cost her a second set of anaesthetist fees and hospital stay. Of course, I could be missing something, in which case, pay no attention to me!  |
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pilcas
Pearl Clutcher
Posts: 3,238 
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Post by pilcas on Aug 26, 2024 2:56:48 GMT
I’m a medical coder so I have a good guess why. If he documented a C-section and endometriosis removal, the coder would have to bill for both UNLESS the MD specifically states no charge. That's exactly what I would have thought. It was two separate procedures, so it makes sense to me that there would be a charge for each. 🤷♀️ I can't quite work out from the article how much each part cost. But the way I see it, if the tubal ligation cost, for example, $3000 and the anaesthetist fee was $1000 and the endometriosis treatment was $2000, and the hospital stay was $500, then why shouldn't she have to pay all that? Even if it all got done in the allotted time. The only thing that shouldn't be doubled up on is the anaesthetist fees and hospital stay. Or was her issue that he did it without her consent while she was under anaesthetic? In that case, I would be annoyed too. But chances are, she'd have to go back and get it done at a later stage, and it would cost her a second set of anaesthetist fees and hospital stay. Of course, I could be missing something, in which case, pay no attention to me! I know my insurance requires pre authorization before any procedure. It has to be medically necessary by their standards. So a procedure without pre approval would not be covered. Done at a later date if deemed necessary would be covered. Could be a difference of several thousand dollars. |
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Post by iamkristinl16 on Aug 26, 2024 17:38:03 GMT
I had an ablation and a colonoscopy in the same day, same surgical center. However, they took me out of anesthesia in between the two, saying that they wanted to minimize the amount of time under anesthesia (it was a very short time between and IMO not necessary to do that). But I wonder if they did it to be able to charge me for the anesthesia twice. They did charge for two procedures and it does not surprise me that the patient in this situation was charged for two procedures, either. Same with my husband when he had his colonoscopy. There was the charge for the initial colonoscopy then a separate procedure to remove polyps (which then made the procedure non-preventive and not covered by insurance until deductible was met).
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Post by lily on Aug 26, 2024 17:59:04 GMT
"Back in the day" when I worked at a hospital, this was called an "incidental finding" and even then we usually billed extra for it.
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