Texas Health Alliance

Comment: Acct: ***
There seems to be a big issue and my insurance company recommended I protest my bill.
Before the procedure I had done on 11/15/2019, I asked what my financial responsibility would be (because I have a deductible, but I have no idea what the negotiated rates are). I did not ask for the portion of the "hospital charges," or the "the radiologist charges" or the portion for any INDIVIDUAL charge. I asked what my financial responsibility is for everything being done.

While in the office the day of my appt, I asked the receptionist if I could pay my portion of the bill. She stated that we should wait until after my appt was done just in case the doctor did something additional or if maybe something was not needed and therefore the charge on the estimate wouldn't be applicable.
After my appt I went to the front desk and I paid what she said was my financial responsibility for the visit/procedure. I paid $314.52 using my HSA debit acct card. This matter should be behind me. I've since rec'd a bill from radiology services for an additional $201.24 and then the Texas Health MyChart site says I still owe $225.13 on top of the $314.52 I paid on 11/15. This brings the grand total to $740.89. That is a FAR cry from the $314.52 I was led to believe was my financial responsibility.

I NEVER would have had this procedure done had I been given accurate information. EVER! I would have had my regular annual breast exam. I even spoke with my primary care doctor the day before my appt and we were going to just do a regular mammogram and if something seemed suspicious, then a sonogram would be ordered. We all felt comfortable with that approach ESPECIALLY since the radiologist at TX Health told me (and my significant other) that if I had my original mammogram done at Texas Health, versus where I went in Oct 2018, I wouldn’t be having a sonogram/biopsy today (today being the appt I had in Oct 2018). In fact, we were told that it is NOT a rare occurrence for them to see patients from the place I had the mammogram done and it saddened them because of the unnecessary stress it causes to patients.

Needless to say, there was no biopsy done in 2018; the radiologist made my boyfriend and I both comfortable that there was little to nothing to worry about. The radiologist did recommend a Follow up in 6 months just to “be sure” and I agreed. After that appointment concluded I went to the front receptionist desk and asked her if she would estimate what my total financial responsibility would be when I came in for the 6 month appointment (because I knew I would be 100% responsible since it was a new year and my deduct would doubtfully be met). We discussed how prices are always subject to change, etc… but the “ballpark” figure was $350. That concluded my appt and we left. When the 6 month timeframe came around, I did not establish the 6 month follow-up appointment. I know I should have, but my boyfriend and I felt REALLY secure in the doctors findings and therefore I decided to wait until my yearly mammogram time.

When it came time for my annual exam I called to make an appt and that is when I was told that if I wanted just my annual breast exam done I would need to get approval/orders from my primary care doctor since TX Health records showed I still needed that follow up appt that I didn't establish in addition to my annual mammogram. The TX Health person I was talking to (the one who set up my 11/18 appt) said she would reach out to my primary care doctor and we would go from there.
A few weeks later I heard from my doctor’s office and that is when we discussed the option of me just having the annual breast exam (which insurance covers 100% of) or having the “BC DIAG MAMMO BIL IMP/TOMO” and the “BC US BREAST UNILAT LT LTD” done. By this time I had already asked Texas Health about my financial responsibility and I decided that I was willing to pay the $300ish just this once for a good solid peace of mind. My doctor and I discussed that if I went ahead and ONLY did my annual mammogram and IF something was suspicious….I would need a follow-up appt at another time to get a sonogram (which would mean “another: appt which no one wants). Based on our conversation and my awareness of the cost, I told my doctor that I would “do it this time” but next year I would go back to a regular mammogram unless something concerning was found. My doctor’s nurse sent the order back to Texas Health and I went to my appt on 11/15/2019.

As previously stated, while checking in for my appt on 11/15/2019, I asked the receptionist for my financial responsibility and she stated I could pay it after the appt had concluded. She told me if everything stayed the same as the order it would $314.52 and that is what it was upon me checking out after my appointment.

I understand that estimates are just that….an estimate. However, I have NEVER had one be this far off and per my discussion with BCBS, it should not have been “this far off.” Whomever verified everything with my insurance company SERIOUSLY goofed up and this is not fair to me at all. Had everything been properly done properly by the folks that do it, I would have had a Much more accurate “financial responsibility” figure given to me and I would not have done the procedure. I would have only had my annual mammogram done (which is covered 100% by my insurance).

The healthcare provider contacts your insurance company in order to verify:
· Preauthorization: Some insurance companies require prior authorization before they cover a medical service or medication. The insurance company collects further information regarding your appointment and medical records before determining whether the services and medications are covered.
· Co-Pay: The healthcare provider’s office also determines how much the patient must pay out-of-pocket for this visit.

My health insurance company suggested I protest with Texas Health and I tried. I sent on 01/07/20 and I received a response back on Tue, 14 Jan 2020 19:25:11.
The response stated…..
“Guarantor Account Number: ***
Encounter Account Number: ***
Thank you for your email.
The deposit is for hospital charges for anticipated care and recovery, taking into consideration insurance coverage, co-payments, deductibles, coinsurance. Actual charges on the final hospital bill may vary from the deposit, based on the patient’s medical condition, unknown circumstances or complications, final diagnosis, and treatment ordered by the attending physician. The deposit covers hospital charges only, and does not include professional fees for services such as those provided by a physician, radiologist, pathologist, anesthesiologist, nurse practitioner or other independent practitioner.
We filed a claim with your insurance per the Explanation of Benefits $539.65 deductible, you paid $314.52 leaving a balance due of $225.13. Since your insurance company - not the hospital - allocates the patient responsibility, please contact them directly if you would like to verify and/or appeal their decision.”

Clearly the person who responded to my email did not understand what has me So upset. I am not upset with my insurance company. I am upset with the provider not doing their job adequately and providing me with accurate information regarding my financial responsibility for everything done that day.

I am protesting these bills for unclear and inaccurate information given to me. I based my decision to have the procedure done on the information given to me…and it is NOT fair for me to be screwed over because apparently the information was VERY, VERY inaccurate.

Thank You

I visited the ER with regard to a broken rib, of which the doctors were unable to give any help. Just an X-ray and prescription for 10 Hydrocodeine will run you in excess of $1,200 to me personally in addition to the money paid by my provider. The accounts billing department will be sending my information to collections without so much as ever contacting me or sending a bill by mail.

I can assure that after my experience at the ER, I was assured by the attending doctor that all billing would be clear and concisely completed.Spent hours of time on the phone explaining the situation to people who seemingly don't care about it. I certainly pay all my bills, on time and in full. 90 days later and countless hours of my time later, the issues still remain unresolved and Texas Medical Resources has been unhelpful.