SLOAN BILLING QUESTION

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hart2hart
Posts: 798
Joined: Wed Nov 23, 2011 10:46 pm

SLOAN BILLING QUESTION

Postby hart2hart » Fri Feb 21, 2014 9:38 pm

Hi -

Just wondering if anyone from Sloan is getting these misc "Outpatient"
Additional Charges on your statements (for your visits) when you see Dr. K or another Dr at the Center.

When Pete has his appointments with Dr. K there is always a charge on the bill for
an additional $350.00 (approximately). This is in addition to the charge for seeing Dr. K. Sloan Customer service reps
tell me it's a "facility charge" that MSK bills for seeing the nurses, schedulers, assistants, etc.

Our insurance won't pay these claims because they are worded "Outpatient Visit" and now
I have to send in appeals for each visit. I asked MSK to change the wording and they say they cannot!
Anyone else have this issue? If so, I'd love to know how you
got results with your Insurance Company. The CSReps that I spoke to were of my no help.......Frustrating!



Julie and Pete
Stamford, CT
Pete (hubby) Stage 3 VLRC - 11/11
Chemo/Rad/Ace Surgeon - 11/11 - 4/12
Oxi/Xeloda (Severe Toxicity to OXI) - 5/12 - 6/12
5Fu Only - 8/12 - 2/13
Liver Resection/Hai Pump/Folfiri/FUDR - 10/13 - 5/14
Lung Ablation (MSKCC) - 12/31/2014
Xeloda through 4/2015
NED - 1/2015 - 1/2024
Hai Pump/Port Removed - 1/2020

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BrownBagger
Posts: 7954
Joined: Fri Jul 24, 2009 2:56 pm
Location: Central NYS

Re: SLOAN BILLING QUESTION

Postby BrownBagger » Fri Feb 21, 2014 9:44 pm

That's news to me, Julie. I just pay my $40 copays.

They are pretty good at appealing stuff, although the stuff needs appealing because they don't always submit the claims in a timely fashion and the ins. co. freaks out. But I've never had to pay anything, ultimately, other than the copays.

All ins. cos. are different. But that sounds like a raw deal to me.
Eric, 58
Dx: 3/09, Stage 4 RC
Recurrences: (ongoing, lung, bronchial cavity, ribs)
Major Ops: 6/ RFA: 3 /bronchoscopies: 8
Pelvic radiation: 5 wks. Bronchial radiation—brachytheray: 3 treatments
Chemo Rounds (career):136
Current Chemo Cocktail: Xeloda & Erbitux & Irinotecan biweekly
Current Cocktail; On the Wagon (mostly)
Bicycle miles post-dx 10,477
Motto: Live your life like it's going to be a long one, because it just might, and then you'll be glad you did.

mom_2_3
Posts: 361
Joined: Sat Nov 29, 2008 8:09 pm

Re: SLOAN BILLING QUESTION

Postby mom_2_3 » Fri Feb 21, 2014 10:57 pm

Julie,

Checked my bills and see and "Hospital Outpatient Visit" in the amount of $234. It is on a day that I saw Dr. K for results. Interestingly, I could only find it on the most recent bill (after start of 2014) and it's nowhere to be seen in 2013 bills. I am curious now as to whether it will show up on my pump fill which is in 2 weeks or whether it's only on days I see her.

My bill doesn't detail how/whether it's covered but seems like it was included as part of my benefit.

HTH,
Amy
CC discovered during c-section (11/4/08)
Diagnosed Stage IV 11/10/08 -- Happy 39th Birthday! 5 bilobar liver mets
02/09: Colectomy, liver resection, HAI pump implanted, 7 of 42 nodes
7 months of FUDR and 5FU ended 11/2/09
10 years NED.

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juliej
Posts: 3114
Joined: Thu Aug 05, 2010 12:59 pm

Re: SLOAN BILLING QUESTION

Postby juliej » Fri Feb 21, 2014 11:36 pm

My bill just says "Outpatient Visit" in the amount of $188. No other charges. I just pay my $30 co-pay.

It sounds like there's a coding error or misunderstanding. You're right about it being frustrating! Hope you can get it straightened out!
Stage IVb, liver/lung mets 8/4/2010
Xelox+Avastin 8/18/10 to 10/21/2011
LAR, liver resec, HAI pump 11/2011
Adjuvant Irinotecan + FUDR
Double lung surgery + ileo reversal 2/2012
Adjuvant FUDR + Xeloda
VATS rt. lung 12/2012 - benign granuloma!
VATS left lung 11/2013
NED 11/22/13 to 12/18/2019, CEA<1

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vilca11
Posts: 730
Joined: Fri Feb 14, 2014 11:19 am
Location: Moscow, Russia; Baltimore, USA 1992; Vilcabamba, Ecuador 2012

Re: SLOAN BILLING QUESTION

Postby vilca11 » Sat Feb 22, 2014 12:07 am

Julie,

When you see a physician there are two scenarios possible:

a) you might see a physician in the physician office space that physicians lease from the Outpatient Facility b) you might see a physician in the Outpatient facility space. In the a) case all expenditure for seeing patients (equipment, tables, nurses, room, etc) are physician's expenses and are included in the "profee bill" - the charge that you are getting from the physician. And you are getting only one bill - from the physician.

In the b) case all expenditure for seeing patients are Outpatient Facility expense and physician is just rendering his "labor", for which he charges a reduced rate to you or insurance. In that b) case the Outpatient Facility is billing you or your insurance for their incurred expenses, which is called a "facility fee", usually small, $50 sounds about right. Therefore, you are getting one bill from the physician for his "labor" and one bill from the facility. Or, Sloan just combines these two charges on one bill.

So, the conclusion in your case is that this time you saw your Dr. K on the facility premises, that is why the facility charged you a fee. It could be very well the same space you saw Dr. K before, but it is possible that starting 2014 the agreement between Outpatient Facility and a Physician's Group at Sloan has changed and now it is a "facility space", so you will be getting this charge all the time. Profee (physicians) charge full fee only on their own premises, otherwise it is reduced and a portion of charges is charged by the facility that owns the space, technical personnel and equipment.

In a Physician Fee Schedule that every year is updated in the US, the allowable amount that insurance pays to a physician depends on the place of service that is reflected on the claim. Insurance sees Outpt and pays less to physician, but they must know to expect a bill from the facility, which they will pay according to a facility fee schedule (APC rate).

Anyway, talk to your insurance - a manager or supervisor, not with the rep and explain to them that you should not be appealing this, they should be paying it to the facility according to the APC fee schedule.

Good luck educating these people... Vilca :)
11/2005 CC stage 1, F,50yo@dx
Mod dif adenocar, MSS, APC, TP53, CEAs1.6-4.8
1/12 1met liver@Vena Cava, RFA, 3oxi,11 5FU
8/13 2 mets same place,SBRT
4/14 2 Xeliri+Avastin
5/14 Nano Knife liver same 2 mets
6/14 2 Xeliri, ADAPT
4/15 PET, 2 same mets,Cryo Liver
5/15 MJ Oil, Herbs, Suppl, ADAPT
10/15 PET, same area, doubled in size, high SUV
10/15 RH, HAI, visceral involv., no LN
2/16 red FF, 50% red dose FUDR, CEA trends up
3/16 CT, PET, MRI L.Lobe all in small tumors
4/16 No acceptable options, going home

mymom
Posts: 1299
Joined: Fri Aug 12, 2011 11:07 pm
Location: Connecticut

Re: SLOAN BILLING QUESTION

Postby mymom » Sat Feb 22, 2014 9:55 am

I will ask my parents when I see them later today.
Stage 4 CC DX 5/11
colon/livr rsct 5/11(1 met)
Folfox July-11/11
NED to 5/12
New Primry BC-4/12,Stage 1
2 livermet 5/2012
Liver rsct,HAI 6/12,Folfiri
NED to 10/13,1 liver met,ablation, Folfiri
NED to 12/14, another spot
3/15 NED
Ablation 1 liver met 10/15
1/16-current NED
6/22- small spot liver again, ablation oct 2023

gtownguy
Posts: 151
Joined: Thu Nov 22, 2012 7:57 pm
Location: Washington, DC

Re: SLOAN BILLING QUESTION

Postby gtownguy » Sat Feb 22, 2014 3:09 pm

This past summer I was talking with this guy at chemo, and apparently the Cleveland Clinic pulls that crap too - the "facility charge." Must be the new thing and just another cheap way to add extra revenue. He was saying, as much as he'd tried there didn't seem to be a way of getting out of it. Guess I've been lucky - so far they've never charged me any of these. Have seen tons of "miscellaneous services" listed but the insurance company always paid those. Whole thing is such a racket!
Sep 12 - dx rectal cancer - stage 3B - T3N1M0
Oct/Nov 12 - 6 wks daily radiation & Xeloda
4 Feb 13 - LAR w/ temp ileostomy
18 Mar 13 - install port
19 Mar - 02 Jul 13- FOLFOX chemo
23 Jul 13 - clean CT scans
26 Sep 13 - reverse ileo & remove port

hart2hart
Posts: 798
Joined: Wed Nov 23, 2011 10:46 pm

Re: SLOAN BILLING QUESTION

Postby hart2hart » Sun Feb 23, 2014 12:30 pm

Vilca and All --- Thank you.

I will be calling Our insurance Company (Supervisor) on Monday.

I think we have about $3,000 worth of these charges on our statments and I DON'T think
it should be our responsibilty. I wonder if people just don't call
on it. See we don't have copays. We have a upfront deductible, the 100% coverage.

However, these facilty charges were Outright DENIED by our Insurance Company. Greedy- The Hospital that is.
Anything to get more money out of you.


Thanks again,



Julie and Pete
Stamford, CT
Pete (hubby) Stage 3 VLRC - 11/11
Chemo/Rad/Ace Surgeon - 11/11 - 4/12
Oxi/Xeloda (Severe Toxicity to OXI) - 5/12 - 6/12
5Fu Only - 8/12 - 2/13
Liver Resection/Hai Pump/Folfiri/FUDR - 10/13 - 5/14
Lung Ablation (MSKCC) - 12/31/2014
Xeloda through 4/2015
NED - 1/2015 - 1/2024
Hai Pump/Port Removed - 1/2020

mymom
Posts: 1299
Joined: Fri Aug 12, 2011 11:07 pm
Location: Connecticut

Re: SLOAN BILLING QUESTION

Postby mymom » Sun Feb 23, 2014 6:05 pm

Hi. I asked my parents about their medical bills (spent the weekend there with the kids, had fun) and they have not received one in 2014 yet. So not sure. But I did ask. Will let you know if I find out anything additional.
Stage 4 CC DX 5/11
colon/livr rsct 5/11(1 met)
Folfox July-11/11
NED to 5/12
New Primry BC-4/12,Stage 1
2 livermet 5/2012
Liver rsct,HAI 6/12,Folfiri
NED to 10/13,1 liver met,ablation, Folfiri
NED to 12/14, another spot
3/15 NED
Ablation 1 liver met 10/15
1/16-current NED
6/22- small spot liver again, ablation oct 2023


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