Anyone have this happen with insurance and rads?

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PJ47
PJ47 Member Posts: 376
in Head and Neck Cancer #1

Had a Christmas surprise after rads today.  Two ladies from billing came to see me about Cigna who decided the last week of radiation that I would have to pay $40.  each day of radiation which amounts to about $1300. This came as a surprise and we (the Century 21 oncology center), me and my Cigna oncology case manager checked this out with a Cigna insurance representative prior to starting radiation and we all were told I would not have to pay a $40. copay each therapy session.  

The billing folks said the second Cigna rep said the first one misinformed us and that since they are not a "surgical center" I must pay.  If I had gone to a hospital for rads ie Chapel Hill in Raleigh, then no $40 daily fee?   They then offered me a 10% "discount" if I paid within 30 days.  Woo hoo.  Merry Christmas.  Wonder if they will be waiting for me tomorrow?  

Has this happend to anyone else?  If so what was the outcome?  

 

PJ

Comments

  • phrannie51
    phrannie51 Member Posts: 4,716
    #2
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    Not with rads....but I did get on

    a real merry-go-round with the Oncologist.  My employer told me that my Onc was in network, so after 2 chemos, it turns out he was not....I was UPSET to say the least, and thought that I might have to change Oncologists in the middle of treatment, or pay 40% of the costs (ummmm....not cheap at all.....each chemo treatment was about $6000, and I was going in every day for an Amifostine injections at $2800 a pop)....As it turned out, my employer got the insurance company and the Oncologist together and they hammered out a deal.....so the Dr. had a "contract" with the insurance company rather than being in the network......the Dr. was also kind enough to date the contract starting with my first chemo treatment.

    Thing is...if they say the first rep was wrong.....now we know that the reps don't know everything, so who's to say the new rep is right....I'd be taking this up one step to a higher level....also, if you have the book on your coverage, you might see what it says.  I never had single copay for going to radiation.....the ONLY time I've had a copay is when I actually talked to the Dr. or his assistant.....I don't know what Cigna's policies are, but I'd be damn sure somebody pointed it out to me in their policy where it says that.

    p

  • Ladylacy
    Ladylacy Member Posts: 773 Member
    #3
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    Radiation Co-Pays

    My husband has a Medicare Advantage Program we have a co-pay for everything.  His first round of radiation was $35 for each radiation treatment (35) and the second round of radiation (37) it was $40.  But we knew that going in and his radiation was not done in a surgical center.  You can file an appeal with your insurance company and see what happens.  I have found that what one rep tells you isn't always right, so I got into the habit of double checking even after we are told by the doctor's office what our share was.  I also got good at filing and winning appeals.  Many insurance companies don't think that people will file an appeal.  We were also billed monthly by the second radiation center and the first one I paid weekly our co-pay.  

    Certainly won't hurt to file an appeal and see what happens and in the meantime just paid a small amount monthly until the appeal is final.

    Sharon

  • lornal
    lornal Member Posts: 428
    #4
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    Insurance Reps

    I am thouroughly convinced they don't know anything.

    I was forced on Medicare in 2012 after my 2007 cancer.  I was "supposed" to sign up in 2010, I guess, and I would have to pay back 80% of what insurance paid (LOL - like that was going to happen).  Not even close to the correct story.

    Don't pay anything until you complain to your insurance company, your hospital, your employer.   Really $40 per treatment is a drop in the bucket - and if you really do owe it - they will probably waive or deeply discount most of it.

    An aside:

    My Dad didn't have very good insurance.  His insurance didn't have a discounted contracted like many other companies.  After prostate surgury - he owed lots of money - and wouldn't pay it.  It went to collections finally - Then, he called the hospital, told them he wouldn't deal with a collection agency, and offered 50 cents on a dollar to settle the bill.  They took it in a heartbeat.

     

  • PJ47
    PJ47 Member Posts: 376
    #5
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    lornal said:

    Insurance Reps

    I am thouroughly convinced they don't know anything.

    I was forced on Medicare in 2012 after my 2007 cancer.  I was "supposed" to sign up in 2010, I guess, and I would have to pay back 80% of what insurance paid (LOL - like that was going to happen).  Not even close to the correct story.

    Don't pay anything until you complain to your insurance company, your hospital, your employer.   Really $40 per treatment is a drop in the bucket - and if you really do owe it - they will probably waive or deeply discount most of it.

    An aside:

    My Dad didn't have very good insurance.  His insurance didn't have a discounted contracted like many other companies.  After prostate surgury - he owed lots of money - and wouldn't pay it.  It went to collections finally - Then, he called the hospital, told them he wouldn't deal with a collection agency, and offered 50 cents on a dollar to settle the bill.  They took it in a heartbeat.

     

    Spoke to a supervisor at Cigna today who is working

    on a resolution with the radiation oncology center.  Cigna informed me that the company is billing in "many different ways" with different codes for the same procedure.  Interesting tidbit.  Now I am thinking they are trying to squeeze as much as they can out of Cigna and me.  Good thing I like my Doctor and I will inform her of this Thurs.

    I agree $40. per treatment is a "drop in the bucket".  it just frosts me they are coming up with this when I am almost finished, full of side effects, and the day before Christmas. The  financie ladies were waiting to pounce at the door of the TOMO/IMRT machine!  Very poor form.  I budgeted for my annuall deductible and copays and out of pocket fees when this saga began and have paid everyone off.  I checked that this place was "in-network" with Cigna and addressed the copay issue before I got started and it still got screwed up.  

    Just got another interesting bill from the first feeding tube disaster and it seems the ER billed my inpatient stay as an ER visit for 2 days.  Does anyone know how to do their job?  Grrrr,  more calls to make to get that one straight.  I am sure many of you have similar experiences with this crazy health care mess.  Lornal, I love your Dad's hutzpa and bargaining ability!  

     

    Cheers (with water that tastes like salt),

     

    PJ

  • jtl
    jtl Member Posts: 456
    #6
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    Century 21

    They did my rads and i never had to pay anything.  The actual amount paid to them was about $700 per treatment vs the billed amount of $1800.  These providers never get as much as they bill.  I think the chemo was around $6000 and they got $2500.  Lots of billing games played in the medical field.  Oh, when I had prostate surgery 10 years ago the total billed amount was over $60K and Aetna paid out a little over $10K.  People love to talk about how much the procedures cost but they really don't cost nearly as much as the "gross" bill says.

  • PJ47
    PJ47 Member Posts: 376
    #7
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    jtl said:

    Century 21

    They did my rads and i never had to pay anything.  The actual amount paid to them was about $700 per treatment vs the billed amount of $1800.  These providers never get as much as they bill.  I think the chemo was around $6000 and they got $2500.  Lots of billing games played in the medical field.  Oh, when I had prostate surgery 10 years ago the total billed amount was over $60K and Aetna paid out a little over $10K.  People love to talk about how much the procedures cost but they really don't cost nearly as much as the "gross" bill says.

    Maybe they have changed their practices

    The Century 21 I go to is charging anywhere from 2000 to 3000 a treatment and they are billing as though I am in a physicians office!  The billing part is very wierd.  I do think I have great MD and the rad therapists are also very good.  They work long 12 hour days.  Companies usually charge a lot more than they will be paid but not different codes for the same treatment.  Were you happy with your treatment at the rad facility?

    PJ

     

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