Is This A New Healthcare Scam Or What?

As you may recall, I recently went for my annual mammogram, which was quite an adventure. But now, dear friends, the adventure continues!

We’ve got really good insurance from BlueCross/BlueShield, so my annual exams of this type have always been covered 100%. But this time, for the first time ever, the hospital’s billing office called me prior to my appointment to “pre-check me in,” and also to let me know the cost would be “around $150.” I let them know my insurance has always paid for this in full and asked if they were sure about the charge? The woman on the phone sounded unconcerned, like this is something they routinely tell people without checking what their insurance plans call for, just a heads’ up of what they might need to expect. Or not, as the case may be.

I found that totally weird. If I hadn’t been doing this every year for a while and knew I was never charged, I might be a little freaked out. I’d especially be panicked if $150 was a make-or-break amount of money for my monthly budget, which it easily can be for a lot of folks. Especially the kinds of people not accustomed to shelling out large amounts of money on regular health services like mammograms. For example, people new to the healthcare market, thanks to Obamacare. Just sayin’.

As it happens, I get my mammogram and there’s no charge, as usual. The office said they’d file with insurance, as usual.

So imagine my surprise when about 4 days later I get a bill from the hospital! Again: this has never happened before! I assumed it was a bill I could ignore because BlueCross/BlueShield typically takes months to process claims. But the bill showed a discounted amount of around $143, and I’d had that phone call saying I should expect to pay around $150 … so I was a little confused. Again: if I hadn’t done this before and known not to be worried, I’d be in a panic.

So I called the hospital’s billing office and asked WTF is this thing I got in the mail. And get this: she says, “Oh, we just send that out in case you want to pay it. You don’t have to, but if you want to.”


I asked her to clarify what she meant. “You mean, pay it and then have you pay me back when the insurance company pays?” Yes. That is what she meant. If I wanted to. But I didn’t have to.

People, I ask you: who the fuck would want to do that?

Now might be a good time to remind everyone that this service was performed at the for-profit HCA (now TriStar) hospital in Nashville, Centennial. And I just have to wonder again if this isn’t some kind of scam they’re running trying to get money out of people who are new to dealing with hospital billing departments and insurance, now that ObamaCare has brought thousands of newbies into the system.

It just seems a little sleazy to me. I absolutely would not be surprised to learn that staff at Centennial are given a bonus for every “early payment” they coerce out of patients.

Meanwhile, BlueCross/BlueShield has started sending me a stupid newsletter it calls “Healthy Options,” filled with recipes and coupons for Kellogg’s Frosted Mini-Wheats, Minute Maid Light Lemonade and other crap made out of toxic waste I wouldn’t touch with a ten-foot fork. I don’t know when my health insurance company got into bed with ConAgra, ADM and the rest of our Big Food Overlords but I find this an ominous sign and I’m pretty sure it can’t be good for anyone. I just really don’t want to be marketed to by these people. Seems like there might be something better to do with that money.


Filed under HCA, health insurance, healthcare, Nashville

18 responses to “Is This A New Healthcare Scam Or What?

  1. someone-else

    There is no no way to impute a non-sinister motive to this practice. Someone made the decision to scare people if the could, scam people if they could, and create uncertainty wherever possible.
    This certainly isn’t about health, and it’s probably not even about money. This smells like politics … like someone wants people angry at the “new improved” healthcare system.

  2. Joseph Stans

    Scam? Yes. Sleazy? Yes. but in the finest tradition of the market place. I suspect they were hoping you’d pay it and then they could use your money for as long as it took for BCBS to process and as long as it took them to cut you a check.

  3. CB

    What I have been hearing is that BCBS has become horrible about reimbursements, taking months and months to even admit that the service in question is indeed covered under the patient’s plan. This is from friends who work in health care. Not saying that the hospital is in the right here, just that the insurance co. is dragging its butt getting the money where it belongs. I get statements from BCBS for anything beyond standard primary physician care. They used to be very clear and logical — a column for what they paid, several others that you’d need to be in the business to understand, and a column indicating that I didn’t owe anybody anything — but they have become much less so, with weasely text offerings, indicating that I might or might not owe the provider some nebulous amount of money. The weasely ones started showing up — TA DAH!!!! — in January. To date, I have not received a bill from any of these providers, and I’ve had x-rays AND an MRI, not to mention multiple physical therapy sessions. Somebody’s just being a turdblossom, and I’m sure it’s the insurance company.

    • I’m on their “Blue Voice Panel” and they addressed the patient statement issue not long ago, offering three or four different options, none of which were any better than the convoluted mess we get now.

      But if hospitals are having issues getting reimbursed from insurance companies, and they probably are, that’s their problem that they need to address. Leave me out of it. The idea that patients would voluntarily put themselves in the position of being the one screwed by BCBS instead of the hospital is ludicrous.

      Reason number fifty gazillion why health insurance companies are parasites on the healthcare system and why we’re all better off if they’re put out of business eventually.

    • Seeker

      CB, this has been exactly my experience with BC/BS as well. Additionally, now my doctor’s office is claiming I owe them money…and there’s absolutely no way to tell if that’s true or not because the BC/BS explanations are incoherent.

      • Jim in Memphis

        I have been getting the BCBS Explanation of Benefits forms for several years now. They have not changed that I am aware of. Anytime someone goes to the doctor BCBS will send a summary of the charges, their discount, what they paid the doctor (if anything), and what I owe as part of my deductible. There is also a summary of the deductible paid so far that year for the person involved as well as the family in general. All I have to do is hold on to this EOB and compare it to the doctor bill that will usually come a few days later.

      • They change the EOBs every couple of years, actually. At least, ours have changed. Yours may not. And they’re about to change again because they got so many complaints about the last round.

  4. I’ve not had health insurance for several years but when I had I happened to end up in the ER at a local hospital. Every time I received information about my claim in the mail it was wrong, and I had to call to get them to correct it so I did not receive a bill from the hospital or doctors. Someone told me the insurance company did that on purpose so people would just pay the full amount. Since every claim was wrong, I’d have to agree. Also, too, when my former employer switched my coverage to COBRA when I got laid off (at that time some employers were paying 60% of the monthly premiums) it was a nightmare, Untied Health – I mean, United Health – could never find the information that I was indeed still covered but under COBRA. It took months and a very kind lady to get it fixed. But I’m sure our wonderful media will be more than happy to blame any glitches on Obamacare, when the truth is health insurance has always had the potential to be a nightmare.

  5. Mary Wilson

    Look, I helped with the ACA,enrollments here in TN and I know what has happened to you, SB.
    First did you get a letter from BC/BC that your current policy had been cancelled back before Oct 1st? Any policy you had before the ACA went into effect should have been cancelled because by law, if it did not meet the guidelines and provide you the 10 recognized medical benefits. they had to offer you one that DID or cancel your current one. Not only is BC cheating you and your family, but so is Dr. Doom Frist’s ‘former HCA for profit hospital if they do not accept policies listed in the ACA marketplace.. This is not only a scam, if more folks like you have been duped, you may have legal grounds to fight this misrepresentation of benefits now available to ALL Americans who qualify.. And I do know one of the 10 basic benefits include ‘pre-cancer screenings including mammograms FOR FREE. When the law was first passed in 2010, I got to have a mammogram FREE.
    Let me know if you need more information. I can list the 10 basic benefits if y’all like…which are FREE with your premiums..

    • My insurance is through my husband and his is through his employer, so any cancellation notices would not have come to me, anyway. I have no idea if this policy is new or what. I’ll have to ask Mr. Beale.

      I’m sure they will accept the insurance I just think they’re being sleazy trying to get me to pay before my insurance co does.

      • Jim in Memphis

        Some doctor’s offices will make me pay the full amount for the visit on the day of the visit and then reimburse me when the insurance claim is returned to them. I was told this is specifically due to me having a high deductible plan instead of a flat co-pay for a visit.

  6. “could never find the information that I was indeed still covered but under COBRA. It took months and a very kind lady to get it fixed.”

    Exactly the problem I had when I left Verizon and moved to COBRA. It was mismanaged by Hewitt who jerked me around for almost 8 months before they got it straightened out–but they collected that friggin’ premium every month. I only wish I could have had MORE stuff done–I only got to stick the bastards for about $45K for a couple of surgeries and the care involved with them.

  7. Jimbo’s “high deductible” makes perfect sense for a him, Mr. Imakeacoolquartermillper, for his lower paid employees, maybe not so much, but he is, after all a job maker.

    • Jim in Memphis

      The company switched to high deductible plans so that we could afford to still pay for our employees’ health insurance. I will keep watching how the exchange plans function and may decide to just drop our group plan in favor of using exchange plans if they work out cheaper. Looks like I will have at least another year to decide since Obama pushed back the business requirements at least another year so we will probably stay with what we have for now. The sad part is that even though we are a very small business, we pay our employees too well to qualify for the small business tax credit made available to help offset the cost of health insurance. Since our average salary is well over $50,000, that provision does nothing for us.

  8. Nutella

    I disagree that this is a little sleazy. It is a LOT sleazy.
    You will find if you get a lot of hospital bills that there will be a fair number of errors. This might be reasonable — it’s complicated, right? — until you notice that all of the errors are in the hospital’s favor.
    I once knew someone who had a temp job at a hospital accounting office. Her job was to review patient bills before they went out to find any errors so they could be fixed but she was not permitted to report any errors in the hospital’s favor. Errors to be fixed were only the ones in the patient’s favor.