[JoanieK]

Cautionary tale re: out-of-network consult billing

by JoanieK on Sun Oct 12, 2014 10:45 pm

Earlier this year, my spouse and I worked with her HMO insurance to get authorization for an out of network second opinion consult with a myeloma specialist at Froedtert Hospital in Milwaukee. We were very careful to check back and forth between his clinic and the HMO to make sure it would be covered and were told by his consult coordinator that the cost would have been about $500 if not covered by her HMO. We were never told that Froedtert would not accept usual and customary payment amounts.

Her HMO did issue nearly $2500 in payments for both the doctor and clinic/hospital sides of the billing, but two months after the consult, she received a bill from Froedtert for over $800 for the hospital/clinic side. (Note that the doctor side has never sent a bill, so has presumably accepted the usual and customary payment from the HMO.)

Although we have spoken with Froedtert billing department three times since late June and been told each time that someone would follow up with the billing issue, no one has. The last two contacts said they would see that we got a written explanation of why Froedtert was billing above the accept usual and customary payment that the insurance company paid, but there has been no written explanation received. This week she received a bill stating that the balance would be sent to collections if not paid within 10 days.

Since second opinion consultations among myeloma patients can be quite common, we wanted to make other patients aware that they may be paying quite a bit out of pocket if they seek one at Froedtert (and perhaps elsewhere). While the consult was very interesting for us, our interaction with Froedtert Hospital billing has been very disappointing.