This entry is about the (moral) victory I had today. Still a colossal waste of time to do something simple… and looking back on it, I probably should have been a bit less flexible — but to make a long story short, I was sued in Prince George’s county civil court for an unpaid bill to my anesthesiologist’s group (First Colonies Anesthesia). The lawyer representing them (Herbert A. Thaler, Jr.) filed the suit back in August — and I wound up paying the “health company” price for my service as opposed to the “full price” they tried to stick me with.
My rationale was simple — I don’t begrudge my anesthesiologist for the work done. A fair price would be fine by me. However, they billed me for the “full cost” simply because Care First PPO had not negotiated a contract with them. As a result, they tried to pin me down for the full cost. Communication between myself and First Colonies was bizarre — I’d receive bills for the full amount, but when I spoke to folks in billing on the phone, they recommended I push CareFirst PPO and let them sort that out.
After a few months, it went to a collections agency that demanded the full amount. I contacted First Colonies and was told that it could be sorted out… but no invoice was ever sent for any adjusted amount.
Finally, I got a (threatening) letter from a Mr. Thaler, claiming that I’d be seeing him in court if I didn’t pay up. A call to Mr. Thaler’s office netted a really nasty conversation with a lady named “Tyra”, who was incredibly rude and who simply got all the “piss ‘n vinegar” in me ramped up to the highest level — she made statements like, “Sir, if you would pay your bills instead of being a deadbeat, we wouldn’t have to come after you!”.
So today, when I wound up in an impromptu conference with Mr. Thaler and a gentleman from First Colonies, we began with them asking for the full amount. I told them that given the circumstances, and how much crap I’ve had to put up with — I see no advantage in taking a day off from work just to hand over the full amount.
They then mentioned that my credit rating could suffer if a civil court ruling was made against me. I pointed out that I have the house I always wanted, the car I always wanted, and absolutely no desire to finance anything that would be affected by my credit rating. Given the generous salary I receive from my employer, I really have no reason to capitulate and pay them the full amount.
I pointed out that I had no problem paying for the services rendered, but it was simply the amount that was bothersome — I knew that an insurance company would not pay that much, so why should I?
The First Colonies representative gave me an example of how much the service would be if it were billed to an insurance company , I said, “Well I’d gladly pay that right now!”
I pulled my checkbook out of my shirt pocket, and paid the bill on the spot.
That said, I feel pretty good about how this was resolveed — yes, I paid more than I would have if CareFirst PPO had stepped up the plate and paid the anesthesiologists — but I feel it was fair to pay people for the work they performed. I’m a healthy, happy person after that surgery — and I can’t complain that the anesthesiologist had made any mistakes in my care.. so they deserved to be paid.
The only thing that bothers me (personally) is that it had to become a matter of principle — and that lawyers and courts had to get involved. If someone had simply followed up with me months (if not a year) ago, I would have paid the same amount I did today. Instead, we had to go through a lot of litigious crap to get to a reasonable solution.
The other thing that bothers me (socially) is that the civil court system seems to be geared towards pounding the accused debtor. On the plus side, if someone sues you and they don’t show up to present their case, you’re off — the matter is over, and you owe nothing. I saw a few cases where the plaintiff did not show up and the defendant was literally off the hook for all the money being contested. However, given the weight of the legal power brought to bear on the individual, and looking at the people in the court room today — I realize the “justice” I had was simply reflected by the fact that I was well off enough to not have to care about the threats to my credit rating, and I could focus purely on fighting on principle.
And it appears that fighting for matters of principle is a luxury that is available to people who have the means to fight it.
Flip,
It sucks for us too! As a member of First Colonies Anesthesia I would like nothing better than to be paid fair compensation in a timely fashion by the insurance companies however they often refuse to do so. When we try to negotiate with them they refuse to come to the table or use patients as pawns to try to force us to sign contracts that are not advantageous for us. We are currently sponsoring legislation that would prevent insurers from involving patients in negotiations and payment disputes. Would you be interested in sharing your experiences with legislators to help us illustrate the aggravation and confusion brought about by the insurers handling of non-participating providers? I look forward to hearing from you.
Jeremy
Jeremy,
In my case, I feel like the problems I had with First Colonies were primarily the result of a problem internal to the billing department — phone calls would net me one set of answers (“Talk to your insurance company” or “We’ll make provisions for people whose insurance company was not under contract”) and the bills for the full amount of the work performed kept coming to my address.
I do agree that Care First PPO was also a significant part of the problem… but I’m probably not a poster child for this scenario, where the big, bad health care organization leaves the consumer trapped in medical billing purgatory.
I also agree that it just plain “sucks” that a health care organization would not shield a patient from the complexities and headaches involved in resolving a medical billing issue — but when a “simple” surgery requires over thirty pages of bills from a half dozen parties, it already seems that things have spiraled out of control.
The other issue here is that any legislation that is passed would probably leave consumers at even more of a disadvantage if the health care providers and doctors can’t agree on a fair price, and the consumer is trapped by a pile of contracts that still pin the responsibility for paying the doctors on them.
Personally, I’ve always thought it was ridiculous that a person who is experiencing a trauma in an ER, or a person who is going in for surgery, has to sign a legally binding contract in order to receive care. In ERs every day, we have this absurd scenario where people bleeding all over the place while having to sign contracts in the waiting room. Would a car purchase under the same circumstances be legally binding?
Consumers lack a lobbying firm to fight for them — so this is really a battle between doctors and health care companies. And I think this can be extended to also include the insurers who provide malpractice insurance, and the lawyers who bring cases against doctors in malpractice suits. All of these parties have vested interests in getting their piece of the pie, but tell me, who really cares about the patient?
P.S., One interesting point — I notice that if I search on “First Colonies Anesthesiology”, my blog comes up first. Is the only recourse for the consumer with a problem with companies like Care First PPO and First Colonies to basically hope that Google and Yahoo! make their plight public?
I gotta agree with Flip completely. I went through a similar experience with First Colonies, though my experience with Thaler’s office hasn’t been as bad, as the woman I dealt with was not in the least rude. Luck of the draw, I guess, but again it was still the same situation where I was standing on principle – being billed the full amount was ridiculous. First off, CareFirst has a provision in their contract with the patient that the patient has the right to choose an in-network or out-of-network provider. First Colonies just puts themselves “in the rotation” for surgical procedures in or outpatient, with absolutely NO REGARD for the patient’s insurance coverage, and since we don’t get the chance to choose, since First Colonies does not volunteer the information that they were not providers, and since the patient file contains everything, they HAVE to have known who the insurers were, thereby VIOLATING the patient’s right to use an in-network provider as per contractual agreement with CareFirst. Therefore, the patient gets caught in the middle. Once the phone calls started, First Colonies claimed that they were trying to become providers to CareFirst but that CareFirst was refusing them, but on the flipside when I spoke with a rep from CareFirst, they said that First Colonies had OPTED OUT, which made no sense to me at all. In the meantime the two are pointing fingers at each other, I’m caught in the middle, the bills are rolling in, the collection process starts, and here I am standing on principle because I felt that First Colonies should have accepted what CareFirst paid, especially now that First Colonies is NOW A CAREFIRST PROVIDER!!. So all the time the fingerpointing was going on, so was the application process and now First Colonies is a CareFirst provider. Did that affect the collection process? Hell no! I received a Writ of Summons to go to court just like Flip, so rather than get REALLY screwed in the process I opted to deal with Thaler’s office, pay the money (balance minus CareFirst check) and be done with it, which according to Thalers office would make everything go away with no credit hit, and it would be like nothing happened. THe word she used was “poof” . I do not have a problem with First Colonies’ docs, as many of them have been around for years and are a bunch of good guys who do good work, but ENOUGH IS ENOUGH with all this insurance crap and sticking us patients in the middle when the insurance company and provider should be working it out without sticking it to the patient. BOTH are getting paid one way or the other for their services anyway. I cannot abie by the way that First Colonies has handled themselves, but I’m not thrilled with the way that CareFirst did nothing to help the patient (me) either. So I can certainly sympathize and empathize with Flip, having been through the mill the same way. Any others in the same predicament??
[...] Using your fill in the blank forms I send them out to the appropriate firms. Then the funds arrive to my PO Box. Its like magic. Its so exciting opening up the payments as they arrive.. This motherfucker sounds like he’d be the type of bastard who’d stir up shit on behalf of firms like First Colonies Anesthesiology… but I’m not bitter! [...]
Flip, DC -
I am also in the midst of dealing with a First Colonies, and have had suit filed by Mr. Thaler. This is particularly frustrating because in good faith, I paid the “in network” amount ($410), already. Am I correct in undestanding that they settled your account for payment of the in network amount?
That is 100% correct. First Colonies accepted the “in-network” payment. The key is to document all of your communications with their billing department and make sure you make it clear that the billing issue has to do with “unresolved issues” between them and your health care provider.
Also, take this with a grain of salt — if they choose to take it before a judge instead of settling, I’m not sure how a judge would see it.
[...] Funny how the work costs more when the individual has to pay instead of the big, bad healthcare company. Lucky for me, I found that showing up in court, ready to fight encouraged them to settle for the same amount CareFirst would ha…. [...]