Hey all,
So about a month ago while on vacation in Hawaii, we took my FIL to Urgent Care late at night because he had a pretty bad cough, his chest hurt and his heart was racing. He initially waived it off as he thought he just had a bad cold but the symptoms weren't getting much better by the end of the week so we decided it would be best for him to see a doctor. We brought him to the closest Urgent Care facility in Waikiki (Doctor's of Waikiki) that was still open (near midnight) and had good reviews all around (including the doc).
My in-laws have Medicare and so my wife called the Urgent Care facility ahead of time to ask if they would take it. The person who answered initially told her "yes we take Medicare" so we decided to go. My wife had to go to help translate because he would have had a hard time with all that. At the front desk she was told by a different person that they only accept Medicare PPO and not HMO (my in-laws have HMO but my wife didn't realize there would be differences in coverages when it comes down to urgent or emergency services) - she was not told this over the phone. However, she was also told that they would take the Medicare card as-is and 'process' it and that the charges would still be 'adjusted' based on the level of Medicare (where some would be covered and others would be billed to my in-laws directly). He paid a $70-80 copay and the person at the front said she thought the bill might be a few hundred or so after these 'adjustments.' Since he was in pretty bad shape and since we were there and worried, we just decided to have him seen by the doctor. They checked for flu, put him on a nebulizer, and prescribed him some meds. He was fine after the visit and getting meds.
Just a couple weeks ago, they received a bill for $1100 in the mail. The bill has insurance completely waived from it due to them not covering the Medicare he has as well as this facility being out of network. Since this was late night, we didn't really have much of a choice - I suppose we could have brought him to an ER too but not sure how much that would have cost either.
Anyway, the whole thing with my wife asking if they accept Medicare and the answers they gave seems pretty misleading. The people answering the phone/at the front desk could have just been misinformed but for such a small practice/facility, you'd think they'd know all the details and be transparent about it up-front. Almost feels "bait and switch"'ish...
My wife called my in-law's Medicare insurance and they tried contacting the facility but were repeatedly told that no claim would be opened and the insurance also informed my wife that they couldn't force this facility to open one since they're out of network. The Urgent Care facility also claimed and told insurance that a prior authorization from PCP was required else they wouldn't submit a claim to insurance. Insurance says if that were really an issue, they could have retro'd it but the Urgent Care *never* informed us about this whole "prior authorization" thing.
Insurance did file a grievance on behalf of my in-laws but not sure where or how far that will go.
My in-laws recently retired (and not with much) so $1100 is a not a small amount for them.
Any suggestions on other things we can try or if there's any potential recourse in a situation like this? At least to reduce their bill? My wife has yet to call the Urgent Care facility directly so will probably be doing that, but we don't have a good feeling about it and think they probably won't budge much if anything on reducing the bill amount.