The University Hospital system is incredibly efficient. I’ve spent a lot of time lately in both the suburban facilities and the main campus. The clerks manning the check-in desks and the schedulers don’t do anything until they make a copy of your photo ID and insurance card. I once went to the same office, same clerk, two days in a row. She didn’t deviate, didn’t skip a step. University Hospital knows how it is going to be paid. And that’s a good thing. I just thought it weird when the gift shop asked for my photo ID and insurance card…
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The young widow had her own share of nagging health issues. Last May her doctor looked her in the eye and told her that he wanted her to have a heart catheterization. This wasn’t an emergency. He just felt that it was warranted. More importantly, he wanted a specific doctor at U.H. main campus to perform the procedure. This would be fine except that Brenda (name changed) has Medical Mutual of Ohio. MMO’s network includes the Cleveland Clinic and the suburban University Hospital facilities. It is common knowledge that Brenda had great coverage throughout Northeast Ohio. Everywhere but U.H. main campus.
He sent her to U.H. Main Campus.
Brenda should have known better, but she was totally focused on the fact that she needed a heart catheterization. The doctor simply didn’t care. The schedulers, both at the doctor’s office and at U.H. main campus, noted her coverage as they set up her non-emergency appointment. And since it was not an emergency, she had close to a month to worry about this procedure and her health.
Brenda got the call the day before the procedure. It was a courtesy call from University Hospital to let her know that she was going to be out-of-network. Did she still want her heart catheterization? It was too late to turn back. She had worried about this for almost a month. She made a snap decision. How bad could it be?
$11,000
Brenda paid $11,000 in out-of-network fees. I consider this an abuse of privilege. Everyone involved knew that Brenda was going to the wrong facility. This was not an emergency. And this was too high a price to pay for good news.
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The bills are coming in for my little adventure. University Hospital, the doctors, and the labs have submitted claims in excess of $250,000. So far. My share, to date, has been my $5,500 deductible. All of my services were rendered by in-network providers. Anthem seems to be doing their job so that I can do mine, recover.
$250,000! I think that it would have been cheap at twice the price.
DAVE
I agree the Lady got the raw end of the deal.
Not all of University doctors and offices operate the same. There are some doctors left that put the patients needs ahead of the institutions financial gain.
My wife also had Med Mutual and a heart procedure was recommended. The specialist she was seeing at Southwest told her only 2 Cleveland doctors were qualified to do the procedure.1 at UH Main campus and 1 at the Clinic Main campus. He was the person that told her Med Mutual would cover her Out of Network if she went to UH Main Campus and personally called the Clinic doctor, set up her appointment and forwarded her records to the Clinic Specialist.
I was very impressed with his professional attitude and the fact that he recommended she go to the competition. Unfortunately, after meeting with us and running more tests, the Clinic doctor determined her risk was too high to operate.
You don’t win them all.