ATLANTA — It’s a surprise no one wants – a medical bill because of a mistake made by a doctor, hospital or pharmacy.
For Scott Sinagra, it started with a cancer scare. He said that his doctor ordered an MRI and the doctor’s office told him it was covered by insurance.
“About two months later, I get a bill and I’m going, ‘OK, well, where did this come from?’” Sinagra said.
He said he was under the impression he shouldn’t have owed anything, or very little.
Instead, he got a bill for $5,200.
“Me, as the patient was, hey, I’m just doing what I’m supposed to do. I’m just being there to try to get healthy again and identify what the heck is going wrong,” Sinagra said.
He said he asked his insurance what happened.
“They didn’t have any record that my doctor’s office actually reached out to them,” Sinagra said.
So, he said the insurer wouldn’t pay the claim.
Craig Rae and Frank Trammell own separate medical equipment stores. They’re constantly interacting with patients.
“I think it happens more often than most people think,” Rae said.
They say when providers make billing mistakes, they hear about it.
“We see it every day and there’s a lot of anxiety and there’s frustration from our patients,” Rae said.
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Natasha Taylor with the consumer advocacy group Georgia Watch, told Channel 2 consumer investigator Justin Gray that complaints like these are common.
“Oftentimes, consumers end up paying the bills or the bills end up on their credit reports. So, we have a lot of consumers that end up with medical debt for bills that they don’t even owe,” Taylor said.
But she said there are ways to fight back.
“Consumers can appeal that because that’s not the consumer’s fault that the prior authorization wasn’t received,” Taylor said.
And if the appeal with your insurer doesn’t work…
“Our Department of Insurance is in place to look out for our consumers and ensure that consumers can file appeals and receive justice if they are incorrectly billed,” Taylor said.
To avoid this situation before you get billed, get pre-authorization in writing before any medical procedure.
And when your explanation of benefits comes, read it. Remember, it isn’t just junk mail. It may be the key to catch a mistake early.
And be persistent about mistakes.
After months of going back and forth with his doctor’s office, the MRI provider, and insurance.
The MRI provider cut Sinagra’s bill in half – a cost he said his provider should have paid.
He is still on the hook for $2,500.
“I just want somebody to take responsibility for their actions. Me, as the patient and also customer, just going, ‘Well, how am I stuck here holding the bag when I’m relying on the people to care for what I am going through to know that they’re supposed to do?’ So we don’t get stuck,” Sinagra said.
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