Linda Brandwin, R.N. Linda Brandwin is a registered nurse and a medical billing and claims specialist. For the past 10 years she has worked directly with insurance companies to give advice and guidance to the health care consumer. Readers may send email or write Linda Brandwin at 5500 Single Oak Hill Ct., Woodbridge, VA 22192.

Becoming an informed medical consumer will help avoid problems
Mar. 22, 2004

Q: My husband was sent to get a spine x-ray by our internist. When he arrived at the radiology office, he gave the receptionist his insurance card which she copied and returned to him. Nothing else was said.

About five weeks later I needed an x-ray and went to the same place. They took my card, copied it, and then told me that they didn't accept my insurance. I told them they had accepted this insurance from my husband the previous month. They said they were not in our insurance plan. I left and went to another radiology facility that I know my insurance covers. I assumed the first radiology office had left the plan in the five weeks between my husband's x-rays and my x-rays.

We received a bill for the full charges for my husband's x-ray. I thought my insurance company was just late in paying. I sent the office $20, then another $50. Two weeks later we received a letter from our insurance putting the full amount of $296 on our out-of-network deductible. I called the radiology office and they said they had not been in our insurance plan for a long time. I stated that they never informed my husband at the time of his x-rays that they don't accept our insurance; they just simply copied his card. They told me to call the main billing department. I talked to a customer service representative and was told basically "tough." I asked her if we could just pay what a reduced bill would have been if there was an insurance write-off. She said absolutely not, we would have to pay the full amount. I told her we were disputing the bill and I asked for her manager's name and number, but was not able to get through to the manager.

We went out of town and when we returned we found a bill from a collection agency. It said we have thirty days to pay the balance or they will place a judgment on us unless we notify them why we are disputing this. I have three questions. Is it the hospital's place to tell a patient when their insurance is not accepted? Since I have been paying on the bill, can they still send me to a collector? Exactly what rights do I have in this matter?

A: The short answers…no, yes, not many.

First, the hospital does not have to let you know if they accept your insurance or not. It would be nice if they did. It would be nice if all of the people who worked in the radiology office were knowledgeable and understood how insurance companies worked. It would be nice if they knew how important it was to communicate this information to the patients. But the responsibility ultimately falls on your shoulders. You need to ask all health care providers if they accept your insurance. You can also check with your insurance company if a particular radiology facility is part of your insurance plan. Some insurance companies also have a website with this information.

Secondly, usually if you make reliable and reasonable monthly payments, a hospital will not send you to collection. However, they have their own rules regarding collection which may not always be fair. Talk to the billing department to see if you can work out a payment plan acceptable to both of you.

And thirdly, there is not much else you can do. Patients are fairly dependent on the health care providers' guidance and knowledge. Don't assume anything. Ask questions and become a more informed medical consumer. The more you know, the fewer problems you will have. And I bet after this incident, you will never have this situation come up again.