scam or not?

[u/ConsequenceOver9269]

last month i went to fl for a week and went to the ER for a uti, as that is the only place to take my insurance. i received a bill from the ER already for $50 after insurance covered 2.5k for lab, ER and pharmacy. today i received a bill from physicanbillpay.com for $1,261 and a bill from east coast pathology of florida for $40 from my UAC. i was wondering if these 2 bills are scams. they came in about 2 weeks after my ER bill.

[u/EmZee2022]

Actually, No Surprises ought to cover this. The OP went to an in-network hospital and secondary practitioners should be covered under NSA.

Whether the 1200 dollar bill from the physician is a valid amount or not, it's hard to tell. Has insurance covered any of it yet? If not, wait until they process it, and pay what insurance says you owe. I don't know how your plan works with physician coverage for emergency services, whether you've met your deductible yet, and so on.

The doctor who saw you there is likely a contractor, which is why you got a separate bill.

The pathology is odd: since you say your initial bill included labs, I would not have expected them to need to send out anything to a path lab. But I don't know everything :-)

The fun of our healthcare system is that for any hospital encounter, you will get a MINIMUM of 2 separate bills, one for the facility and one for the doctor. For my colonoscopies, I get a facility bill, a doctor bill, an anesthesiology bill, and a pathology bill. You can also run into bills for imaging services, and possibly others that don't come quickly to mind. Surgery I had recently incurred bills from the doctor, the hospital, the pathologist, and the anesthesiologist (2 of them, for some reason).

I had an ER visit last year for diarrhea that lasted a week, was not improving, and left me clinically dehydrated. That incurred a huge bill (8800) from the hospital, a smaller one (800) from the radiology practice, and one for about 1600 from the doctor (I assume; the EOB isn't terribly detailed). Obviously the negotiated rates were a lot less.

[u/Sloppysteaksslick → u/EmZee2022]

I didn't say it wouldn't cover it. I just said the rule was created truly for emergency situations.

[u/EmZee2022 → u/Sloppysteaksslick]

For emergencies, but also the situation where you are receiving services at an in-network facility, but some of the staff (anesthesiologists etc.) are contractors and not in-network. You have no real control over such providers.

Friends of mine got a 4,000 dollar bill for anesthesiology for a colonoscopy. Having had a few of those myself, 4K is about triple the "rack rate" my place bills for that, and about 10 times what the provider actually receives. In theory, the practice could have demanded the full 4K (they actually wrote of the bulk of it) as this was long before NSA. With NSA, the anesthesiologist could not collect more than the 400 dollars or whatever that they'd have paid an in-network provider.

[u/Sloppysteaksslick → u/EmZee2022]

Believe me. I work in the field that created the law and worked with those who drafted it. It was created initially to protect patients from "surprise" out of network bills in emergency situations. It has since, luckily expanded within certain healthcare systems due to the gray area of what constitutes an emergency.

I'm happy that your friend got their bill taken care of appropriately.

[u/EmZee2022 → u/Sloppysteaksslick]

Good to know!!

From what I see in the forums, the ambulance industry managed to lobby enough to get excluded from the bill :-(

[u/Sloppysteaksslick → u/EmZee2022]

Yes. They truly suck! Most of the ambulances in the U.S are privately owned and operated with just a contract between them and the hospitals. It's a big scam.

[u/EmZee2022 → u/Sloppysteaksslick]

I'm curious as to how ambulance billing works if it's a municipally-provided service. If I dial 911 here, I get someone showing up in a vehicle branded with the county's fire department logo. Luckily we've never needed to test this out.