Memorial Hermann Health System / changed my estimate due after test performed
My husband and I have both spoken to many people in the Memorial Herman billing department with great efforts trying to get this issue resolved. Including a managers, Jennifer and Alex in regards to a change in pricing for a procedure my husband had done by Memorial Hermann 05/01/2017. The following is our issue in which we need resolution please.
Dr. Hand in Houston, TX (Memorial Herman Copperfield) referred my husband to have a CAT scan of his lower abdomen.
We made appointment for this at a location that was at Eldridge near 290 in Houston, Tx. After appointment was made we received a reminder a day before telling us of a balance due for the procedure which was $878.00 in addition to arriving early for check in and instructions to bring Insurance Card and I.D.
My husband went to the appointment and was asked if he fasted, he had not, so they informed him that he would need to come back having fasted. They arranged for him to go to another location the next morning instead of coming back at a later date. *Note he was never advised to fast prior to this time by appointment set up or confirmation call.
There was never a mention of the amount changing for the procedure so he went to the appointment for the test the next morning. No payment was collected up front at this location, only his insurance card and I.D. After the test was completed, he went to check out and was then informed he owed additional amount of $957.69 than the amount previously told of $878.00. He explained he had a voice recording of amount due that proved his amount of owe and played this message for the representative, he ended up only paying the $878.00 believing it was a error and left. The representative suggested he should call billing and get it resolved.
After returning home he called and explained the matter to billing. We did not hear back for a while and that was only with a bill in the mail for the additional amount due. They claim they leave him voice messages but we don't ever receive them or the calls.
We both continued to call billing with attempts to reach upper management with our issue and explain what happened with billing and test. However, the end result was you still owe the amount due, the claim was processed correct and to call Aetna but honestly, the claim was processed correct as we reviewed on the EOB. What was not correct was how Memorial Hermann did not inform us of the correct price. We are now getting told when we call that we will be going to collections since we will not pay the amount due. Our best chance to get help was when my husband called and dealt with a female supervisor/manager named Alex. She had told him the reason it is most likely higher is because the test location moved from test facility to hospital. No one ever told him or us this would increase our portion due when they rescheduled him, this would have made our decision to not do the test very easy at that location. She then told him she would escalate his case to upper billing appeals after offering to reduce his bill 50% but we wanted to appeal again since we felt this is not acceptable because had we known the bill would be this high we would not have opted to get the test done with Memorial Herman, we would have found another facility to get the test. We were told it would be a while to hear back on the bill as they would go to upper management for review. It had been almost 3 months and we never received a phone call or anything other than another bill for full amount once again, no longer the 50% reduction in billing. Please note they say they have called us but we have no record nor do they leave messages.
Today, I called on my husband's behalf to Aetna. I explained our issue and Jason at Aetna asked me if he could call Memorial Hermann Billing to see what could be resolved. I agreed and after speaking with a Memorial Hermann representative, being transferred to a Memorial Hermann Manager and another round of explaining what had happened both the Aetna Rep and myself were told it was my husband's full responsibility since the claim was processed correct. She offered a 25% discount if I accepted to pay in full while on the phone and I declined. She reminded me that we are most likely being sent to collections for nonpayment and thanked me for calling in. The Aetna rep tried to explain that even though medical procedures like testing and surgery etc can't be exact charges by medical providers, they give estimates to patients, however, he stated this estimate originally given to us was lower by 100% in consideration of the procedure being performed and that is not normally the case for large medical groups such as Memorial Hermann, to inaccurately give amounts this low to patients. As the Aetna rep looked over the claim he said, this procedure was claimed in amount of $5, 959.25, he believes they should have had a better idea of what to tell us as far as a portion due for our part to pay. No deductible had even been met so they had obligation to collect this. He recommended me to file a complaint with TDI as he would take this to Aetna to review to see if they could assist us in any way with a resolution of the amount due. I did file a complaint with TDI on July 9, 2018. I am waiting to hear back presently.
We feel strongly that we were misled by the estimate of payment due for the service, we pay all our bills on time and maintain very good credit. We truly believe this is fraudulent behavior on Memorial Hermann's part because of how they advised of new amounts after the test was done. They have a right to charge us a reasonable and customary charge but as a patient, we have a right to accept the responsibilities because it is based on the estimation of charges should anyone to decide if they wish to pursue the procedure or treatment or care. I know estimates can be off by exact amounts by a few dollars but this one is off by a large margin of over 110%. Would anyone expect to be charged over 110% more after the fact, than the original estimate given? Its just truly wrong. Thank you in advance for looking at our case. I hope you can help us. Attached is EOB and few bills I have received and few bills we have received from Memorial Herman.
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