Saturday, November 28, 2015

Northwest Medical Center Billing Fraud?

The menu they showed us, and the price we paid

UPDATE 12/8/15
My wife got a call from the billing office. They said that this was a mistake and that they would fix it and send something in writing to confirm it.

Something is very wrong at the billing department of Northwest Medical Center in Bentonville Arkansas. When I say "wrong" I mean very likely unethical and maybe even criminally fraudulent. They have a lot of affiliates in a lot of areas in our state, and I wonder if this is a one-off or if we have a large scale problem.
In January of 2015 my wife gave birth to our third child. I choose to insure outside of Obamacare so my family had a Blue Cross plan which did not cover maternity. I just knew we would have a medical expense and set some money aside to pay for it. I went to each player in the delivery, hospital, doctor, and anesthesiologist, and asked them to give me a cash-upfront price for the service. 
At the hospital in Bentonville I saw a woman named Kim. When I explained our situation she handed me the "menu" pictured above. It gave a cash up-front price for mother and child of $4095. That was just the hospital cost: the delivery doctor and the lab and the anesthesiologist were separate, but I was pleased with the hospital price. A few days later I brought her a check for the whole amount.
The delivery went off without a hitch and we went home happy. Then more bills started showing up. To be fair, at first they showed up from all three providers. It was understandable that providers these days are not used to people who pay for services cash-up front. Still, a phone call and a visit cleared it up with the delivery doctor and the anesthesiologist. With the hospital, I went by in person twice and showed Kim the price that she gave me. It did not matter, the demands for an additional $1,712 kept coming in the mail. At first the reason for the bill was non-descript. Later it said it was for the baby.
I wrote back several times and explained the situation, and even included a copy of the above, which clearly says the price listed is for both mother and baby. I asked them to explain to me why I owed it since I paid the up-front price for both and the delivery went off exactly as planned. The only answer I got was more and increasingly threatening form letters demanding money for a service for which they were already paid the agreed-on price. 
I also learned that Northwest Health Systems attempted to bill my insurance provider (Arkansas Blue Cross) for these same services. Since the plan I had with them did not include maternity, Blue Cross did not pay anything. If they had, it seems to me that it would be insurance fraud, since they had already been paid for these services by me. Isn't it attempted insurance fraud anyway? How is this different from going to a restaurant and paying the menu price for your food only to have them try to shake you down again on the way out the door?
Northwest has since turned this over to a collection agency called PASI. When they started sending letters I wrote them too. It did not help. It seems like the machine just keeps rolling along demanding money no matter what. Our healthcare system is definitely not fixed. The Obamacare part is not fixed and neither is the rest of it. What other area of the economy is there such a lack of transparency on price? Without prices, costs and benefits cannot be rationally decided. You can't ever have a rational allocation of resources without known prices. Its crazy, and yet medicine, in collusion with government and possibly big insurance, has kept price discovery for its services obscure, and in this case possibly deceptive. There is no effective reform in healthcare which does not involve patients knowing what price will be paid for the services received, yet here we are after politicians have reformed their reforms and we still don't have anything close to price transparency. 

Has anyone else had trouble with Northwest Medical System over billing, or trying to bill you more than you were led to believe something would cost? Right now anytime we get a major medical service it seems like they can just keep making up bills for vague "services" and we are just supposed to keep paying them until they decide to stop billing us. Are they doing this in the government health care programs too? Are they just sending as many bills as they can get away with until the bureaucrats decide it is just less paperwork for them to pay it with our money rather than dig into each one? 


Blogger so said...

I had a similar problem with Baptist hospital in little rock. They asked me to pay my part all up front after checking with the insurance company. I paid over two thousand up front then got another bill for eight hundred. I called them and they just said the insurance after they adjusted the costs said I needed to pay more. But at the hospital they said it was my entire payment. She told me the hospital person made a mistake the first time. When my husband had surgery the year before we paid the hospital his share for out patient which mine was too and he got a lot more bills afterwards like you said from the doctor,anesthesiologist and more from the hospital which they told us to expect. With my surgery they said I could pay it all up front. For my husband they said they needed at least eight hundred upfront. What a mess our medical has become.

10:39 AM, November 28, 2015  
Blogger Mark Moore (Moderator) said...

I expect to get a lot more stories like yours. Is it a con game to just see how much they can squeeze out of people? Without price transparency it is impossible to know. Barring legislative action (and we have seen how strong the hospital lobby is in recent sessions) the only solution I can think of is a bunch of us getting together for a class-action lawsuit. Everyone the hospital said "pay x" and then they wanted more money even though treatment went as planned.

10:51 AM, November 28, 2015  
Blogger Kathy Hall said...

Yes! My husband had the exact same experience when he had vocal cord surgery to remove a polyp. They billed us incorrectly 3 times - thank goodness we had the exact billing codes and payments from our insurance company. We not only called Northwest Medical, we were in email contact with a rep out of Dallas (where they are based) to inform them of their mistakes. We refused to make any payment until they got the bill corrected (and we communicated that to them and stated, in writing, the reasons why). By the 3rd billing, they had made the correction but were threatening to turn it over to collection. After they corrected the bill, my husband made arrangements to make monthly payments to NW Medical and they agreed. However, only a couple of weeks later, he received a call from a collection agency stating that the hospital had turned over the account to them! What?! This was AFTER they had already begun charging his credit card for the agreed upon monthly payment. The collection agency then made an offer to reduce the total amount if he paid in full. He decided to take them up on it with the understanding that the other monthly payments would, of course, be dropped. Unfortunately, not only did his credit card get charged for over $1500 by the collection agency, NW Med was still taking out monthly payments. He has since disputed the charge from the collection agency with his credit card company and we are hoping to see resolution soon. We both believe there is at the very least incompetence and the worst, fraud within the NW Medical system.

3:39 PM, November 28, 2015  
Blogger scrappyshan said...

We did and called the attorney general and it was cleared up in a week. They were billing us for something ARKods took care of 8 years ago! When we called we received a letter stating if we had anymore problems to contact them!

6:13 PM, November 28, 2015  
Blogger Mark Moore (Moderator) said...

Maybe we should do that, call the AG.

10:03 AM, November 30, 2015  
Blogger Apu Mridha said...

Thank you for sharing such an amazing and informative post. Really enjoyed reading it. :)

Thank you


Cost Containment Management

2:16 PM, October 19, 2017  

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