Medical Insurance Insists on Direct Billing for Dude's Surgery, Gets Hit With More Expensive Bill

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    Font - r/MaliciousCompliance u/FresnoMac • 23h Insurance firm insists on direct billing even though cousin preferred reimbursement. Okay, then. Have it your way. M I may get some insurance-related terms confused because I am not knowledgeable about private insurance systems outside my country (India). My cousin is Indian and lives in India and works for a major American cruise line. His usual schedule is nine months of work sailing around North America and three months of vacation time back in I
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    Font - The maritime insurance company that he's insured with provides medical coverage for him. When he was on vacation in India, he tore his ACL and MCL, and injured his meniscus playing football (soccer). It required a ligament reconstruction surgery and some months of rehab before he was fit to work again. There is public healthcare in India but for something like knee ligament reconstruction, it still costs money (although not as much as private hospitals) and also takes time as there is a w
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  • 03
    Font - So he decided to go private which is costlier. He contacted the insurance company to confirm his eligibilty to receive coverage and they confirmed that he was indeed eligible. So he went to an arthroscopic surgeon and got a letter from him detailing the estimated cost of the surgery, the date and other relevant medical details. He emailed the details to the insurance company, and they approved the surgery. Only one problem. They insisted on direct billing to the doctor. Now, doctors in In
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    Font - Naturally, the doctor was hesitant to accept the arrangement despite receiving a letter of guarantee from them. He simply wasn't convinced of the legal validity of a letter of guarantee from a foreign insurance company in India. What if they, for some reason, refused to pay? He can't do anything about it. So at this point, my cousin stepped in and suggested to the company that he'll foot the bill upfront and then submit a claim, after which the company can reimburse him. The insurance com
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  • 05
    Font - At last, he said screw this and went on a city-wide search and finally found a top doctor in one of the most expensive hospitals in the city who was willing to operate on his knee with a letter of guarantee. The doctor also worked in 3 months of post-op physiotherapy costs into the surgery bill. The hospital had the best rooms, the best service and the highest quality of care (the doctor worked with some of the top athletes in the country) and the final estimated cost was at least 700% mo
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    Font - At the end of the day my cousin got the best care possible because of the insurance company's inexplicable insistence. Or maybe they had good reason, but they lost money at the end of the day. Edit: Everybody amazed at the 8k bill, let me tell you it's a small amount for Americans, but it's still a big bill in India. A lot of Americans are flocking to India for surgeries for this particular reason. You receive great quality healthcare at some of the best hospitals here and the end cost is
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    Product - Material Strawberry 22h It's kind of depressing to admit that that price is actually more like two ambulance rides. Reply ↑ Vote The_BOFH 20h If that. My son tried to refuse an ambulance ride because of cost...he has brain cancer. Was over that for the single ride between hospitals
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    Font - Ok-Regular2135 18h For reference, my ACL reconstruction in the US 10 years ago cost about $30-40k B Reply Vote Grouchy Old_GenXer 18h I was going to say that this insurance claims guy was laughing at the $8k and approving it as quick as it came in.
    via Ok-Regular2135
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    Font - Charles Buckburner 22h a top doctor in one of the most expensive hospitals American here thinking, oh shit high 5 low 6 figures easy. 8k..... Imao. I can't tell what joke is funnier, that build up for that price or the American healthcare system. Reply Vote FresnoMac OP • 22h Haha, 8k is still big money in India though. The dollar stretches quite a bit in some countries. Which is why India has an unofficial "medical tourism" thing going on where Americans fly here for expensive operations
    via Charles_Buckburner
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    Font - Impossible-Bear-8953 23h Good for your cousin!! US based insurers have had problems in the past with paying the patient who then goes and spends the money on other things and lets the medical bills just go to collections. That's probably why the private insurance was leery. B Reply Vote FresnoMac OP • 23h Yup, that makes sense. I can definitely see that happening.
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  • 11
    Rectangle - bonethug 17h American Insurance company: "Hahaha look at this idiot, he put a decimal place in an $800k bill, let's pay it before they notice" Reply Vote ↓
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    Font - IGottaHandltToMe 22h The insurance company didn't blink twice because they're used to dealing with inflated numbers on a daily basis. This is just par for the course. Americans spend a bazillion dollars more on healthcare than the rest of the world to get worse outcomes and wholly inequitable coverage. For-profit care and private health insurance is the main reason why.
    via IGottaHandItToMe

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