Advice for an escort friend who had an ER visit!

[marylander1940]

In July of 2023 he was visiting a city and woke up with sciatica pain. Went to the University hospital, received treatment and assumed that as usual his insurance would cover the entire bill but unfortunately that wasn't the case. 

He started getting bills for a total of 4,200 in December of last year and now he got the final notice. If he doesn't pay within 15 days a collection agency either USCB America or Professional Credit Services will take care of his debt.

What should he do? 

Edited April 27 by marylander1940

[wsc]

Do you know of any explanation as to why the visit wasn't covered? As ER visits go, though, a bill of $4200 isn't that bad; my last one was $14K+, although after Medicare and Supplemental adjustments, my share was less than $500.

I know insurance companies do not like their insured customers going to an ER for non-life threatening or otherwise less serious conditions, and many people use them in place of a regular primary physician. ERs are notoriously -and ridiculously- expensive and visits to a doctor's office are almost always much cheaper. For this reason, his policy might have severe limitations for ER coverage, including a significantly higher deductible.

Of course, the escort was in a tough situation, being away from home base, with no local connections for medical care/doctors, and in pain. And since he was away from home, he would almost certainly have been out-of-network, if that applied to his coverage.

He might talk to his insurance provider to better understand their reasons, and if they don't appear to be reasonable or contractually compliant, he might contact his state's insurance regulatory office for advice or to file a complaint.

[+ APPLE1]

If all else fails, he should also call the hospital billing directly. Being accepted by a hospital subsidy program, or working out a payment plan with the hospital, is much easier than negotiating with a debt collector or migrating through a civil action in court for unpaid debt.

[marylander1940]

7 hours ago, wsc said:

Do you know of any explanation as to why the visit wasn't covered? As ER visits go, though, a bill of $4200 isn't that bad; my last one was $14K+, although after Medicare and Supplemental adjustments, my share was less than $500.

I know insurance companies do not like their insured customers going to an ER for non-life threatening or otherwise less serious conditions, and many people use them in place of a regular primary physician. ERs are notoriously -and ridiculously- expensive and visits to a doctor's office are almost always much cheaper. For this reason, his policy might have severe limitations for ER coverage, including a significantly higher deductible.

Of course, the escort was in a tough situation, being away from home base, with no local connections for medical care/doctors, and in pain. And since he was away from home, he would almost certainly have been out-of-network, if that applied to his coverage.

He might talk to his insurance provider to better understand their reasons, and if they don't appear to be reasonable or contractually compliant, he might contact his state's insurance regulatory office for advice or to file a complaint.

He decided NOT to contact his insurance company because among other things his social doesn't match his name and belongs to a friend's cousin who had Down Syndrome and passed away in May of last year. 

He's afraid of placing a phone call, being unable to verify/answer certain questions and having his insurance cancelled. He did have a couple of other Dr. visits preapproved by his primary care physician and he had a small copay at the moment and no surprised bill after. 

[marylander1940]

4 minutes ago, SouthOfTheBorder said:

just curious - why is it relevant that the friend is an escort in this story ?  
can’t it just be my friend, without the label ?  

insurance is typically based on in-network or out. some plans have geographic limits w exceptions for emergency treatment. the profession of the person has nothing to do with it.  and, lots of people of all professions travel for work and have medical issues away from home - it’s not unusual.

i have sciatic issues about every 18 months & it is painful. There’s really not much in the way of ER treatment other than prescribed muscle relaxers, pain meds & bed rest.  $4200 is a very low bill for US ER services & suggests nothing much was actually done. Urgent care scenario would have been much better/cheaper to get prescriptions. 

Lol - if he was traveling outside the US, the bill would be $200

US healthcare is basically like going to a very expensive restaurant, not looking at the prices & hoping someone else picks up the check

Let's say his employer doesn't pay for his insurance. Next time you want me to suggest editing a thread please contact me by PM. I think by now it's too late. 

[SouthOfTheBorder]

3 minutes ago, marylander1940 said:

He decided NOT to contact his insurance company because among other things his social doesn't match his name and belongs to a friend's cousin who had Down Syndrome and passed away in May of last year. 

and you’re wondering why the coverage was declined ?  The insurance company thinks the patient is dead 

[marylander1940]

1 minute ago, SouthOfTheBorder said:

and you’re wondering why the coverage was declined ?  The insurance company thinks the patient is dead 

Possibly but he is still charged monthly, and he had a couple of referrals by his PCP for other visits and only paying a Copay.

[Thelatin]

If his social doesn't match his name it seems like a debt collection agency might have a hard time collecting?  I've actually been getting late notices at my house from a provider who stayed with me a few times.  It's like well...good luck.

[+ sniper]

You'd have to look at the EOB to see what the deal is. Did the insirer pay some of the bill but not all of ot, or did they not pay a penny?

Was this his first medical bill of the year, in which case a big chunk of that $4200 might well be his annual deductible, ans the rest his copay. Say he's got a $2600 deductible for out of network care(not unusual) and then the plan pays 70% of out of network leaving him to pay 30%. If the original bill was $7500 that woud work out to roughly what his bill came to and it could well be legit. Mind you, this probably took him past his out of pocket max on his in-network care hence no bill for his other stuff.

There's a very good chance this is his actual responsibility and if he makes a partial payment it likely will keep it from going to collections. He might he able to negotiate a payment plan since the collections agency pays them pennies on the dollar.

 

[marylander1940]

2 hours ago, Thelatin said:

If his social doesn't match his name it seems like a debt collection agency might have a hard time collecting?  I've actually been getting late notices at my house from a provider who stayed with me a few times.  It's like well...good luck.

Could the investigation make his insurance company drop him? 

 

[wsc]

39 minutes ago, marylander1940 said:

Could the investigation make his insurance company drop him? 

 

Given his lack of transparency, as well as -kindly put- the "misinformation" involved (SSN), the less he talks to his insurer the better off he might be. That sort of behavior and lack of honesty will not make him seen trustworthy and might well negate any effort for a scheduled payment plan to the ER. Also, providing false information to the insurer may be grounds to negate the coverage contract altogether.

I genuinely feel for his predicament, but his lack of candor has not helped him.

[+ BenjaminNicholas]

As others have said, if he's using someone else's SSN and name, the debt collector worry isn't really a worry.

My worry is him being hit with insurance fraud at this point.  It's a very real possibility when they find out.

[maninsoma]

Not addressing the insurance fraud, another issue is the choice of treatment.  Was this really an "emergency" or just something that required urgent care?  My guess is that his insurance company considered the condition that was treated to reasonably require some treatment even though the insured was out of their coverage area, but not so emergent that an ER visit was necessary.  Thus, it's either not covering the services rendered at all or is covering it at a lower level.

It's also possibly just a billing issue.  I have a friend who did, in fact, have a need for emergency care (and an ambulance transport) while traveling last year.  While the hospital he went to seemed to be able to understand how to bill for his visit, the ambulance company bill required a lot of effort on his part to get the right information that the billing service needed to submit a claim for that (the name, address, and policy number was entirely different than his medical coverage).

[SouthOfTheBorder]

using a dead persons social security number for healthcare insurance is not sustainable.  He will get caught at some point if it continues & could be very unpleasant.  I’d say best plan would be enroll ACA during open enrollment periods and talk to someone familiar w the intricacies & subsides to minimize the actual cost.

the worst case scenario is something catastrophic happens, he needs reliable insurance and the fraud is exposed w current situation.  it’s much easier to just move on.  frequently these type changes appear much more complicated & overwhelming than just getting it done. 

[Boaxxx]

He should have called about the bill(s) back in December when they first arrived. If he hasn't made any payment then he is just being irresponsible and needs to start paying.

I did not have insurance about 12 years ago when my appendix ruptured. I ended up in the hospital for 10 days. The doctors saved my life (without surgery I would have been dead) and over time I paid the $86,000 bill. 

[MaybeMaybeNot]

Given that he doesn't technically have insurance,  $4200 is pretty good. I went in with pain that turned out to be a kidney stone about 12 years ago. I was in for 4 hours, had insurance with my own social security number, and that was about what I paid.  

[NJF]

3 hours ago, BenjaminNicholas said:

As others have said, if he's using someone else's SSN and name, the debt collector worry isn't really a worry.

My worry is him being hit with insurance fraud at this point.  It's a very real possibility when they find out.

Is the fake SSN only used for medical insurance? Income tax or banking?

[+ sniper]

As I noted above, even WITH insurance, that might very well be a legit bill. Lots of people are oblivious to how their health insurance works until the first time they use it for something more than a routine office visit. I have a friend at the gym who's 35 and started going to physical therapy for an injury at the beginning of the year and was shocked by the bills he's getting. He's never really had to use his insurance before.

[+ sniper]

4 minutes ago, NJF said:

Is the fake SSN only used for medical insurance? Income tax or banking?

Assuming it's how he stays in the US unless he's ducking some other debt. 

[BuffaloKyle]

2 hours ago, SouthOfTheBorder said:

 I’d say best plan would be enroll ACA during open enrollment periods and talk to someone familiar w the intricacies & subsides to minimize the actual cost.

If he doesn't have a full time job and most of his income is from escorting and not getting reported to the govt he can sign up anytime and get Medicaid.

[Boaxxx]

2 hours ago, BuffaloKyle said:

If he doesn't have a full time job and most of his income is from escorting and not getting reported to the govt he can sign up anytime and get Medicaid.

But it sounds like he is not even a citizen, if he is using someone else SS# and insurance, so why should he get any kind of government assistance?!?!

[+ Vegas_Millennial]

8 hours ago, marylander1940 said:

Could the investigation make his insurance company drop him? 

 

If the insurance company isn't paying for the $4200 ER visit anyway, then what's the worry of being dropped?  It's silly to continue to to pay a premium for insurance if there's no coverage because of the false information.

[+ Vegas_Millennial]

13 hours ago, marylander1940 said:

He decided NOT to contact his insurance company because among other things his social doesn't match his name and belongs to a friend's cousin who had Down Syndrome and passed away in May of last year. 

He's afraid of placing a phone call, being unable to verify/answer certain questions and having his insurance cancelled. He did have a couple of other Dr. visits preapproved by his primary care physician and he had a small copay at the moment and no surprised bill after. 

Best advice is to stop committing insurance fraud.  It's one thing to have debt.  It's another to have debt and go to jail.

[marylander1940]

5 minutes ago, Vegas_Millennial said:

If the insurance company isn't paying for the $4200 ER visit anyway, then what's the worry of being dropped?  It's silly to continue to to pay a premium for insurance if there's no coverage because of the false information.

His company has paid for other things before and after and he only had cover the copay.