Located in Florida. Had surgery August 9, medical supplies not covered, hospital billing me thousands for it.

34/M, 33708, no income (disabled)

I had surgery that took place August 9, 2023 at a Baycare facility in Florida. A week before surgery, I received a good faith estimate of $1,048 which was the remainder of my coinsurance and out of pocket maximum for the year. I paid that balance before the surgery as the hospital had called me and really pushed for it.Forward 8 weeks, they are now billing me for medical supplies deemed "experimental" by my insurance company. These were for stem cell injections. They want over $7,500 for it. Now, I understand that stem cells are experimental and are not covered by insurance, and that is not my argument. My argument is with the hospital and I will explain why. The main points that outline why I feel this bill is illegitimate will be in bold.

This is the 4th surgery I've had at this particular hospital with this same physician. Each of the previous 3 times, my doctor used the stem cells. And none of those times was I billed for it. I have an itemized statement for each surgery, and have looked at the insurance EOB for each one as well. And every time, either insurance paid for it, or it was written off. I think it is probably the latter. One of the EOB's is clear that that time, they tried to charge insurance over $13,000, they refused to pay, and in the end, they wrote it off and I paid nothing more than my coinsurance.

Later that day I called my doctor and he clarified that he has used the stem cells every time. We did not really talk about it this time. He had my implied consent to use them again because I've never had side effects not been billed, and this has never been an issue. My explanation of benefits does say the following item is excluded, but that it is not patient responsibility. This gives me the impression that they are not contractually allowed to bill me for it under my current plan, which is why they didn't any of the previous surgeries.

Furthermore, my doctor offers these for $800 in office, not $7,500. So they are also price gouging me too trying to charge me retail, that they know full well would've been negotiated down to 85% off had the insurance company paid up.

I have read about Florida's balance billing protections laws. Again, the way I understood it you are only allowed to be billed for your copay, coinsurance, or deductible when having a procedure at an in network facility. Florida law also says if the final bill comes out to more than $400 more than the good faith estimate, you can dispute the bill. On the other hand, my interpretation is this only applies to emergency services OR non emergency services from providers, like physicians or anesthesiologists, or radiologists, but not for experimental medical supplies. So while I may not win on balance billing protections, I feel I can win on it being contractually not allowed with my insurance plan.

However, this still most certainly should have been clarified to me over the phone and provided with the good faith estimate that was given DIRECTLY TO MY DOCTOR. There is virtually no chance the stem cells weren't discussed with the hospital.

I have called Baycare and they insist it's a valid bill. They will not even negotiate on the price.Should I contact a lawyer? The No Surprise Billing Help Desk? Someone else? Am I protected under Balance billing laws? How on earth does an insured patient have surgery at an in network hospital, with a good faith estimate of a thousand get a bill for $7,500?

TLDR: Had surgery 8/9 at an in network hospital. Good faith estimate was $1,048. Paid it. Now get a bill for $7,526 a month and a half later for stem cells that my physician could've done for 10% the price in office. I have had these injections before with prior surgeries at the same hospital with the same doctor. I think they are contractually prohibited from billing me with my plan, and they blatantly lied on the good faith estimate unless they decided to inject the stem cells at the last minute, for which informed consent wasn't provided. Can't pay, won't pay. Don't think its a legal bill.

submitted by /u/SickOfAnklePain
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