I'm sorry your family member went through this. That's terrible and no one should have to deal with that kind of treatment.

I'll echo much of what you said. When I was 21, I was diagnosed and treated for malignant melanoma (skin cancer) that had metastasized to my lymph nodes. The treatment worked and I've been healthy for many years. That said, it changed the way and manner in which I deal with billing and insurance, so I'll share a couple of things that I learned in case someone else runs into the same issue.

- Do not immediately pay any invoice. Wait until the explanation of benefits arrives first and then verify that the two match. Basically, verify that the doctor is billing what the insurance company states is uncovered. Sometimes they're different and that indicates a problem.

- Check all statement of benefits for uncovered claims. It's important to understand why a claim is denied. If a doctor is not in network, it's important to drop them right away. If the doctor used an unapproved billing code or sequence of codes, it's important to know this and insure that this doesn't happen again or else it gets expensive. Alternatively, the doctor's office can resubmit the claim using different billing codes.

- Just because a doctor shows up under the "find a doc" in the insurance search doesn't mean they're in network. PHCS is notorious for this, which happens to be the network used by the health sharing ministries (which is part of the reason why these organizations are a terrible idea.) Anyway, even if a doctor is listed, it doesn't mean that they're using that tax id for their services. The insurance company and the underwriter maintain a database of tax ids that really determine who is in network or not. The doctor nor the front desk will have this information. The billing department does. As such, the process is to call billing, before the appointment, and get their tax id. Then, call your insurance and verify the tax id directly. Some phone support want to just verify the name. That is not good enough. Verify the actual tax id and insist that this is what is checked.

- Even if the tax id is verified, the claim may still be denied. This an innumerable number of reasons why this may happen. I had one denied because they billed a new patient the same day as a procedure. Anyway, the only way to truly know the cost is to get the procedure code and the tax id and then verify with the underwriter that this is covered. I mention the underwriter because the insurance company doesn't have this information, at least the ones I've used. Generally, the insurance company will refuse to give the underwriters contact and the underwriter will refuse to talk to you even if you get it, so the insurance company has to call them and then verify both the tax-id and billing codes. This only works some of the time, but they really can do it if they want. Most of the time, I don't go this far unless there's a dispute. Generally, verifying the tax-id is good enough.

- Hospitals do not just hire their own people. Most are filled and staffed with medical groups who use their own billing. Here's where things gets stressful. You basically have to be forceful, while sick, and ask each new physician and lab tech what medical group they work for and what their tax-ids are. The really crappy situations occur when the hospital gets slammed and then they bring in someone to help cover the gap and they use a tax-id that's not in network. This gets astronomically expensive quickly. And, look, the hospital will get tired of you asking. I get it. If I'm there, I'm either sick or dying and don't want to ask either, but these surprise bills can bankrupt you.

- Hospitals may randomly apply funds paid to random invoices. If this shell game goes on long enough, bills can be sent to collections even if you've paid them purely because funds paid were applied to new invoices and not old. Generally, hospitals will try 3 or 4 times to collect on an invoice. If you know one has been paid, verify the money has been collected from checking or credit, and then call the hospital to complain. It needs to be fixed sooner rather than later.

- As far as paperwork, I save the doctors notes from that day, the insurance explanation of benefits, the bill, and the receipt of payment from my bank, in a single file labeled for that day of service. This has saved my ass multiple times because I can quickly determine whether a bill has been paid and when.

- Do not overpay. Ever. Getting money back from a hospital is extremely difficult. Then, they'll randomly apply the credit to new invoices, which screws up the bookkeeping. This is part of why I delay paying invoices till I know they're good.

Alright, that was longer than I anticipated. Anyway, the situation is ridiculous and I hope no one here has to go through this mess. Hopefully, what I wrote above will help someone else.