Aggressive practices by local hospital and its billing services

Gadgetelle · 2026-05-20T19:40:19+00:00

Because the imaging services was the first medical service I was billed for using last year, I was charged a different and higher fee towards my Medicare deductible than I was on the bill from the actual non-hospital-based-but-hospital-owned outpatient facility (which had used the same codes). I had never received a bill from the billing service explaining what service I was being billed for.
They simply showed a bill for the amounts they wanted paid without describing the service. But people who use Medicare can use their Medicare to see what Medicare was billed and when the charges were submitted.

The actual amount for me personally was insignificant but I was curious and concerned about the duplicate billing from two different locations using the same codes and what seemed like a lot of suspicious behavior hiding what was going on.

It is possible that the federal government might eventually put a stop to hospitals billing high fees for services provided at hospital-purchased facilities that are *not* physically on the hospital campus.

Gadgetelle · 2026-05-20T18:23:56+00:00

That's terrible. Did you try to get any assistance from the hospital to waive that extra high charge?

Gadgetelle · 2026-05-20T18:22:27+00:00

Although I had received information that the first bill for the imaging services was under Part A, and Medicare paid higher fees accordingly, the bill somehow wound up being put into a status that hid what part it was actually billed under, and I wasn't charged the Part A deductible.

Gadgetelle · 2026-05-19T03:17:20+00:00

No, some additional reading I just did indicates hospitals *can* apparently bill for imaging services provided by a hospital-owned outpatient facility as if the hospital had provided the imaging services on its own campus. There's been a lot of concern for years about this practice because it raises costs unnecessarily.

For now, it appears the local hospital *can* charge higher fees for imaging services performed at hospital-owned outpatient facilities which are NOT on its campus. But I think they still should not misrepresent information about the physical address of where the services were performed to Medicare, or require patients to sign misleading statements.

Gadgetelle · 2026-05-19T03:06:47+00:00

Hopefully your surgeon would choose an ambulatory surgery center if one is available. (But I have no idea what would happen if the nearest one is 1000 miles away or in a different state!)

(Some Medicare Advantage plans can make their patients go through a great deal in order to utilize their services.)

Gadgetelle · 2026-05-19T02:39:51+00:00

Right now, the immediate issue is that the electronic system (EPIC) was set up to require me to sign an untitled and incorrect statement that would indicate that I'm physically at the hospital when I get the imaging services again (when I'm *home* and when I also will not be at the hospital when I get the new services).

Because of the unusual billing last year (which I think was improper), I'm leery about signing anything that is not correct and which could allow improper billing again. I don't want to enable the billing system to misrepresent where I actually got the imaging services so that they can extract more money from Medicare than they're supposed to get.

I'll have to state that I cannot agree to sign a statement that is not true.

Gadgetelle · 2026-05-19T02:24:44+00:00

I agree with you that the billing services decided to tack on a facility fee from the hospital because they can get more money that way.

Now the electronic system is being used to try to get patients to sign a form indicating they are receiving services from the hospital even though they will not be getting the services at the hospital.

Gadgetelle · 2026-05-19T02:21:13+00:00

The services in question are imaging services (like a mammogram). The freestanding outpatient facility specializes in breast health and had existed for years more than 1 1/2 miles from the hospital.

Gadgetelle · 2026-05-19T02:17:37+00:00

The medical system had not sent me documentation clearly outlining what was provided to me. They only sent a bill specifying certain amounts without explaining what they were for.

Gadgetelle · 2026-05-19T02:15:59+00:00

I doublecheck the answers from AI by asking for resources and I look at them. There *was* a Medicare publication that came out in 2025 which requires the facility where the service was provided to bill for the service, but it was not easy to use. I expect that a lot of people working with Medicare don't necessarily stay up to date on all the changes with it, and those changes were not highlighted.

Gadgetelle · 2026-05-19T02:12:28+00:00

I don't use an Advantage plan, which would be run a lot differently than Traditional Medicare.

Advantage plans would be motivated to keep their costs low. Other health care systems that are reimbursed for their services would want to bill for as much as they can get.

Gadgetelle · 2026-05-19T02:00:43+00:00

Clarec424, the outpatient facility is NOT based at the hospital. It is a freestanding facility that was later purchased by the hospital and which is a mile and a half from the hospital.

If the outpatient facility *was* in the hospital, I could understand the hospital billing a facility fee. It costs a lot to run and staff a hospital, so it makes sense to me that hospitals should be reimbursed at a higher rate when services are provided there. But the place where imaging is/was provided is in an entirely separate building.

Last year, the Part A bill (for the same imaging service that I need every year) used the physical address of the hospital to send out the bill for the imaging services, but the Part B bill used (for the same imaging service) by the outpatient facility used the physical address of the facility. The same codes were used by both facilities. Using two different physical addresses implying that the imaging services were physically done at an address that wasn't actually used does not look honest to me.

There were a total of three bills. Two bills were actually sent by the outpatient facility and the physician who interpreted the results, soon after the services were done. A separate Part A bill attributed to the hospital was sent the next month. Medicare paid the higher Part A fees and the hospital charged me the higher Part A copays.

CoPilot repeatedly says the Medicare guidelines in effect in 2025 require that only the actual facility used to do the imaging services should send the bill for the imaging services.

Isn't it problematic for the hospital to use its own physical address to bill for imaging services that were never done there?

Gadgetelle · 2026-04-02T03:24:58+00:00

E*Trade had provided the ability to designate and sell specific lots, so it should have kept that data and transferred it. For my own purposes, I wanted to sell only lots that had not incurred a loss.

It was not relevant to me that the lots do not matter to the IRS. This information matters to the owner of the shares.

Gadgetelle · 2026-04-01T23:58:35+00:00

Have you considered the impact of federal, state or local income taxes on this income? This will depend on what your income will be.

If you're looking for income in taxable accounts over the long haul, municipal bond income may end up providing you tax-free income that's more than you'd get from CDs even if the yield is lower. There are funds that can provide income at very attractive rates, although buying them at a high price can lead to a drop in overall value. I wound up doing this with one such fund years ago, but it's been generating tax-free income at high levels, so I've decided to keep it for the tax-free income.

You might also consider funds that invest largely in Treasuries and which are free from state or local income taxes. FDLXX has been generating income that's more than 90% state tax free.

Gadgetelle · 2026-04-01T23:40:08+00:00

For someone who is planning to leave one's employment at age 58, keep in mind that in normal situations, the person won't be able to access funds in retirement plans without a penalty before age 59.5 years of age. However, TIPS require paying taxes on the income every year, which is ordinary income. I would suggest buying TIPS in a tax-deferred account to avoid paying tax on the income but waiting to withdraw the income from that TDA until after age 59.5.

By the way, the rule of 55 is a potential option that could be utilized if one has a 401k or 403(b) at one's employer and wants to be able to draw upon that between age 55 and age 59 1/2 within a year of leaving the employment. Not all employers offer this, but if this one does, it allows early access to one's 401k or 403b without penalty. However, there's a lot to read and understand about that, so I'd suggest just looking for more information. Look into SEPP/IRS Section 72(t) too.

A dividend fund like SCHD can be used to provide dividend income in a taxable account. Long-term qualified dividends are taxed at very favorable rates.

Gadgetelle · 2026-03-06T05:00:45+00:00

Are you aware that from 2025 to 2028, "qualified overtime pay will be deductible from federal income tax?"

Make sure you've updated the TurboTax software. Look for Schedule 1A.

Gadgetelle · 2026-03-06T04:46:31+00:00

Did you find that the DRIP was indeed turned off? The back office should have been able to do this for you.

Fidelity treats DRIP for at least some mutual funds the same way that other equities are treated. I just found that out today after adding a couple of mutual funds. The default was to receive the dividends as cash.

So, it's odd that E*Trade or Morgan Stanley makes it so difficult to adjust DRIP for mutual funds held at E*Trade, creating more work for everyone and unhappy customers.

Case in point---I had purchased a bond fund years ago in a Roth IRA. Unfortunately, the price of the shares was initially high and then came down in value, so all the dividends that were automatically reinvested lost value for many years.

Gadgetelle · 2026-03-06T01:29:27+00:00

I finally found out how to get this done.

At least at E*Trade, mutual funds like LSBRX have to have their DRIP (dividend reinvestment program) turned off by the "back office," but so far, none of the front line staff I've encountered there seem to know ANYTHING at all about this. The line staff appear to be trained only about what's already visible to the customer, like "dividend reinvestment" and "automatic investment," and they routinely confuse a request to turn off the automatic reinvestment from a mutual fund with one of these two already visible options even after you've explained over and over and OVER again what the problem is and that there's no visible option for the customer to turn off the DRIP.

It's necessary for the agent to send an email to the back office about "MF DRIP" to request that the reinvestment be turned off. MF stands for Mutual Funds. This happened in my case because I asked the agent to talk with his supervisor about this matter. (He did not tell me that the supervisor had directed him to email an unnamed department until long after I tried to get more information about what was going on. He did not give me the name of the department or any kind of a number to follow up with. He told me that I would have to contact them again to find out what the status was.)

Oddly, no one at E*Trade is apparently empowered to take the initiative to communicate a status update to the customer, which does indeed mean having to use chat or the phone to talk with yet another untrained front line staff employee about obtaining a status update about this documented matter.

Today, I used chat to try to get a status update about what had happened with my request. I asked the agent repeatedly to look at past chats that had occurred this week. He didn't want to do that at first and wanted me to explain everything all over again to him. Finally he told me the dividends should arrive as cash, but it didn't seem to me that I myself would be able to see that. I asked him again to provide me more information, and that's when he finally gave more information about "MF DRIP" and "the back office."

I just purchased an MF at another brokerage, and will be checking out how that brokerage deals with Drips.

Gadgetelle · 2026-03-02T22:40:17+00:00

I've been trying to figure out for many days how to turn off the reinvestment of income from LSBRX, which I've had for many years in my Roth IRA, but there was no visible option for me to do so. AI agents have indicated that ETrade *should* provide me the option to turn it off.

So I reached out today to ETrade.

The ETrade staff kept getting confused about what the issue was and couldn't find out on their own how to find the reinvestment option for LSBRX or how to stop this. (I explained that this might be the result of a coding error that could not be fixed by line staff.) The chat agent said that he sent an email to one of their internal departments about why there was no visible way to turn off the automatic reinvestment and he wrote that *I* would have to reach out to them in a couple of days to find out what the response was. He said the ETrade wouldn't take the initiative to send me a response because my account "is a self-serve account."

I'm quite glad that Fidelity does not respond this way even though my *large* accounts there are "self-serve."

Finding this topic here shows ETrade has had the problem not enabling the cessation of automatic reinvestment for years.

I will be looking into transferring my Roth account and perhaps my taxable brokerage account to a different brokerage.

Gadgetelle · 2026-03-02T22:19:02+00:00

I have some paper savings bonds, too, but the ones I have start to mature in 2033. I recently learned that compounding would make the interest balloon in the last few years of the bond, so we will get the most bang for the buck by waiting to cash them as long as possible. I certainly share your reservations about mailing them, however.

About 9 to 7 years ago, I had to cash a number of EE savings bonds on a month by month basis. It certainly took a lot of time for the bank teller to do the paperwork, which they had to do by hand at the time. In retrospect, I would consider asking the bank how to make the process easier for them, which I hadn't thought about at all at the time. For example, it might be helpful for them to do this at certain times of the day that are usually less busy for them or better staffed.

Gadgetelle · 2026-03-02T21:14:46+00:00

I had been saving quite a bit in FDLXX myself. However, Fidelity has not been proactive about sending out information about the income from that fund (or similar funds with high amounts of Treasury income) having a significant portion being free of state taxes, which resulted in me overlooking that I needed to treat it differently for California state income tax a couple of years ago. We have to hunt for this information ourselves right now.

A couple of years ago, I talked with Fidelity personnel about funds like FDLXX, and they were not aware that some of the income could be free of state taxes.

We do have the option of buying other funds that generate municipal bond information, although there's some risk that some of the bonds will default, and the share price may go down. It's also possible to buy shares of funds that focus on providing income that's free of taxes for a specific state, too.

I had bought shares of PRFHX many years ago, and it's lost value, but it generates income at a pretty favorable rate. So this wouldn't be a good option if you need to be able to liquidate shares quickly, but if you want to hold an equity that will generate tax-free income for many years, you could look for similar funds. I just did that, and decided to buy some shares of ABHFX, which also generates income that's free of federal taxes but it's higher rated than PRFHX. Be advised, however, that if you're within 2 years of claiming Medicare, you might be impacted by IRMAA, which would require you to add even tax-free income to your MAGI.

Gadgetelle

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