letter from the insurance company notifying is that they were aware of the upcoming surgery and that if we wanted to avoid a $500 fee that the patient or the medical provider would need to provide a pre-notification of a hospital stay if there was going to be one following the surgery. So after the pre-op appointment I called the insurance company and told them that I was told during the pre-op appointment that my son would be staying at least one night and I was calling to notify them. The person on the phone told me that the medical provider needed to notify them of this, not me. I explained to them that the letter I received in the mail said it had to be the medical provider OR me that had to pre-notify them. They responded that it was the medical provider that needed to do it. So I hung up and called the medical provider who said that we were both wrong and that they would call the insurance after the surgery to notify and as long as they called the same day as the surgery it would count as pre-notification and we wouldn’t get the $500 fee. The day of the surgery when we were checking in we asked the hospital about it to make sure someone was planning on notifying the insurance company of the hospital stay and they said that he likely wouldn’t be “admitted” to the hospital, he would be staying overnight for observation so it wasn’t something that they had to notify them. It wasn’t that long ago that he had his surgery and so I haven’t seen any bills from anyone yet and I have no idea if I will have to pay an additional $500 for failure to pre-notify for the hospital stay since we got 4 different stories on how pre-notification works, 2 from the insurance company and 2 from the medical provider.

To answer the question in the related thread, nothing about medical billing is ethical and the way it is done should be illegal. I would imagine that some medical providers feel the same but are essentially forced to used the current system in order to do business.