All very good info.
I don't think there is anything you could sign that would take away your right to access the governmental consumer protection officials before going through VM's internal process.

It would be good to contact the AG's office and start the process.
I don't believe having them involved could be harmful to you and your treatment by the internal grievance committee.

Again having the documentation of the charges you paid before for the same procedure on other occasions would be very important. Don't forget you can ask VM for those records if you can't find your copies. They may charge you for researching and making copies for you. Your point is that the care you received was not different from those previous times and that the extra fee does not pertain to your care when at that facility.

And when you file your grievance indicate that you are pursuing a complaint with the AG's office simultaneously. You may be assigned an investigator and, if so, report that name on your grievance so that they can talk to the AG's office as well.

Sacrelicious didn't sign away their rights to the grievance process, but did make an implied contract with Viginia Mason. When you go to the doctor you are agreeing to pay for the service you will receive. Also just because they had the same procedure done in the past doesn't mean VM can't change their fees, or Regence can't change the way they reimburse (or don't reimburse) those fees. It's still worth appealing though IMO to argue the hospital service fee isn't fair.

From Wikipedia: "An implied contract is one in which some of the terms are not expressed in words. This can take two forms. A contract which is implied in fact is one in which the circumstances imply that parties have reached an agreement even though they have not done so expressly. For example, by going to a doctor for a checkup, a patient agrees that he will pay a fair price for the service. If one refuses to pay after being examined, the patient has breached a contract implied in fact."

I never said she signed away her right to the VM grievance process. I was indicating there was no reason not to contact the WA Attorney General's Office and have them apprised of the situation and possibly involved as she pursues whatever internal process VM makes available to patients. I think the internal grievance process is certainly the process to follow as it is set up to handle the patient's issue with the billing. However, the major change with the addition of the 'hospital fee' is certainly something to examine. Did the paperwork given to the patient explain the addition of the new fee now being added to bills at this facility? Certainly comparison of the paperwork signed this time and on the previous occasions will be of interest.

The legal definition of implied contracts is all very nice and certainly the basis of acceptance and recognition of the responsibility to pay forms that all of these hospitals and clinics require to be seen for services. Sacrelicious has not refused payment, in fact she indicated that she has paid the fees presented. Her description actually sounds like they sent the 'hospital fee' bill first and followed with the procedure bill later.

It isn't fair to argue the added fee? Whoa, in what universe do you live that consumers don't have a right to look for support and understanding when a new fee totaling a 200% increase in the cost of a well defined procedure is added (going from $300 to $900 total cost) without any specifically presented notice?

Again, I think the AG's involvement can only be helpful in having this internal grievance process work effectively and appropriately. I think the AG's presence may just cause VM to rethink their process of notification of these new fees.

Sacrelicious, I think a letter of explanation and copies of all the paperwork involved as well as how this is resolved with the AG's involvement could be sent to the television media's consumer advocate reporters when this is over. People need to be informed of these issues of new added fees. In these times particularly, folks may just need to shop for a better fee structure at other medical facilities when considering care for non-emergency care procedures.

Russ, we're on the same page. In my opinion it is still worth arguing that the hospital fee is not fair - I see that the wording of my comment wasn't very clear.

I live in the universe where "caveat emptor" is the rule, even when it comes to health care, and have had my own struggles with hospital bureaucracies that have left me cynical. I think it's important to know the legal realities anytime you are appealing a charge like this, which is why I included the info about implied contracts.

It seems that when you have insurance the hospitals/clinics just assume you can pay for anything, and I've racked up some big medical bills in the past because I didn't ask how much I was going to be charged. The only places where I feel I have been informed about medical charges were at sliding scale clinics like Country Doctor, and I usually had to ask.

The cost of healthcare is disgusting - everyone knows it but it seems like the costs just keep going up. I think as consumers we need to be more proactive but there aren't a lot of alternatives out there.

Thanks for all the help and advice here, both of you. I saw a VM billing person in person when I was in Seattle and she basically told me to go to hell, so I think Patient Relations is the next best option. I will do the AG office too, and others as I find them.

Whether it's Patient Relations or the AG, I don't think I have any hope of getting my money back. Hospitals have lawyers coming out their ears. I simply feel that this is an abusive way to treat their patients and I want them to know it. If I can't get the money back, at least I can publicly complain and maybe impact future policy for other people.

I had to get this procedure again last week (thankfully, in Lynnwood this time). I was holding back tears through throughout the whole appointment, and cried through the whole MRI I couldn't really afford (I'd just heard about this), and my doctor told me he was doing the procedure "off the books." So, as betrayed as I feel when people or organizations don't do the right thing, it's wonderful when others try to make up for it. Good people are out there.

I also found out that the facilities charge gets levied when the doctor uses anything from the facility (as soon as they open a drawer, for example), so I was ultra-paranoid when I had a consultation at VM downtown. The doctor assured me he wasn't claiming facility charges for the visit, but I was even scared to sit on the table, in case I got charged for 6 feet of wax paper. Jeez.