<p>Do any of you contact doctors after they overcharge you? By “overcharge” I am referring to submitting a claim for an “extended” visit when you know you were in the room with doctor less than five minutes. And charging $35.00 to inject the vaccine, with a separate $50.00 charge for the actual vaccine. (What am I supposed to do, carry the vaccine home in my purse?) The injection is not covered by insurance, only the vaccine.</p>
<p>Or, another doctor recently submitted a claim stating I had presented with fatigue and malaise when I had none and in fact stated when making the appointment that I wanted an annual checkup, that it was a preventative care visit (which is coded/billed differently than if I had an health problems. Which I don’t).</p>
<p>OR, do you just pay when they nickle and dime you like that?</p>
<p>I once had a statement from the eye doctor billing the insurance company for an exam, when he had specifically stated while I was there that I was only there for a contact lens fitting and needed to return soon for an actual exam. </p>
<p>I contacted the insurance company. They called the eye doctor. The doctor’s office said that I had, indeed, had an exam (not true). The insurance company said they had to go by what the doctor’s office said whether it was true or not. They implied that I didn’t know whether I had been examined or not.</p>
<p>Another time, some years ago, I paid a bill from a hospital for a CAT scan. I didn’t realize that my health care would cover it. THEY paid the hospital for the CAT scan. I called the hospital and asked for my payment back, since they had been paid twice (it was around $100, but hey, I was in college). The hospital informed me that they were not required to repay me or the insurance company and subsequently kept both payments. </p>
<p>I learned to wait until I am absolutely CERTAIN that the insurance company is not covering an expense before paying it myself.</p>
<p>Do you have private insurance? I have great sympathy with medical professionals that have to deal with two hundred different insurance companies and who are trying to get paid for their time.
If I am paying premiums, co-pays & deductibles, I want my Dr to be able to continue to provide my care.</p>
<p>But I would call the bookkeeper to ask about it.
And see if your ins is paying market average, many drs aren’t even taking ins anymore.
I don’t think the CEO should be making $12.9 million.</p>
<p>Wow sylvan that sounds like fraud to me. I do call whenever some bill seems off or even excessive. If nothing else I am going to let them know I’m paying attention. Sometimes you can negotiate the fee downward. We once received a bill from a lab we had no knowledge of or agreement with. Our doc’s office had used them for our lab work. I called and said I had no agreement with them, I never heard of them, I had no obligation to pay and the doc’s office would pay them and how dare they and do not contact me again. I figured they were using the “throw the bill out there and see who’s willing to pay” and we’ll keep the extra. I think it is dishonest. I think the insurance companies are in a game now called bill the patients, lay off the workers, and pay for the executives’ yachts. I am not willing to play that game without protest.</p>
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<li>Edit: EK we cross posted. I have a friend (single mom) just laid off from an insurance co. whose CEO is making 7 figures. I call foul. To me it’s the top of the list of what’s wrong in our country right now. Who raised these people??? Why do they believe they are worth that much? Good grief.</li>
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<p>My D went to the dentist her freshman year in college. H was suspicious when D described the billing and sure enough, his office was actively attempting to collect the full amount from us and the insurance company.</p>
<p>Last year I was so ticked at my ophthalmologist that I sent him a demand letter. </p>
<p>First, his “exam” (for which I was charged $80) was “I’m going to refer you to a lid specialist.” Really? I’m a real estate lawyer and if my client needs to see an estate planning lawyer instead of me, do you know how much I charge them to tell them that? $0. </p>
<p>Second, the problem that resulted in the referral to the lid specialist was totally caused by medication that the ophthalmologist had me on. It was about a $2500 adventure and I sent the lid guy’s bill to the ophthalmologist. Of course he didn’t pay and of course I received a very carefully worded letter describing how he had met the standard of care.</p>
<p>I knew he wouldn’t pay; I just wanted to let the guy know that I was angry at him. (I’m still looking for another ophthalmologist.)</p>
<p>The CEO of our local *non-profit<a href=“you%20should%20pardon%20the%20expression”>/i</a> Blue Cross Blue Shield makes $3.5 million per year. Their billing and customer service practices are shameful. Premiums go up every year, benefits down. I agree that it’s outrageous.</p>
<p>Great wealth and power affects some, but not all, people for the worse. As a lawyer, I run into my share of CEOs and other high ranking/paid folks. Some are the proverbial “guy you’d like to have a beer with” while others are virtually unrecognizable from the guy you knew before he “made it.”</p>
<p>The reason you get a charge for injection and a charge for the vaccine is the reimbursement codes are different. That’s partly sensible; it means vaccine costs are accounted for properly. It also reflects the insurance reimbursement regime; the doctor can get paid for injecting and can get paid for the cost of vaccine. I assume the cost of the vaccine is marked up and that the insurer actually pays a lower number. That is part of the problem: you get a bill but the insurer only pays a percentage of what you would be billed for as an individual. </p>
<p>It’s funny but without getting into healthcare law politics, one consequence if we change Medicare by making it a voucher system is that this billing system will not function well. A voucher system is designed so “your skin in the game” is money you pay out of pocket; you buy an insurance policy to the extent of the voucher and pay the agreed on deductible, copays, etc. and overages for stuff not covered. (I’ll just assume the vouchers work reasonably well, which I doubt.) Current Medicare is more you show up and the doctor bills Medicare. As a senior, you don’t have to deal with much. Future system would be that some is billed to your insurer and some is billed to you, which means all older people would have to deal with figuring out bills and trying to understand what this costs, why it’s billed like this, etc. I would also expect administrative costs to go up.</p>
<p>Contact the doctors’ offices and ask about the charges and if they’re incorrect, have them correct them. You should also seriously consider finding some other doctors who are either more honest or more accurate in their back office or both. They may have a legitimate reason to segregate some charges like the vaccine from the injection due to insurance requirements. Be open minded and willing to learn but also willing to be assertive.</p>
<p>You probably wouldn’t put up with incorrect or unknown charges from a mechanic, a plumber, a landscaper, PC repair person, etc. so why would you with a doctor? There’s really not much difference other than with the doctor there may be more that you don’t understand due to the technical terms but you can ask and have it explained to you.</p>
<p>Well after a call to my insurance company I have written a letter to the doctor who charged for the extended visit suggesting that his office review the bill and resubmit to my insurance co. under a different code. I worded it like “there appears to be a mistake on my bill”.</p>
<p>The injection charge I will pay since I know that’s more about my own insurance coverage than that particular doctor. </p>
<p>The other doctor who billed for fatigue and malaise I can’t reach because his office is only open 9-3 Monday thru Thursday, and they close 11:00 - 12:30 for lunch. Don’t even get me started.</p>
<p>In my opinion the biggest scam in medical billing is the calculation of the percentage you owe for various services. Say your medical plan says you pay 20%, and your insurance company pays 80%. </p>
<p>If you have a procedure where an unisured customer would pay $100, you pay $20. Sounds right, eh? But the insurance company only pays 80% of the amount they have negotiatied for that procedure to the provides. So say the insurance company has negotiated that down to $70; they then pay 80% of $70, not 80% of $100.</p>
<p>Net result:</p>
<p>You pay $20
Insurance company pays $56</p>
<p>So you paid 35% of the total cost, not 20%.</p>
<p>I personally think this is extremely deceptive, and should be illegal. But every hospital in the country does it, and most patients are none the wiser. </p>
<p>I also think it is a travesty that uninsured customers pay more for a service (eg, $100) than the insurance company can negotiate for the same service (eg, $70). I believe hospitals should be able to charge different prices for different procedures (eg, hospital A charges $100, hospital B charges $90), but one hospital should NOT be able to charge different prices to different customers for the same procedure.</p>
<p>Yep, makes me sort of nuts to think about it all.</p>
<p>I will say that we are generally NOT educated consumers, in part because many of us are fortunate to have decent health insurance. We are on a high deductible plan, which means that at the first of the year, we are paying for everything out of pocket. H’s doctor prescribed this teeny tube of salve that cost $150. If we had to pay that out of pocket all the time, we would likely try to make do with whatever we could find for $5.99 at CVS.</p>
<p>We keep very close records of the billings and insurance payments, and even though we record and put everything on a spreadsheet, it’s still really hard sometimes to make sense of it. I have no problem calling the doctor’s billing office if I have any question about the bills. Just an," I was looking over my statement, and I’m confused about such and such," is enough to get the conversation going. Keep asking questions until you are satisfied and you understand the billing.
My docs offices have made honest mistakes, and they haven’t minded correcting them. I’ve also called the insurance company if I feel they should have paid.
Unfortunately, with the crazy way things are billed and accounted for, the patient really has to stay on top of it. Mistakes are made all the time.
I would definitely make sure that the billing for your Wellness visit was documented as such if it saves you money!</p>
<p>Its the same with dentists. My dentist hands you a summary of services BEFORE you go in to the chair and they add floride to the treatment plan of everyone, adults included. It is up to the patient to notice this and have it removed before service is rendered (insurance pays for 14 and under floride treatments 2x per year under our plan, $0 for adults), otherwise you get stuck with a bill for services you didn’t ask for.</p>
<p>DD had a root canal at 15 (long story). Last week, the tooth cracked in half (age 19). She called and they said to come in for a 10 minute check to determine treatment and to make the actual appt. She calls me from the chair - they are pushing an estimate of service costs in her hand asking her to sign so they can do a crown and post prep right then! I told her to put the dr. on the phone and I gave him what for for pressuring her like that. She doesn’t pay the bill. They would not let her take the estimate home for us to look at. I went in and asked to see it. They would not let me touch it but held it down on the desk for me to see. I had to write down on the info on an envelope. I called the insurance co. to verify amounts (they were wrong). GRRRRRR!</p>
<p>Had her set up a real appt and went with her. Guess what? The bill is coming out to what the insurance co. rep told me, not the Dr. GRRRRR part 2!</p>
<p>That should not happen, and I would bet that you could fight it successfully. We keep very close tabs on our bills ( I have cancer, DH has heart issues, so we have a lot to keep track of) and this isn’t the way our insurer operates (Anthem.) We pay the percentage of the negotiated fee. It’s all there in black and white.</p>
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<p>I agree. It is possible to negotiate with the doc directly, in some cases. I was able to negotiate a network price from an out-of-network doctor for some surgery, and I have a friend who was able to get his by-pass surgery reduced to the negotiated rate. But it takes a savvy and assertive patient to do this successfully. (and a reasonable doctor.)</p>
<p>Moonchild, I worked in medical billing for years, and this is EXACTLY how most hospitals and insurance companies handle it (legally, I might add). You are lucky that yours does not, but they are in the minority.</p>
<p>Agree that you can negotiate sometimes, but one problem is that often the doctor does not know for sure what they will be doing until they are in the middle of the procedure. Or exactly what drugs, supplies, specific medical device, etc. will be used. So neither of you knows exactly what should even be negotiated.</p>
<p>If the provider is participating with the insurance plan in question, they agree to a fixed fee schedule for the total payment. So the sum of what they get from the primary insurance and the secondary insurance or the patient is what is in the contract between the provider and the insurance company. I am familiar with the billing practices of many hospitals in PA and intparent’s statement does not apply here as long as the hospital is a participating provider.</p>
<p>Hospitals and doctors typically have a list price that exceeds the fee schedule price for all the common insurance companies so that they don’t leave money on the table. It is not uncommon to be able to negotiate the list price down to something similar to what the good commercial payors or the Blues would reimburse. Many hospitals know that collection from Self Pay accounts is very difficult and have a discount that is automatic.</p>
<p>If this is really the case, then thank goodness we will have more consumer choices eventually with the insurance exchanges. And good for Anthem/Blue Cross. Paying the percentage on the non-negotiated rate would make an enormous difference in our health care costs, and you can bet we’d leave any company, or doctor, that had that policy.</p>