<p>mom of3… if your doctor is an in network provider… he technically can bill whatever he wants but must accept what the insurance dictates… so his actual charge is irrelevant. once he files the claim the insurance company will say what the service is worth… then they will either pay that reduced price at the percentage allowed for durable medical equipment, apply it to your deductible if you have one, and will basically tell the doctor what is left and the doctor is expected to bill the patient for the difference (AS DETERMINED BY THE INSURANCE)… if he has a contract he is legally bound to collect that difference…he cant just waive it for one person, and not another… his contract states that he is responsible for collecting the portion that the insurance determines is the patient part of the contract. Once you use an in network doctor, it is the insurance company in control…
Everyone’s insurance will have a different rate, different copay, different deductible, …the doctor may have a rough idea of what insurance x may pay, but it really isnt his responsibility. If your insurance approves but leaves a patient balance… there isnt anything wrong with what he did… If they approved a certain amount and he is trying to collect OVER that amount, then you have a legitimate problem. when you look at your bill, did the doctor take the amount off between his charge and the allowed amount (an adjustment)? if he did, then imo he is only following the law.</p>
<p>should add, if the doctor has reason to believe that a service will be denied or rejected in full…then he is obligated to advise you of that fact before hand in writing… not if he knows it will be covered but may leave a balance</p>
<p>Had a similar situation and if I make myself go into long detail it will ruin my nights sleep since it was so maddening.</p>
<p>In short…son broke arm…son went to PPO in network provider. DH told Dr. we had several arms slings at home and did not need/want a new one. Dr. insisted son needed it. Got bill from Dr. with negotiated and anticipated charges. Got second bill for $200 for a sling which was $29.95 at pharmacy down the street. The reason given…although the Dr was an in network PPO provider, the slings they purchased and then sold to patients were from a non network approved supplier !!!</p>
<p>This same cr@p happens when you go to an in network PPO ER only to find that the ER Docs are independent contractors and not part of the hospital. Oh and of course the contract Drs are out of network. Kaching $$$$$$</p>
<p>The whole medicare/medical system only survives because of cost shifting - where private cash or insured patients pay very high rates so providers can afford to accept Medicare patients whose payment schedule is about 20% of full pay clients.</p>
<p>Okay…going to practice my yoga breathing…ohmmmmmm</p>
<p>I had a situation similar to dietz. Had bladder surgery in August (never knew there’s such a thing as vericose veins of the bladder, but such is my luck…). The insurance company covered everything since we’d met our deductible, except the surgical supplies - the company isn’t in netword. Made no sense at all. Guess if I need surgery again I’ll have to bring my own clamps and the like.</p>
<p>As to DME’s, I sleep with a ventilator. It is cheaper for me to order my masks, hoses and whatnot through online sources than it is to pay the co-pay charged by the DME supplier in town.</p>
<p>Wanted to get back to all that posted on this thread. </p>
<p>After speaking to the Billing Specialist last week, I got a call today from the doctor’s office. They reduced our bill for the DME “because they want all their customers to be happy”. </p>
<p>I have agreed to pay $75 for the ankle brace they originally billed at $325. With a little patience and firm negotiating skills, I saved 77%! </p>
<p>Part of me wishes Six on Your Side would broadcast a story on this subject. I feel strongly that this is a public interest matter. If more people had knowledge of these billing/insurance practices, more people would start asking questions BEFORE they are over charged. </p>
<ul>
<li>This was never a personal attack on the Ortho office that treated my husband.<br>
My outcry was against the systems that permit this to happen in the first place. </li>
</ul>
<p>I am going to join dietz199 in a yoga class now. : )</p>
<p>momof3boyz, so they were paid by your insurance company and then they “want their customer’s to be happy” so they only charged you $75! How very kind of them!</p>
<p>deb922, My husband paid the out of pocket co-pay for the office visit. Our insurance paid the remaining balance of the office visit fees. </p>
<p>The doctor submitted a bill to our insurance for $325 for the ankle brace. Our insurance company reduced/adjusted the bill by $104.59 leaving a remaining balance of $220.41 for our portion. Since we had not met our annual deductible for DME/other charges, we were responsible for the full $220.41. </p>
<p>I just can’t wrap my head around the billing abuse in our medical care.</p>
<p>I’m glad you got them to be slightly more reasonable.</p>
<p>I paid $75 to the veterinary hospital for a dog sling that is available for about a third that price online – or for free if you cut up some old sheets. But that was nothing compared to the rest of the bill. Dog went in for disk surgery and when his heartrate was slightly low the day after surgery, they ran every test in their repertoire – including an abdominal ultrasound !?! – without checking with me. The bill was insane.</p>
<p>My vet always gives me an estimate of charges before doing anything. They call if during a procedure if there is a problem or an issue which would increase the fee. </p>
<p>The problem with our current medical billing/fee/charging/cost shifting/gag-claused contracts system is that it is secretive. I have spent many hours on this problem. For example…a tale of two colonoscopy providers.</p>
<p>This service requires a facility and a doctor. Both facilities are in network and the same Dr. performs the procedure at both. Facility one, part of a large and predatory ‘non-profit’ health care provider who is taking over my state tried to tell me they can not give me the charge for the room, since there may be extenuating circumstances. After kindly explaining that state law requires them to do so they state that 1 hr usage will be charge out at $4500! But reassured me that my insurance would automatically reduce this by 33%. And, no, if I am on the steel table with the thin white sheets for less than an hour it is not prorated. BUT, If I go over by a minute - bingo - charged for another hour. </p>
<p>Second facility - billed at $1500 for the hourly rate. Now here is the trick. The first facility has contracted with my PPO in such a manner that their charger rate is the actual billed rate! The second facility has a different contract so that their charger rate is automatically reduced and then the 33% insurance discount is applied to the second, lower rate</p>
<p>Oh, and the Dr. fee was the same at both places.</p>
<p>Being the sarcastic individual I am, I called the first place and asked if for the additional cost I can expect an 18K gold prob and a string quartet to be playing Mozart while I was in their care!</p>
<p>This first provider is sometimes the only option in more rural areas. When our largest state union was renegotiating their contract they requested a list of charges so that they could compare it to other providers. Guess what, this provider stated that not only would they not provide this info, the were putting a gag clause in the new contract which prevented any disclosure of this info.</p>
<p>I needed a machine called a nebulizer that makes respiratory medications into a fine mist that can be inhaled. ALL 4 of us in my household are asthmatics. I was able to get the durable medical equipment company to locate the brand of nebulizer that my lung specialist recommended, after waiting A WEEK! They wanted me to RENT the machine (which cost only $175) and charge me for “instructing” me on how to use it though I can read & follow the simple instructions in the booklet & on-line perfectly fine. I fought with insurer for 6 months for the right to purchase the machine outright instead of renting it before they finally relented. </p>
<p>I COULD have bought the blasted machine from another provider for only $100 but then it would have been a NON-preferred and NON-participating provider & would have cost me the same out of pocket and less to my insurer. I told them that the price of the machine was similar to an electric toothbrush, which also is NOT rented and could save any or all of the 4 of us from ending up in the ER or hospital for our asthma, which would be many, many times the cost of the machine, especially if they decided I didn’t need it any more & took it away & then took a week or longer to get me another one when it was needed urgently.</p>
<p>I have seen the same and even better models of nebulizers on-line for even lower prices than the ones available at the pharmacies and durable medical equipment suppliers.</p>
<p>Pulse oximeters are even more over-priced. They were selling for $500-1000+ when I wanted to buy one in 2002 (I asked around). I ended up buying on-line for under $400. Now, you can get them at Fry’s & many other places for $30-40! Insurer will fight (& usually win) to keep from paying any portion of it though, saying it’s only for CLINICAL use, not patient use.</p>
<p>My regular vet is wonderful. This was a veterinary hospital. I had signed a release to the effect that I authorized them to do additional procedures if necessary. Of course I thought this meant that if something went wrong in surgery or if they found something unexpected during the surgery, like a tumor, they should do whatever was necessary to save my dog’s life in an emergency situation. I didn’t anticipate that they would use that as permission to do whatever they wanted after surgery, when there was no emergency and no clear need for the tests they ran, and they could have easily contacted me to discuss it. And then they seemed to want to keep him there indefinitely. They told me I was taking a chance that he would die if I brought him home. I said it seemed likely that he was going to die in their care and I would rather he died at home with his family. I brought him home and he recovered, but I don’t think I’ll ever again put an elderly dog through major surgery.</p>
<p>Sorry to go off topic. The main point was the annoyance of being charged $75 for a sling when an old towel would have served the same purpose.</p>