<p>Find out who actually does the testing; it’s usually an outside lab. They would have a stack of bills to compare it to. Writedowns for testing is usually in the 70-80% range, but you should really get it in writing before going ahead. The billing person in the specialist’s office is the one with the ability to get you the correct charges.</p>
<p>I have been very happy with my “high deductible” policy, because office visits are subject to a $15(primary)/$30(specialist) co-pay and the $2500 deductible applies to hospital stuff. I have received a lot of care, including skin surgeries, that only cost me the co-pay.</p>
<p>I was recently referred to a specialist ($30 copay) who recommended some further tests, and we scheduled an appointment. It took me many phone calls but I finally determined that these tests would go against my $2500 deductible, so I will be responsible for the full amount. I finally determined that the provider bills these tests at $2062, but I am pretty sure Blue Cross Blue Shield North Carolina has a lower “negotiated rate” or “allowed amount” as they call it. This is the amount I would ultimately have to pay. I cannot for the life of me find out what this amount is! BCBS assures me they do not have access to those contracts and refers me to the provider who is equally adamant they do not have the information. So I have cancelled the appointment because $2062 is too much, but I don’t know how much I would actually have to pay if I went for the tests. It could be the full amount, it could be $1000, but it could be $500… I don’t know! They can’t answer my simple question: How much will this cost me?</p>
<p>I have no idea but I’m with you. It is so hard to get a price from someone. I had a cyst and they referred me to a plastic surgeon but no one could say how much it would be. I procrastinated until we had a year where we met our deductible. </p>
<p>I find it very frustrating. I’ve put off tests until the first of the year when we have our flex fund available so that we can better plan.</p>
<p>Yes, the lack of price transparency to the user is an extremely annoying part of the medical care and billing system in the US.</p>
<p>It is equivalent to a college student not knowing what the financial aid and scholarship offers are until after May 1.</p>
<p>The insurance company can’t give you an estimate because they don’t know for sure what procedure codes will be used. It is possible the doctor will start off thinking they will use one but will need a different or an additional one, which will change the price. The doctor’s office can tell you how much it will cost, but again it could change based on what is actually done. It usually isn’t the people at the front desk answering the phones who would have that information, it would be the staff that is responsible for the billing.</p>
<p>Call the dr’s office, ask what code/s they will use to chart the procedure and then call your insurance company back for an estimate. It’s not a simple question because they don’t have all of the information they need to answer your question.</p>
<p>Our deductible has to be met with clinic visits as well, I am envious, although we have a $15 co- pay for Drs in network, including specialists.
I just put large costs on my credit card and pay it when I get reimbursed.</p>
<p>Call the physician’s office ask for the person who does the billing. Ask that person what CPT codes the doc uses for the procedures/tests he has scheduled for you. Also find out if there are modifiers w/ the CPT codes. And lastly find out what the ICD9 coding is for your diagnosis. Call the insurance company back w/ that information. If your physician is a participating provider w/ the insurance company they should be able to tell you what the “allowed amount” is for each CPT code.</p>
<p>I have the codes. I have called BCBS several times and I have called the provider (including their billing office) several times. Both refer me back to the other, explaining in detail how they do not have access to that information.</p>
<p>Did you ask to talk to someone in the claims department at the insurance company. The customer service reps usually don’t have access to that information since they are not claims specialists.</p>
<p>If your provider is a participating- provider w/ your BCBS they should be able to tell you what the allowed amount is for each CPT code associated w/ your dx (ICD9). The offices billing clerk also has that info available on the providers copies of BCBS EOBs from previous patients the doc has performed the same procedures/tests on. Im sorry NJres your insurance co is being so un-cooperative.</p>
<p>I got a nice email response from Carolinas Medical Center (The provider). Their email was in response to an email/feedback I sent from their website expressing my frustration in not being able to find out the cost of these procedures. They gave me the telephone number of their “pricing line” which I called with the CPT codes that I already have, and I can expect to get their allowable/negotiated costs in 2 to 3 business days. </p>
<p>So maybe that phone number - pricing line - should be a little easier to find, or maybe I just missed it. Either way, it was the provider (not my insurance company) that is going to give me (I hope) my estimated actual out of pocket costs.</p>
<p>Sounds like you should be receiving the BCBS allowed amounts sent to you for the procedure code(s) you requested. Keep us posted.</p>
<p>With my Dentists Office, the submitted for pre-certification of benefits. It comes back with my cost. I’m guessing the Doctor’s office can do the same thing.</p>
<p>NJres,
I am surprised that you did not ask provider to do pre-determination of benefits. If you did, you would have an EOB in your hands wich will clearly state amount that you will pay, because it lists it under “covered” If your provider is participating with your incsurance than he cannot collect more from you. If he is not participating, then he can charge whatever, but again, you will see it on a statement. I am just repeating post #14.</p>
<p>MiamiDAP, don’t be surprised, because I am not familiar with the process, the acronyms and the buzz phrases. I have had the good fortune of only needing services up until now that were subject to a $30 co-pay. My deductible for diagnostic procedures and hospital care is $2500. To my thinking, the relevant question is, “How much do I have to pay?” not, asking for a pre-determination of benefits when from my perspective there aren’t any benefits until I spend $2500, or an EOB, whatever that is.</p>
<p>NJRes,</p>
<p>An EOB is an Explanation of Benefits. Thats what you get in the mail (or on line) that shows the date of service, the procedure code(s) the amount charged, the amount allowed, the amount to be adjusted/ written off by the doctor, the patient responsibility (copay/coinsurance/deductible) etc. There is not necessarily a need for the Drs office to request a letter of predetermination if they are quoted benefits over the phone or if they have routinely dealt with your employer, its insurance benefits, etc and are pretty comfortable with the anticipated payment. </p>
<p>A letter of predetermination is helpful if the benefits quoted are vague, are subject to pre-existing (rare these days), state that it is “subject to medical necessity” or require preauthorization. Even with a letter of predetermination, they typically claim that this is not a guarantee of payment, but that the procedure codes are covered. Insurance companies, when quoting benefits, will usually end with something like “verification of benefits is not a guarantee of payment. Payment decisions are made at the time a claim is processed”.</p>
<p>Don’t know what type of procedure you are having or what the referring diagnosis is, but insurers can be squirrel-y and sometimes deny a covered benefit for ridiculous reasons (don’t get me started-- rant for another time). That may be why the Drs office won’t commit to what your payment will be, in case for some odd reason the insurer denies the claim. They should, however, be able to tell you what the anticipated allowable is, especially if they’ve dealt with BCBS before, as surely they have. It is surprising that the drs office wouldn’t be able to tell you the allowable rate for that procedure, assuming they know all the codes you will be billed.</p>
<p>Be careful-- there may be separate hospital (facility) charges or possibly charges for supplies, or for an anaestesiologist if you need that too. You might want to ask all these questions.</p>
<p>Njres,</p>
<p>The provider more then likely has no clue what blue crosses negotiated fees are. They deal with so many different insurance companies and each company probably has thousands of various policies in effect that could have different rates.</p>
<p>I have heard horror stories about getting information out of BCBS. </p>
<p>call BCBS and ask to speak to someone in claims. Give them the codes and they can tell you their rates. A CPT code is a standard code for what procedure(S) they will be doing. Any insurance company should be able to look these up for you. If they refuse to send you to claims, or if the claims person can’t help you, ask for a manager. Blue cross has this information somewhere.</p>
<p>You may even be able to do this on their website… I know Aetna’s website allows you to look up this information.</p>
<p>Edit - i just read that the provider is getting the information for you. THat’s great! Maybe they will contact the insurance company and give them the codes. We used to get providers calling us with codes half the time and patients calling with codes the other half the time. My guess is they are going to call BCBS.</p>
<p>One of our kids had a $2500 deductible for health insurance. When the kid got the policy…$2500 was placed (partly by the kid and partly by us) into a savings account to be used ONLY for health costs. We didn’t want our kid to cancel or not make necessary doctor’s appointments…and when you have a $2500 deductible…you also need to understand that you MIGHT just end up needing to pay that amount in year at some point.</p>
<p>NJers…I’m glad you found out the answer to your question…or will be finding it out soon.</p>
<p>"asking for a pre-determination of benefits when from my perspective there aren’t any benefits until I spend $2500, or an EOB, whatever that is. "
Pre-determination is very important. If provider has sent for pre-determination, then you will have an Explanation Of Benefits (EOB) in your hands and you will have all numbers in front of you, no more guessing. Also if provider is participating, then he cannot charge over UCR (usual, customary, reasonable, detemined by Insurance). In addition, whenever insurance does not pay or pay too little, there is an appeal process in place. Actually, last time I just called and they said that whatever was not covered for the last claim, should have been covered. And, surely enough I recieved another EOB, stating that it would. I call insurance all the time. You cannot learn anything unless you talk to insurance and provider. You are paying ton of money, they can devote few minutes answering your questions, there are no stupid questions coming from the customer.</p>