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{{update}} Is this how the 'insured' are getting screwed by the health care act?

Since the last quarter of 2012 we have been getting bills from our health care provider to cover the difference our insurance didn't cover.

According to our health insurance our well visits are only supposed to cost us our $25 co pay. Our insurance only covers $60 on top of the $25 co pay, but most of our doctors visits are $130+ on average so we have been billed for the difference.

This didn't happen before October of 2012. Has anyone else experienced this?

May 29, 2013:

After I thought I had handled the bill and solved the 'issue' of being charged for an annual well visit that is only supposed to cost a co-pay I got another bill from the clinic today. It was about 20% less than the original bill. I called the billing dept. at the clinic immediately. I was told that the original person I spoke to was a temp, but only after being accused of being a liar because no one by the name of 'Barbara' ever worked at the clinic. Next I was told that I was billed for an office visit because I discussed my depression with the doctor. HELLO! When the doctor asks how long I've been taking medications and what they're for I'm going to answer. Since when is over-all health not a part of the physical? Since when is listing medications and answering questions not a part of the physical? Hopefully this phone call will be my last.

With my luck the clinic will probably drop our insurance and I'll be left with the clinic and physicians I hate at the only other clinic in 200 miles that is contracted by our insurance.

by on May. 3, 2013 at 8:08 AM
Replies (101-110):
Veni.Vidi.Vici.
by on May. 5, 2013 at 11:03 AM


Quoting Sisteract:

Exactly- Now, I can see practices opting out of contracts, eventually, but not without full disclosure first.

Quoting PestPatti:


  I work in Medical Billing, and if we PARTICIPATE with the insurance WE CAN NOT LEGALLY bill the patient anything except the copay, or co insurance or deductable.   If we do we can get fined, BIG TIME.

 I would check your EOB, or if you have the availability to go on their website you can check it there.    

 We have instances where the insurance company as processed it incorrectly...

 

 

 


we have received ew disclosures about payments, but not that the office is no loger in contract with our insurance. After several phone calls it has been determined that the practice is still in contract with our insurance provider. Our insurance company suggested that we do not pay any 'differences' until it's understood exactly what we're beig charged for. 

Veni.Vidi.Vici.
by on May. 5, 2013 at 11:06 AM


Quoting Stephanie329:

No it's always been like this. Usually by now we still haven't reached our out of pocket limit.

with our insurance plan we don't have to reach a deductible in order to have well visits covered with just a co pay

Veni.Vidi.Vici.
by on May. 5, 2013 at 11:10 AM


Quoting TerriAnne2606:

Yes - check your co-insurance.  You may have that on top of your co-pay.  Find out what your out of pocket maximum is.  Check your policy... read it.  Don't just assume it'll be like last year.  Sorry.

why are you sorry exactly?

I have read my policy and its updates. I always do. This isn't an insurance issue, it's an office/billing issue with our doctors. Our insurance has verified what is covered and what should be covered in the well visit. The practice is still trying to bill us for the difference of what our insurance paid them.

TerriAnne2606
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by on May. 5, 2013 at 7:52 PM

That you're having to deal with the hassle of trying to figure out what they're doing.  That's all.  Nothing more.  

Quoting Veni.Vidi.Vici.:


Quoting TerriAnne2606:

Yes - check your co-insurance.  You may have that on top of your co-pay.  Find out what your out of pocket maximum is.  Check your policy... read it.  Don't just assume it'll be like last year.  Sorry.

why are you sorry exactly?

I have read my policy and its updates. I always do. This isn't an insurance issue, it's an office/billing issue with our doctors. Our insurance has verified what is covered and what should be covered in the well visit. The practice is still trying to bill us for the difference of what our insurance paid them.



Mom31751
by on May. 22, 2013 at 8:36 AM

If your Doctor is in network with your insurance and if they are in a contract with your insurance, your Doctors office should write off what the insurance doesn't  pay, you should only have to pay your copay.. If you haven't contacted your insurance I  would call and ask them about it.  I have work in medical office and  with insurance for several years and they can be very confusing. 

Veni.Vidi.Vici.
by on May. 22, 2013 at 1:25 PM


Quoting Mom31751:

If your Doctor is in network with your insurance and if they are in a contract with your insurance, your Doctors office should write off what the insurance doesn't  pay, you should only have to pay your copay.. If you haven't contacted your insurance I  would call and ask them about it.  I have work in medical office and  with insurance for several years and they can be very confusing. 

we've done that

Veni.Vidi.Vici.
by on May. 29, 2013 at 5:04 PM

bump for update

PestPatti
by on May. 29, 2013 at 5:44 PM


Quoting Veni.Vidi.Vici.:

bump for update

 What does your EOB say from your insurance company.   I have patients calling all day long, and I pull EOBS straight from the Insurance company website and ours.  Just to make sure everything is ok.  

 When I workded for a PCP, we billed for physicals, but we didn't bill for a seperate office visit on the same day as a physcial.   Maybe your doctors have dumbass billers.

Veni.Vidi.Vici.
by on May. 29, 2013 at 5:46 PM


Quoting PestPatti:


Quoting Veni.Vidi.Vici.:

bump for update

 What does your EOB say from your insurance company.   I have patients calling all day long, and I pull EOBS straight from the Insurance company website and ours.  Just to make sure everything is ok.  

 When I workded for a PCP, we billed for physicals, but we didn't bill for a seperate office visit on the same day as a physcial.   Maybe your doctors have dumbass billers.

our EOB is clear and the clinic has dumbass billers that try to blame the doctors for how they code.

turtle68
by Mahinaarangi on May. 29, 2013 at 5:59 PM

I didnt realise how much your insurance companies screw every aspect of your healthcare...Its absolutely mindblowing.

Insurance companies here have absolutely NO SAY in what practice/ hospital and what doctor / specialist you choose to see, whether its a $100 doc or a $1000 doc.

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