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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 (21-30):
JoshRachelsMAMA
by JRM on May. 3, 2013 at 9:55 AM
1 mom liked this
It's not happening to me. But what I'm saying and remember, companies have been preparing for this to go into affect for years now, only it's crunch time now and they're getting more serious. So much so that were seeing more and more of it. Doctors, just like other employers and businesses will pass their margin differences to the customer.

Quoting stacymomof2:

How can you say it's due to obamacare? It sounds like your insurance co is dicking you around. If they say that preventative care us covered and then they don't cover it, what does that have to do with the aca? They have a contract with youand the doc.



Quoting JoshRachelsMAMA:


Quoting moroccanmommy:

Sounds like your dr policy. Or your out of pocket is not reached. My dr accepts the contracted amount.


Maybe look at your policy and ask your dr office.



It has nothIng to do wIth the health care act
of but of course you just need to thInk It does.

Sure it does. Doctors feeling the pinch are now passing on the price difference to their patients. its happening more and more and its due to obamacare.

JoshRachelsMAMA
by JRM on May. 3, 2013 at 9:56 AM
Right. (As in correct)

Quoting jessilin0113:

Only if they aren't currently contracted with the insurance. 



Quoting JoshRachelsMAMA:


Quoting moroccanmommy:

Sounds like your dr policy. Or your out of pocket is not reached. My dr accepts the contracted amount.

Maybe look at your policy and ask your dr office.


It has nothIng to do wIth the health care act
of but of course you just need to thInk It does.

Sure it does. Doctors feeling the pinch are now passing on the price difference to their patients. its happening more and more and its due to obamacare.




MamaAjax
by Member on May. 3, 2013 at 9:56 AM

Well. I don't know. I do know my father ended up with a total hip. He has 3 insurances (My moms from work Humana, Tri-Care from my father's Union retirement, and Medicare)

My parents still ended up paying nearly $15,000 after it was all said and done. This was back in 2008-2009.


After thought I'd like to add. This was after a collective pay coverage of about 80%. A lot of times one or the other insurance won't willingly cover the remaining costs after the first two (or sometimes after just medicare) covers it. Which is driving my parents mad.

They have three insurances to make sure that they both are fully covered (My mom isn't of retiring age yet and does not qualify for Medicare) so basically after they pay their monthly dues of about $400 they also still have to meet their deductibles (which is about $250-$500 per insurance for my mom) on top of they're still not 100% covered AND a lot of times their care is limited by certain amount of visits to specialists.

Mama Ajax @ Blogger

Just a little bit my life experiences.

jessilin0113
by Platinum Member on May. 3, 2013 at 9:59 AM
That should never have happened. I would demand that be looked in to, i don't care how long ago it was.


Quoting MamaAjax:

Well. I don't know. I do know my father ended up with a total hip. He has 3 insurances (My moms from work Humana, Tri-Care from my father's Union retirement, and Medicare)

My parents still ended up paying nearly $15,000 after it was all said and done. This was back in 2008-2009.


MamaAjax
by Member on May. 3, 2013 at 10:03 AM

Sorry got hit with an after thought


Quote:

After thought I'd like to add. This was after a collective pay coverage of about 80%. A lot of times one or the other insurance won't willingly cover the remaining costs after the first two (or sometimes after just medicare) covers it. Which is driving my parents mad.

They have three insurances to make sure that they both are fully covered (My mom isn't of retiring age yet and does not qualify for Medicare) so basically after they pay their monthly dues of about $400 they also still have to meet their deductibles (which is about $250-$500 per insurance for my mom) on top of they're still not 100% covered AND a lot of times their care is limited by certain amount of visits to specialists.


They did, they went around and around about it but in the end due to business politics they got screwed.

Quoting jessilin0113:

That should never have happened. I would demand that be looked in to, i don't care how long ago it was.


Quoting MamaAjax:

Well. I don't know. I do know my father ended up with a total hip. He has 3 insurances (My moms from work Humana, Tri-Care from my father's Union retirement, and Medicare)

My parents still ended up paying nearly $15,000 after it was all said and done. This was back in 2008-2009.




Mama Ajax @ Blogger

Just a little bit my life experiences.

stacymomof2
by Ruby Member on May. 3, 2013 at 10:12 AM

Oh sorry I was mobile and thought you were the poster saying that your insurance was doing that.

But really it is still an insurance company problem.  They are screwing doctors, and they are screwing the people paying the premium.  They are the ones who are benefitting from denying coverage and shorting doctor payments.  IMO really insurance companies need to be out of the mix.  Their reason for existence is to make money off of health care that they don't provide.  Why are they in there at all?  


Quoting JoshRachelsMAMA:

It's not happening to me. But what I'm saying and remember, companies have been preparing for this to go into affect for years now, only it's crunch time now and they're getting more serious. So much so that were seeing more and more of it. Doctors, just like other employers and businesses will pass their margin differences to the customer.

Quoting stacymomof2:

How can you say it's due to obamacare? It sounds like your insurance co is dicking you around. If they say that preventative care us covered and then they don't cover it, what does that have to do with the aca? They have a contract with youand the doc.



Quoting JoshRachelsMAMA:


Quoting moroccanmommy:

Sounds like your dr policy. Or your out of pocket is not reached. My dr accepts the contracted amount.


Maybe look at your policy and ask your dr office.



It has nothIng to do wIth the health care act
of but of course you just need to thInk It does.

Sure it does. Doctors feeling the pinch are now passing on the price difference to their patients. its happening more and more and its due to obamacare.


Ziva65
by Gold Member on May. 3, 2013 at 10:13 AM
1 mom liked this

I haven't experienced that, but our premiums have gone up. My firends (who don't have an HMO type plan) have seen that. Same with our dentist office. They set their new fee schedule, based on the area standard. They do not all have to accept what the insurance company pays, as payment in full. It all depends on the office's agreement/ contract with the carriers. While HMO's defitinely have their drawbacks, this is one thing that doesn't happen- unless you want a service completely not covered by your plan (such as cosmetic, botox, designer/ name drug/ etc.)

We have however selected palns for our employees (ourselves included) that don't have huge co-pays. That many change as all this moves forward. We will stay within the limits of the law, but that's it. There are certain limitations on how much an employee has to pay for the premium, depending on what their income is. That will be interesting when you have to ask an employee who has several different jobs to bring in verification of their income level. It will be interesting how all this pans out.

However, everything else is changing as well.

My family have a variety of meds- from acne to allergy and whatever in between/.. We have found the formularies changing as to what is covered by the insurance or not. It is becoming very straighforward. These things are changing with private carriers too.

Plus, as a volunteer FNP in a low income clinic- we see tons of people who do have private insurance, but our sliding scale fees, and even standard fee list are far less than a private office. We therefore end up seeing a lot of people who don't want to pay their physician co-pay charges- they end up using their insurance for emergecy hospital care instead. Saves them a lot of money. We also see a lot of people who want treatment for something but don't want it in their full medical record, such as mental health issues, HIV testing, etc.

Here in our city- a lot of private MD practices have closed to Medicare and Medi-Cal. Many have become private boutique/ concierge practices. People pay it. They pay anywhere from 1000-1000 per year to their MD to be on his patient panel. That doesn't include whatever their insurance covers for the visit.

It is interesting to watch all these changes. I am concerned whatever happens when I retire. I just need to be prepared to pay for everything.

Tag3.0
by on May. 3, 2013 at 10:14 AM

I only pay a $15 copay. I have primary and ssecondary ins

Peanutx3
by Ruby Member on May. 3, 2013 at 10:14 AM

Could it be vaccination costs?  We had insurance that covered all well child visits except the cost of vaccinations. 

Bigmetalchicken
by Silver Member on May. 3, 2013 at 10:17 AM
1 mom liked this

not this exactly, but wehave been informed that thanks to the new laws, each issue has to be billed seperately. For example, my daughter recently had her six month checkup. While we were there, The docter found that EG had an ear infection. So my insurance sent me a bill for $35 dollars, because based on the new rules, I had to pay two copays for the visit. 

Freaking insane.

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