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Current Events & Hot Topics Current Events & Hot Topics

{{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 (31-40):
jessilin0113
by Platinum Member on May. 3, 2013 at 10:50 AM
Well, that's complete bullshit. They should NEVER owe that much with Medicare, and if they have Tricare that is payment in full. The only issue would come from if the hospital is not contracted with Medicare. And if something wasnt' payable by Medicare they cannot bill the patient for that without an ABN in place stating the patient knew they would be responsible. I would demand to see the hospital billing records and reveiw their Medicare summary notices. (of course, if it was a matter of contracting, it may be a moot point). This is so completely wrong. Trust me, I do this for a living. They should sue the hospital (again, assuming it's not a contracting issue).
Quoting MamaAjax:

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.





MamaAjax
by Member on May. 3, 2013 at 11:00 AM

I don't know in full detail. I know my mom works for the Hospital that my father did his surgery. He ended up having to stay 5 days after the surgery cause they popped it out of place moving him beds and the doctor ordered him to stay for fear of infection.

I know she issued for reports.

But this is also the grand total, not just the surgery it's self, but also the Rehab before the surgery, the surgery + hospital stay, and the Rehab after the surgery both for the in home because he could ride in the car and the center after he was able to ride in a car. And all the doctors visits in between all those.


Quoting jessilin0113:

Well, that's complete bullshit. They should NEVER owe that much with Medicare, and if they have Tricare that is payment in full. The only issue would come from if the hospital is not contracted with Medicare. And if something wasnt' payable by Medicare they cannot bill the patient for that without an ABN in place stating the patient knew they would be responsible. I would demand to see the hospital billing records and reveiw their Medicare summary notices. (of course, if it was a matter of contracting, it may be a moot point). This is so completely wrong. Trust me, I do this for a living. They should sue the hospital (again, assuming it's not a contracting issue).
Quoting MamaAjax:

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.

Veni.Vidi.Vici.
by on May. 3, 2013 at 12:28 PM


Quoting Cutenessmom:

Shoot you got it cheaps!  We pay atrocious amount of money for the coverage we get now.   We pay fifty and hundered. 

Our monthly insurance premium is $585 + co-pay and now this

Veni.Vidi.Vici.
by on May. 3, 2013 at 12:30 PM


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.



I've been on the phone and exchanging emails between and insurance advisor and billing at the practice. Both the insurance and the billing dept. stated that this clinic has a contract with our insurance. The lady in billing told me to take it up with my insurance company, and that I owed the difference I was billed for. That's where I am.


Veni.Vidi.Vici.
by on May. 3, 2013 at 12:34 PM


Quoting Debmomto2girls:

It has nothing to do with the ACA. People are really reaching now.

What I did not mention is that when I contact the human respurces department with questions about insurance I was told that I could thank "Obamacare" for this mess.

happy

The receptionists who work at the practice have said similar things. Should people who aren't directly working in the billing departments be making those kinds of suggestions to people looking for help ad info regarding billing?

I've always supported the ACA

Veni.Vidi.Vici.
by on May. 3, 2013 at 12:37 PM


Quoting Peanutx3:

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

we've never been charged anything extra from our pediatrician, in fact we don't even pay a co-pay for well visits and/or vaccination visits.

kaylamom2004
by Bronze Member on May. 3, 2013 at 12:37 PM
1 mom liked this

AMEN!!!! 


Quoting finnbar:

How's that hope and change workin' out for ya?
Sisteract
by Whoopie on May. 3, 2013 at 12:43 PM

So the offices are not honoring network contracts?

The ACA favors for profit insurance companies- for profit= price gouging of the customers.

NewMom11222011
by Bronze Member on May. 3, 2013 at 12:44 PM

If the clinic contract with the insurance, then you should only owe for your regular visit copay, an coinsurance (deductible, etc.), or for any services rendered that are not covered contractually.  I'm not a huge fan of ACA, but I think the comments your office gave you sound more politically motivated than anything.  I've worked processing insurance in hospitals and offices for over a decade and it's been my experience that non-covered services and posting errors are the most often occurring problems that leave patients with unexpected bills.

Euphoric
by Bazinga! on May. 3, 2013 at 12:45 PM

 Yikes! Hasn't happened to us.

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