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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 (41-50):
by Silver Member on May. 3, 2013 at 12:47 PM
1 mom liked this

Quoting Veni.Vidi.Vici.:

I've always supported the ACA

Good, then it's not a terrible pill to swallow to financially support it as well.

by Whoopie on May. 3, 2013 at 12:51 PM

I agree-

The old, kick the can down the road.

Quoting NewMom11222011:

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.

by Ruby Member on May. 3, 2013 at 1:06 PM

Hmmm.  Well either the office is not honoring the contract or your insurance had some benefit changes.  Does your state have a Department of Insurance?  You can file a complaint with them.  

Quoting Veni.Vidi.Vici.:

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.


by on May. 3, 2013 at 1:11 PM
2 moms liked this
They are idiots. Any professional or slightly educated person still calling it Obamacare lacks credibility

Quoting Veni.Vidi.Vici.:

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.


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

by Christy on May. 3, 2013 at 1:32 PM
1 mom liked this

Many doctors are opting out of contracts requiring them to accept the insurance and copay as payment in full. If the insurance requires the contract the are simply not accepting the insurance. It is indirectly related to ACA in the set payment require of the insurance company is so low but in the end it is the decision of the doctors as to where or not they will take such a payment. People raise much fuss about how much doctors get paid but it is about value and what they value their services, their overhead, and the cost of schooling. When we as a nation truly want to reduce the cost of health care it will not be through measures such as this but through reduction in cost of living.  For instance the minute the price raises on electricity it creates a domino effect that technically could eventually cause an increase on all products.

by Bronze Member on May. 3, 2013 at 1:37 PM
Not happening with us.
by Lois Lane on May. 3, 2013 at 4:16 PM

My doctor accepts the amount the insurer provides. That's part of the deal when they agreed to be a provider under my insurance plan. So it's likely that the doctor you're seeing doesn't have an agreement like that with the insurance company. 

by "Dude!" on May. 3, 2013 at 5:45 PM
How many well visits do you have? And do you have any extra testing done? Maybe a better question is what do you consider a well visit? Sounds like someone at the doctor's office isn't coding something correctly.
by on May. 3, 2013 at 5:47 PM

 I've never heard of anyone having an issue like this.  I hope you figure it out!

by on May. 3, 2013 at 6:01 PM

Quoting Sisteract:

So the offices are not honoring network contracts?

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

This is what I am having a hard time understanding. Neither the insurance company nor the office will tell me what they contractualy agreed upon regarding health insurance and what we pay out of pocket.

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