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post #1 of 13 (permalink) Old 10-16-2010, 09:19 AM Thread Starter
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Frustrated with healthcare

So I had a minor in-office procedure a month ago, and before I did this I talked to a couple of doctors and a couple of nurses within my doc's office, and they all told me that this procedure is great because it takes care of the issue at hand for five years and it only costs a co-pay since it's just like a regular office visit. Actually, I was in and out faster than if I had been there for a regular visit!

Well a couple of days ago I got a statement from my insurance company - turns out the doc's office billed them for over a thousand dollars in supplies, and they're only going to cover a small portion! I'm looking at a nine hundred dollar bill! I know I can call the doctor's office and ask for it to be lowered, but here's the other part of the equation. A couple of weeks ago the doc's office called me because they didn't properly scan my consent form and they need me to come in and fill out a new one. In light of this bill, I'm wondering if I would be able to use the consent form as leverage to get the bill lowered? Obviously I had the procedure, but without a valid consent form they are open to a lawsuit, right? I'm not looking to get 100% of the bill written off, but I KNOW that small tray of supplies did not cost a thousand bucks - the bulk of what was there was equipment that gets sterilized and reused!

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post #2 of 13 (permalink) Old 10-16-2010, 05:03 PM
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If it's an approved procedure in your healthplan manual, your doctor needs to eat the extra costs. That's part of the deal your doctor makes being in a PPO or HMO health plan. They should know every single item that can be charged and can't. I wouldn't sign another consent form. I would contact their customer service representative.

You know what? That doesn't even matter. If you were told by the doctor's office that it would only cost you the co-pay amount, I wouldn't pay a single cent.

I went through something like this with a former dental office. They mapped out my yearly plan for work I needed done, making sure they used all of my annual limits, then at the end of the year, THEY had done the math wrong and wanted several hundred dollars from me. I refused. I fought them for almost two years and they finally gave up. It was their estimate that was wrong.

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post #3 of 13 (permalink) Old 10-16-2010, 07:54 PM
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Sometimes I'm glad I'm on government health stuff. Though other times, it's pretty crappy too.
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post #4 of 13 (permalink) Old 10-17-2010, 02:12 AM
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I agree. Doc office needs to eat that cost. They told you insurance would cover it and all you'd be responsible for was the co-pay. Done.


I had a bit of an issue w/ the local hospital. My specialist wanted me to have a bone density scan because I had been on such high doses of steroids for a lengthy amount of time. She gave me the order and said I could have it done anywhere, which was good because I didn't want to drive 3hrs round trip to have it done in Atlanta if I could do it locally.
I took it to the hospital to drop off, planning on making an appointment for later, but they said they could do it right now. I questioned them and asked if they were sure my insurance didn't require pre-certification and they said 'no'. I asked what would happen if my insurance kicked it back and they said they'd just 'eat the cost'.
So we did the bone density scan.
My insurance kicked it back because of a lack of pre-certification.
Hospital asked me for proof from my specialist Doc, stating specifically *why* my Doc felt the bone scan was necessary at all. I got the paperwork from her. Then they tried to bill me for some outrageous amount and I had to go in to their billing department and explain again the original conversation I had with staff. On my second visit, it was finally resolved. I paid nothing but that original co-pay.

Best wishes for you and an easy resolution of this issue. Just keep calm and remind them of what they told you regarding the procedure. I don't think I would sign a consent form after-the-fact. Especially not one saying I would be responsible for costs beyond my insurance coverage. If I were forced to sign, I would include the current date, state "under pressure and duress" and ask for a copy of that form for your own records.



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post #5 of 13 (permalink) Old 10-17-2010, 02:52 AM
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Is it pretty easy for these organisations to screw you over?
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post #6 of 13 (permalink) Old 10-17-2010, 03:26 AM
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If you sign a new consent form make sure they didn't add anything that says you have to pay differently.
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post #7 of 13 (permalink) Old 10-17-2010, 07:44 AM
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Definitely discuss it with your insurance company. Sounds like a billing error. Its' not their responsibility to find out what happened but I'm sure they'll give your Dr a call and get it straightened out.

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post #8 of 13 (permalink) Old 10-17-2010, 06:34 PM
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I agree with Dave...kinda sounds like a billing error. Nonetheless, it's still frustrating, I'm sure. A co-pay versus a $900 bill is quite a difference!! I would try to talk to the same person who quoted you "only a co-pay" in the first place. Good luck!
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post #9 of 13 (permalink) Old 10-18-2010, 12:04 AM
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I had something similar happen to me a few months ago. My psych waited a whole year to bill my insurance for a simple office visit. My insurance then kicked it back saying it was too late to pay for it and now I have to pay for it myself!! It got so bad that my psych withheld scripts and meds from me until I paid the fee. Seeing as psych meds cause horrible withdrawls when you stop them suddenly, I had to give in and pay. It was around $600. I'm sorry this happened to you.

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post #10 of 13 (permalink) Old 10-18-2010, 01:33 PM Thread Starter
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Quote:
Originally Posted by Huge View Post
Is it pretty easy for these organisations to screw you over?
Yup, it is, unfortunately. Over on this side of the pond it's all about 'who can we shove this bill onto rather than paying for it ourselves?' It's part of why America is full of petty lawsuits and people who don't trust anyone. It's also part of why many of us don't go to the doctor unless we're just about needing a hospital - it's just so difficult to figure out exactly what insurance will pay for! And if you change insurance and have to get your own policy, you can't get coverage for a pre-existing condition until you've had the policy for a year. It's a crazy mess!

~Diana, happy mom to Fern and Fergie
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