posted
A couple weeks ago my wife was cleaning our 3 year old's face. The inside of his ear looked really dirty, like it had a ton of wax in it. Upon further investigation we realized that a small piece of paper was jammed way into his ear.
*he went through a phase*
We tried to take it out but gave up because he was squirming so much and we didn't want to rupture his eardrum.
We made an appointment for the doctor. I figure it was worth the copay plus maybe another $50 or $100 dollars.
We got our bill today. $116 for office visit (after our $20 copay) and $226 for surgery. SURGERY!!!??? He took out a piece of paper with tweezers. No cutting, stitching, or anything like that. Granted we had to hold down my kid and nurses helped...but surgery?!!!
My insurance didn't pay for anything. $342 + $20 copay for surgery, which was nothing more then pulling out paper from an ear with tweezers, seems pretty excessive.
Is this something you would dispute? I have a feeling that it is just an attempt to milk more money since it is known our refund/handout check is in the mail.
What is my recourse? Or is that a fair price in your mind?
Posts: 2445 | Registered: Oct 2004
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I looked up "surgery" in a medical dictionary and was referred to "operation"; "operation" in the same dictionary is defined as "any methodical action of the hand, or the hand with instruments, on the human body, to produce a curative or remedial effect."
Hmmm. It may not be the best definition ever, but by THAT definition, using tweezers to remove a foreign object from the ear canal is definitely surgery.
I think you were overcharged, though, and I'd get your insurance company to dispute the charges if you can.
Posts: 21182 | Registered: Sep 2004
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posted
Don't they pay a portion of it? Or am I reading that wrong?
Our dental insurance, for instance, pays 80% of most of our charges. On a recent statement for work I had done, it showed what they were originally billed, what they "accepted" or negotiated it down to, what they paid, and what we owe.
Posts: 21182 | Registered: Sep 2004
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posted
Don't pay it! Don't let them get away with this crap. This is one thing that I really admire about my parents. My dad went to a doctor years ago and the guy told him to get rid of his ceiling fan, because that's what causes asthma. He never paid the bill. My mom recently had an MRI. They WAY over charged, so she told them that she wasn't going to pay it.
Posts: 1287 | Registered: Apr 2006
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posted
I wouldn't start complaining to the insurance company yet. Try contacting the doctor's office and start at the bottom. Billing department, office manager, doctor, then if you haven't gotten any results, file a complaint with the insurance company. Most doctors recognize that you, the patient, are a customer. They want you to be happy and come back and refer your friends and family. Just remember to keep your cool and be polite when contacting the office, it could make all the difference.
Posts: 2064 | Registered: Dec 2003
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posted
For next time...It is okay to discuss fees in advance of service. Just ask "how much is this going to cost?" If you don't like the answer, then leave.
It's also possible to get preauthorization from the medical insurance, even on an emergency basis, so you know how much they'll cover for any given procedure. And the doctor would have to explain it to them in advance of doing anything so you'd be reasonably assured that what they say they'll cover, they actually will. And you know if that amount was $0.00, exactly why that was the case.
It's also possible to obtain reasonable medical advice from sources like "Ask A Nurse" or online aids (like the Dr. Sears websites). They may advise you to seek medical help because of the dangers involved, or they may be able to allay your fears about potential for causing damage, etc.
Since this is all after the fact, however:
Ultimately, though, this situation with doctors is like any other professional. You are better off settling on a fee up front. Knowing that your insurance isn't picking up the tab, some doctors will work out a plan with you.
Refusing to pay medical bills is, generally, not a good idea. If you want to mess up your credit, that's one way to do it.
My advice: 1) Call the doctor's office to see about an adjustment. Tell them that it took little of the doctor's time and that you are having to pay the bill yourself. Try to remain calm, and ask to speak to the doctor personally if you can't get anywhere with their billing clerk.
2) If they say "no" then ask to work out a payment plan. They'll usually take a relatively small amount each month until the debt is paid. If they won't do that in a case like this, my next advice is to find a different doctor.
3) Remember throughout that you are paying for peace of mind and you chose to seek their professional assistance because of concerns you had. Once the relief sets in, the price of that peace of mind becomes a higher priority. But at the time, you were willing to go there and seek their assistance. And they performed the professional service you requested. They held up their end of the bargain and billed you for the service you requested.
4) I would definitely question my insurance company. If you are up to date on your premiums, and this procedure isn't part of some required meeting of a deductible, and this doctor is in-network, they should be covering some portion of it. If the reason you are paying is because of your deductible...well, sometimes that's something you have to suck up because we live in a society that can't get its act together regarding health care costs, insurance, and treatments. I hate to say it, but if that is the situation, you're probably just going to have to eat this one.
Posts: 22497 | Registered: Sep 2000
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posted
Negotiation of bills probably won't work if you saw a doctor that is part of a larger health system. It may work if the doctor is in private practice (from my experience working in doctor's offices).
Posts: 2064 | Registered: Dec 2003
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posted
Actually, I would recommend your first move would be to call your health insurance company. Find out if the doctor's office submitted a claim (bill) to the insurance company. If they have, find out if it's been paid. If it was denied, find out why it was denied.
Also find out what your policy covers. You say you have a copay. In insurance terms, this means you pay your copay ($20 in your case) and the insurance company picks up the rest.
Unless, of course, you have co-insurance for certain procedures, then billing/payment gets even more wonky.
If you want, shoot me an email and I can walk you through the process of getting what you should be getting from your insurance company. And also explaining how everything works in the system. I used to work for the dark side, so I know how to negotiate their hallways and play by their rules.
Sometimes, I think I should write a guide on how to get what you need and have a right to get from your health insurance company.
Edited to add: Also, if you do have a deductible and this doctor is in-network according to your policy, the doctor's office cannot charge you more than the amount than what they agreed to accept as full payment in their contract with the insurance company.
Posts: 14745 | Registered: Dec 1999
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posted
Listen to mackillian. I should've thought of calling the insurance first. You need to know if the doctor has submitted a claim to your insurance or not, and whether the claim is in process, denied or paid.
If it's an out of network doc or one that doesn't take your particular insurance, you might be expected to submit the claim yourself.
Some doctors bill the patient for the full amount even though insurance is pending. It's often difficult to tell which portion really is the patient's to pay if you look only at the medical provider's statement of charges.
Posts: 22497 | Registered: Sep 2000
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quote:Originally posted by ketchupqueen: Don't they pay a portion of it? Or am I reading that wrong?
quote:My insurance didn't pay for anything. $342 + $20 copay for surgery, which was nothing more then pulling out paper from an ear with tweezers, seems pretty excessive.
quote: Listen to mackillian. I should've thought of calling the insurance first. You need to know if the doctor has submitted a claim to your insurance or not, and whether the claim is in process, denied or paid.
I will do that. Thanks MacKillian. I never thought of calling the insurance company first. After I get more information from my insurance company I will try to renegotiate the price.
I can pay it. I don't need a payment plan, especially with our check from the government, but it does seem excessive. The doctor is under our insurance provider and we have a very professional relationship. He does a good job and we pay all of our bills the instant we get them.
This bill seem uncharacteristic of the service we have received from our doctor.
Posts: 2445 | Registered: Oct 2004
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posted
Did the bill you got from the doctor indicate any submission to insurance? I can't say it's universal but every time I get a bill from a doctor is shows the amount the claimed to the insurance, the amount the insurance paid (if any), the amount they adjust for the insurance (the difference between what they charge and what they've agreed with the insurance company to charge) and then what I owe. If I didn't see any insurance information on a bill I'd assume they never submitted it to my insurance.
MacKillian is absolutely right about calling the insurance company to find out if the claim was submitted etc.
(edited to add...) Also,
quote:This bill seem uncharacteristic of the service we have received from our doctor.
Keep in mind that unless you are with a very small practice the doctor him/herself probably has no idea how much you're being charged etc. They just write down what they did with a treatment code and the biller takes care of it...
quote:They just write down what they did with a treatment code and the biller takes care of it...
This is very true. Doctors are often pretty much clueless about the billing and how it works, because they aren't trained it in, not because they're ignorant.
quote:I will do that. Thanks MacKillian. I never thought of calling the insurance company first.
A lot of people don't. And I think a lot of people end up paying much more than they should because of this. They don't know the rules by which the insurance companies play.
quote:After I get more information from my insurance company I will try to renegotiate the price.
There's quite a few different types of plans (as I'm sure you're aware). For in-network stuff you can have:
-copay+coinsurance
or
-copay+nothing else
or
-in-network deductible and when that is met, then copay.
or
-copay for office visits and a co-insurance for outpatient surgery and/or other services
or
-just coinsurance
(co-insurance is where the patient is responsible for a percentage of the amount due to the provider, the most common being 10% or 20%)
Billing for services works via a system of codes called CPT codes. Each number range of codes refer to different things (office visits are one range of numbers, while surgery is another, and so on).
When a surgical code (any code falling in the spread of numbers for surgery) is included with an office visit code, sometimes the surgical code is lumped in with the office visit and the provider isn't paid any extra. Other times, it's paid as a separate service, meaning, depending on your insurance type, you might have extra responsibility for that office visit (due to the surgical code that represents said surgical procedure). And if you're unaware of how stuff works, you can be surprised by an extra bill from the doctor's office.
So there's two different situations (sometimes more) for just the billing, meaning for each different type of insurance plan, there's at least two different ways payment can play out.
There's also the issue of coding mistakes and billers submitting claims with incorrect codes.
And that's just in-network stuff. Not out of network stuff, and not FSAs or HSAs.
Health insurance is messy, messy stuff.
Posts: 14745 | Registered: Dec 1999
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posted
Yeah, there could be a bunch of different things here.
#1) Don't just pay it. Once you pay it, there is little chance of getting your money back.
#2) Call the insurance company and talk to them. They hire humans to help with such problems. Remember, the only thing the Insurance Company knows is what the doctors office sent them. As far as they know, you had open-head surgery on your child, and got off cheap at $300+. It may be you have a deductible that this won't go over, so you get stuck with the whole bill.
#3) Call the doctors office and talk, don't yell, but talk to them. It could all be a simple coding error. "Removing Foreign object embedded in Ear" is a #42. "Removing Foreign Object embedded in Rear" (which requires full cut and paste surgery) is a #45. Somebody typed a 5 instead of a 2, so....
Once they see their mistake, they will fix it. I had this happen over $300 worth of blood tests that were mistakenly marked down as "Sports Related" which my insurance wouldn't cover, instead of Adoption related, which they would cover.
Posts: 11895 | Registered: Apr 2002
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posted
We have a co-pay and a $500 deductible. I also think we pay 20%-80%. I am not sure how that works with the deductible. My wife does most of the bills.
I need to read our insurance material. Stuff like that knocks me out faster then scotch and late night infomercials.
We have easily met our deductible because we had a baby this year.
Posts: 2445 | Registered: Oct 2004
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posted
Reading your insurance material is a really good idea. You can also speak with your insurance company and they can look up how much of your deductible has been met. They can also explain your plan to you, though some customer service people are better at it than others.
Posts: 14745 | Registered: Dec 1999
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