Fun with health care billing (RANT)

[Cataholic]

You have a right to pay them $2.00 a month if you so wish. Once you send in that amount you can NOT send in $1.00 the next month. It has to be at least $2.00. They legally cannot touch you. On the bill write the following.
I am paying you $2.00 a month which is my legal right.

Legally, this is an inaccurate statement. Everyone is entitled to have their bill paid in full, unless other arrangements have been made. Now, it is true that many places do accept monthly payments...but it is not a legal right violation if they do not.

[lizbud]

LH, ever get your bill taken care of? I guess it's my turn to rant now.
I've never had a reason to quesion any ins bill till just recently. Got a bill
from the Allergist I was sent to by my Primary Care Dr. I do owe then for
my co-pay which is right, but the bill they sent me was for much more
than that, it was huge.

After talking to my Ins co. they said the Allergist I saw was out of
Network & wouldn't be covered. My primary care DR chose the Allergist,
not me. Why would they pick an out of network provider? Seems
to me they made the error, & they should therefore cover the bill.

Last I heard my ins co is fileing a grievance (to themselves) for me over
this error. It's just crazy.

[pomtzu]

LH, ever get your bill taken care of? I guess it's my turn to rant now.
I've never had a reason to quesion any ins bill till just recently. Got a bill
from the Allergist I was sent to by my Primary Care Dr. I do owe then for
my co-pay which is right, but the bill they sent me was for much more
than that, it was huge.

After talking to my Ins co. they said the Allergist I saw was out of
Network & wouldn't be covered. My primary care DR chose the Allergist,
not me. Why would they pick an out of network provider? Seems
to me they made the error, & they should therefore cover the bill.

Last I heard my ins co is fileing a grievance (to themselves) for me over
this error. It's just crazy.

Liz - don't you have Medicare?

[lizbud]

Liz - don't you have Medicare?

Yes, a portion of the bill is covered with Medicare & a portion by my
Insurance co. & I pay a co-pay amount.

[pomtzu]

Yes, a portion of the bill is covered with Medicare & a portion by my
Insurance co. & I pay a co-pay amount.

So Medicare should have paid a big chunk of it - right? - and it's your private insurance that doesn't want to pay?

Might it benefit you to change to a different private carrier? I have Medicare and United Healthcare, and I never have to pay a penny for anything, or stay within any network. I can see whatever doctor I want and don't even need any referral. What Medicare doesn't pay, United does.

[Puckstop31]

My primary care DR chose the Allergist,
not me. Why would they pick an out of network provider? Seems
to me they made the error, & they should therefore cover the bill.

How is it their responsibility to pick a provider that is covered by YOUR insurance?

Ill give you that maybe they SHOULD care.... But only from a good customer service point of view.


I think we can see one of the causes of high health care costs here.... Nobody questions anything with their doctor it seems, especially when it comes to payment. "Somebody else" pays it, so who cares? Until, of course, "I" have to pay it and not "somebody else".

[Lady's Human]

Puck, perhaps it's like the health care provider I use......99.9% of their docs are covered under my ins. plan as the big umbrella "charitable" org that runs they system is normally completely covered by my ins., however, particularly if there's a new specialist involved, they might not be in the PPO list. I only get a PPO list once a year, and I'm fairly certain the list changes more often than that.

[lizbud]

Puck, perhaps it's like the health care provider I use......99.9% of their docs are covered under my ins. plan as the big umbrella "charitable" org that runs they system is normally completely covered by my ins., however, particularly if there's a new specialist involved, they might not be in the PPO list. I only get a PPO list once a year, and I'm fairly certain the list changes more often than that.

You're right LH, that's how it works. My primary care Dr works for the (my)Insurance group.

[Grace]

My primary care Dr works for the (my)Insurance group.

That's how it is for me, also. And my private insurance is excellent. When I need a referral, they never go out of network unless it's absolutely necessary. They're very aware of the insurance coverage problems.

Considering the 'network' consists of physicians in a major med school, we're pretty much assured of quality care without having to leave.

[Puckstop31]

Puck, perhaps it's like the health care provider I use......99.9% of their docs are covered under my ins. plan as the big umbrella "charitable" org that runs they system is normally completely covered by my ins., however, particularly if there's a new specialist involved, they might not be in the PPO list. I only get a PPO list once a year, and I'm fairly certain the list changes more often than that.

Perhaps it is? How does that make it the responsibility of the provider to ensure that a referral participates in the patients insurance plan?

We use the Lancaster General system as our provider... Every provider we see is part of that umbrella. I still always check when we have to see a new provider (mostly for Hannah's vision needs), just to be sure.

I'm not trying to start a ruckus. (Really ) I simply wish people paid more attention to what this stuff costs, even if the insurance company is paying the bill directly. I think Liz's shock at having to pay for something is an example of assuming the provider worries about such things. Thats all....

[Lady's Human]

Puck, it is most certainly the provider's responsibility when they make a statement that "Hospital/Care group A is now 100% PPO's for Insurance Plan B"

Then you get a bill from said insurance plan for the aforementioned group that, surprise surprise, there's a Doc within the care provider's group who is NOT a PPO for your health plan.

Not my fault, it's called false advertising in any other field. In healthcare, it's called too bad, you owe us.

[Puckstop31]

Puck, it is most certainly the provider's responsibility when they make a statement that "Hospital/Care group A is now 100% PPO's for Insurance Plan B"

OK... So the provider said that... They told the consumer, right?

Then you get a bill from said insurance plan for the aforementioned group that, surprise surprise, there's a Doc within the care provider's group who is NOT a PPO for your health plan.

Not my fault, it's called false advertising in any other field. In healthcare, it's called too bad, you owe us.

I reckon this might sound harsh and I can certainly see how less than honest providers might take advantage of people who would not understand the system... But, "let the buyer beware".

OR, to put it another way... IMO, the only real way we can get the cost of healthcare to become more reasonable, short of draconian regulation by governments that would just cause the quality of care to go down, is for the consumer to question EVERYthing. "Why does service X cost such and such. I called provider B and they will do it for x...." Even if your health plan will cover it, question the costs anyway. Its what we did when Tanya was pregnant. I had to pay for all of her care out of my pocket. We shopped around and found a WAY better provider that cost more than 50% less than the "big" women's hospital here. Better care for a lot less money.

In Liz's case... Yes, her doctor said use Allergist X. Why not look for other Allergists? I don't take a mechanics word as gold when my car needs fixed, I shop it around.... In non-emergency instances of health care, why not do the same?