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Started By
Message
Health Insurance Question
Posted on 1/7/19 at 4:00 pm
Posted on 1/7/19 at 4:00 pm
I pay for a family of 5 $1,300.00 a month through my employer. Payroll deducted. Company contributes some I pay the rest.
I go to the Doctor and pay my co-pay.
I go to the Pharmacy and pay my co-pay.
When I go to the doctor. I am forced to sign the waiver at the doctors office that says, "What ever insurance doesn't cover you are personally responsible for"
Once I get home from the doctor, 2 weeks later I usually get a bill from the Lab or from my provider saying insurance covered x amount but you owe me an addition amount of this.
Why can't I tell this doctor to frick off? Hey doctor, you agreed to these rates take em or leave em. I will pay the co-pay but anything after that is between you and my insurance coverage!
It's a shell game. Bill insurance for $900.00 an hour, we will agree to $750.00 an hour with insurance and bill the patient the additional $150.00
Why can't we the people that pay Tens of Thousands in insurance premiums tell these Labs, Hospital facilities and Physician offices "you get what you get and you don't catch a fit"?
That's what insurance is for. Hey doc you think you're so smart negotiate a better rate for yourself and quit fricking the patient.
Why can't I tell these people you will get what insurance pays and nothing more including a co-pay?
I go to the Doctor and pay my co-pay.
I go to the Pharmacy and pay my co-pay.
When I go to the doctor. I am forced to sign the waiver at the doctors office that says, "What ever insurance doesn't cover you are personally responsible for"
Once I get home from the doctor, 2 weeks later I usually get a bill from the Lab or from my provider saying insurance covered x amount but you owe me an addition amount of this.
Why can't I tell this doctor to frick off? Hey doctor, you agreed to these rates take em or leave em. I will pay the co-pay but anything after that is between you and my insurance coverage!
It's a shell game. Bill insurance for $900.00 an hour, we will agree to $750.00 an hour with insurance and bill the patient the additional $150.00
Why can't we the people that pay Tens of Thousands in insurance premiums tell these Labs, Hospital facilities and Physician offices "you get what you get and you don't catch a fit"?
That's what insurance is for. Hey doc you think you're so smart negotiate a better rate for yourself and quit fricking the patient.
Why can't I tell these people you will get what insurance pays and nothing more including a co-pay?
This post was edited on 1/7/19 at 4:02 pm
14
Posted on 1/7/19 at 4:03 pm to Uncs
You sound like a fricking idiot
Posted on 1/7/19 at 4:04 pm to Mingo Was His NameO
quote:
You sound like a fricking idiot
Oh let me guess you enjoy paying these fricking bills. Must be a doctor
Posted on 1/7/19 at 4:04 pm to Uncs
Call your insurance company and see if this is allowed under their negotiated rates. Sounds like the doctor is making an end run on the insurance contracts.
Posted on 1/7/19 at 4:06 pm to Uncs
quote:
Oh let me guess you enjoy paying these fricking bills.
Of course not, but I'm not completely clueless. You agreed to the service, now pay for it. You can negotiate up front, but you want the doctor to do all the work and tell you what's covered and what will be left. It's your insurance, come in prepared. Their job is to render the service, not be your financial advisor.
quote:
Must be a doctor
Nope
Posted on 1/7/19 at 4:06 pm to Uncs
quote:
Why can't we the people that pay Tens of Thousands in insurance premiums tell these Labs, Hospital facilities and Physician offices "you get what you get and you don't catch a fit"?
You would be surprised what you can accomplish by negotiating with them. I've seen it many times
Posted on 1/7/19 at 4:06 pm to Uncs
quote:
Why can't I tell these people you will get what insurance pays and nothing more including a co-pay?
You can, and they can refuse to see you.
This post was edited on 1/7/19 at 4:15 pm
Posted on 1/7/19 at 4:07 pm to Uncs
Someone needs to Google DED and patient pay...
Posted on 1/7/19 at 4:08 pm to Mingo Was His NameO
I am prepared you fricking dolt that's I am telling you they fricking me!
Posted on 1/7/19 at 4:08 pm to Uncs
Your insurance may contract with your doctor, but not with the lab he’s sending your samples to. It’s bullshite, but you have to find out before or you will pay.
Posted on 1/7/19 at 4:10 pm to GetmorewithLes
quote:
Call your insurance company and see if this is allowed under their negotiated rates. Sounds like the doctor is making an end run on the insurance contracts.
I'm not an expert but I would 100% do this. I've had my insurance company tell me to NOT pay any bills from the Dr...
Posted on 1/7/19 at 4:10 pm to High C
quote:
It’s bullshite, but you have to find out before or you will pay
So you are saying that before you contract a service, you should know exactly what service you are being provided?
What a novel idea.
"I agreed to pay this, but now that you've done the work I don't want to pay it so I'm not"
This post was edited on 1/7/19 at 4:12 pm
Posted on 1/7/19 at 4:13 pm to Uncs
Of course the OOP is a fricking but you're mixing in multiple scenarios into your very narrow view of "copay".
Posted on 1/7/19 at 4:13 pm to Uncs
What you are explaining is called balance billing and is illegal, make sure this is what is happening, call your insurance provider and have them go over an EOB with you, if this is the case they will take care of it
You are going to an "in network" provider?
You are going to an "in network" provider?
Posted on 1/7/19 at 4:14 pm to Uncs
quote:
Once I get home from the doctor, 2 weeks later I usually get a bill from the Lab or from my provider saying insurance covered x amount but you owe me an addition amount of this.
Why can't I tell this doctor to frick off?
Every service you get at the doctor is not necessarily covered by just your co-pay. Labs and diagnostics especially. The bill you receive 2 weeks later is the unpaid portion of the allowable, which is determined BY YOUR INSURANCE COMPANY. Not the doctor. Charging you more than that allowable is a breach of contract by the physician. You may pay a $35 dollar co-pay for a service with an allowable of $80. So 3-4 weeks later, when you and the doc receive your EOB, there will still be $45 of patient responsibility remaining. And you will get a bill. If the bill reflects more than your EOB, call bullshite. But I'll bet it doesn't.
The exception being a balance bill from an out of network doctor. But that's not what you're getting.
Its damn near impossible, and extremely labor intensive, to verify the exact amount you will owe before your visit actually happens. So many offices just get the co pay as the "down payment" and wait for the EOB to tell everyone what the total cost for all services actually is.
This post was edited on 1/7/19 at 4:18 pm
Posted on 1/7/19 at 4:15 pm to Mingo Was His NameO
quote:
So you are saying that before you contract a service, you should know exactly what service you are being provided?
What a novel idea.
"I agreed to pay this, but now that you've done the work I don't want to pay it so I'm not"
The issue is the system. Doc orders lab work during visit. If you ask the Doc (or his office staff) what it will cost, they'll say "Not sure, talk to the lab."
You call the lab in the exam room, lab says "not sure, depends on what the doctor codes the visit as and what your insurance deems necessary with the codes"
So you call the insurance company and give them the codes. Insurance company says "not sure, can't give you a cost until the information is submitted and reviewed."
I will admit they're getting better about these things, but there's still some issues that arise. I've actually found more clarity switching to a HDHP w/ an HSA.
Posted on 1/7/19 at 4:16 pm to Uncs
quote:
Once I get home from the doctor, 2 weeks later I usually get a bill from the Lab or from my provider saying insurance covered x amount but you owe me an addition amount of this.
Why can't I tell this doctor to frick off? Hey doctor, you agreed to these rates take em or leave em. I will pay the co-pay but anything after that is between you and my insurance coverage!
no only do you have a co-pay to see the doctor, but you also have a co-pay (usually 20%) for labs/imaging/ect. until you reach you max out of pocket (varies based on plans) you also likely have a deductible that must be met before insurance will reimburse
Posted on 1/7/19 at 4:20 pm to Mingo Was His NameO
quote:
So you are saying that before you contract a service, you should know exactly what service you are being provided?
What a novel idea.
"I agreed to pay this, but now that you've done the work I don't want to pay it so I'm not"
WTF? Are you directing that at me or the OP?
Posted on 1/7/19 at 4:20 pm to Golfer
quote:
You call the lab in the exam room, lab says "not sure, depends on what the doctor codes the visit as and what your insurance deems necessary with the codes"
So you call the insurance company and give them the codes. Insurance company says "not sure, can't give you a cost until the information is submitted and reviewed."
Preach brother, no one can tell you shite.. All the while the doctors own the labs! I am thinking about going to HDHP as well or just negotiating with Cash and having a catastrophe plan in case of Emergency with a terminal illness plan.
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