Search found 873 matches

by toofache32
Thu Jun 22, 2017 2:40 pm
Forum: Personal Consumer Issues
Topic: Please explain how Medicare Billing works?
Replies: 50
Views: 2801

Re: Please explain how Medicare Billing works?

7. I haven't been for a bone density test for a while so the doctor referred me. The results showed my bones aren't so strong so I was sent to the hospital for an bi-annual injection. I was asked by the nurse practitioner if I was on a walker. I laughed and told her that I hauled 40 bags of soil a ...
by toofache32
Thu Jun 22, 2017 2:05 pm
Forum: Personal Consumer Issues
Topic: Please explain how Medicare Billing works?
Replies: 50
Views: 2801

Re: Please explain how Medicare Billing works?

Lynette wrote:
nisiprius wrote:Pssst. By the way. Apple, penny, table. Also, DEFPOTEC.



????


I'm just as confused.
by toofache32
Thu Jun 08, 2017 11:46 pm
Forum: Personal Consumer Issues
Topic: My Wife is having our 5th child. What is an appropriately extravagant push gift?
Replies: 90
Views: 6832

Re: My Wife is having our 5th child. What is an appropriately extravagant push gift?

What is a "push gift"? I have never heard that term. An expectation of a material gift when the real gift is that which you delivered. I have never heard of this and don't know how this idea came into existence. From the description of a "push gift" where it sounds like she is a...
by toofache32
Thu Jun 08, 2017 11:05 pm
Forum: Personal Consumer Issues
Topic: Please explain how Medicare Billing works?
Replies: 50
Views: 2801

Re: Please explain how Medicare Billing works?

Amount Provider Charged: $300 Medicare-Approved Amount: $100 Amount Medicare Paid: $80 MAXIMUM YOU MAY BE BILLED: $20. But I do not get billed. Medicare bills my Medigap insurance company the $20 automatically. They pay. In due course I get another notice from my Medigap insurance company saying so...
by toofache32
Tue Jun 06, 2017 12:52 am
Forum: Personal Consumer Issues
Topic: Source for Finding and Understanding Medical Billing Codes
Replies: 8
Views: 562

Re: Source for Finding and Understanding Medical Billing Codes

To toofache32: Over and above pre-authorization, is there anything I (or my surgeon) can do to increase the likelihood of payment? The thought of bearing the full cost of the surgery is VERY intimidating. When insurance is involved, there are never guarantees unfortunately. The insurance company al...
by toofache32
Tue Jun 06, 2017 12:25 am
Forum: Personal Finance (Not Investing)
Topic: How does a mere mortal navigate healthcare/insurance issues
Replies: 50
Views: 4493

Re: How does a mere mortal navigate healthcare/insurance issues

This issue of being directly billed for non network providers (that you had no choice in selecting) in an in network facility is a problem that needs to be addressed. This practice is unfair to consumers. This thread deals with anesthesiologists but also routinely occurs with er physicians and thos...
by toofache32
Tue Jun 06, 2017 12:16 am
Forum: Personal Finance (Not Investing)
Topic: How does a mere mortal navigate healthcare/insurance issues
Replies: 50
Views: 4493

Re: How does a mere mortal navigate healthcare/insurance issues

When I went in for my age-50 screening colonoscopy a couple of years ago, the check-in person got to the end of check in and then unexpected asked me to write a pre-procedure check (a couple of thousand $, if I recall). I got very confused and stuttered out "but a screening colonoscopy is cove...
by toofache32
Tue Jun 06, 2017 12:04 am
Forum: Personal Finance (Not Investing)
Topic: How does a mere mortal navigate healthcare/insurance issues
Replies: 50
Views: 4493

Re: How does a mere mortal navigate healthcare/insurance issues

I had the exact same thing happen to me during a colonoscopy, pre-ACA not that I think that matters. I didn't read the entire thread but I don't the it matters if the provider was an MD or a nurse or the guy who cleans the toilets in the office (I'm expecting to see a billing code for that any day ...
by toofache32
Mon Jun 05, 2017 11:59 pm
Forum: Personal Consumer Issues
Topic: Source for Finding and Understanding Medical Billing Codes
Replies: 8
Views: 562

Re: Source for Finding and Understanding Medical Billing Codes

As usual, the government resource is unhelpful and burdensome. I use http://www.codingtoday.com for coding. As usual, this efficient and simple resource costs money, as it should. If your surgeon is in-network and expects to be paid by insurance, the surgeon will (should) pre-authorize your surgery ...
by toofache32
Mon Jun 05, 2017 10:42 pm
Forum: Personal Finance (Not Investing)
Topic: How does a mere mortal navigate healthcare/insurance issues
Replies: 50
Views: 4493

Re: How does a mere mortal navigate healthcare/insurance issues

It's hopeless. Things I've run into: Doctor is not in network and has been trying to join in network for 3 years. Network tells me that they have enough of that specialty so are not accepting new doctors. We go to network list and in calling around find several interesting things. Doctors who are r...
by toofache32
Sun Jun 04, 2017 5:31 pm
Forum: Personal Consumer Issues
Topic: Please explain how Medicare Billing works?
Replies: 50
Views: 2801

Re: Please explain how Medicare Billing works?

What CPT code was billed on your EOB?
And did your visit address any existing health conditions?
by toofache32
Sun Jun 04, 2017 4:41 pm
Forum: Personal Consumer Issues
Topic: Please explain how Medicare Billing works?
Replies: 50
Views: 2801

Re: Please explain how Medicare Billing works?

What CPT code was billed on your EOB?
And did your visit address any existing health conditions?
by toofache32
Sun Jun 04, 2017 2:36 pm
Forum: Personal Consumer Issues
Topic: Please explain how Medicare Billing works?
Replies: 50
Views: 2801

Re: Please explain how Medicare Billing works?

I hope for your sake this is not that UHC AARP "Secure Horizons" plan. Denial is the name of the game.
by toofache32
Sat Jun 03, 2017 1:14 am
Forum: Personal Consumer Issues
Topic: Medi-Cal (for CA) equivalent in Texas
Replies: 5
Views: 587

Re: Medi-Cal (for CA) equivalent in Texas

FB01 wrote:Hi,

California has Medi-Cal which provides free Medical to Senior Citizens with GC and low income. Does Texas has similar thing?

-FB


What's GC?
by toofache32
Fri May 26, 2017 7:05 pm
Forum: Personal Consumer Issues
Topic: Should I drink or sell my Pappy 12 year?
Replies: 64
Views: 6621

Re: Should I drink or sell my Pappy 12 year?

CheapFool wrote:Entered a lottery with ABC fine wine and spirits and won the option of buying 1 bottle of Pappy Van Winkle 12 year. I haven't drank much bourbon. I'm a Scotch fan (Lagavulin, Laphroaig, Highland Park).


What do you mix with the Laphroaig to hide the turpentine taste?
by toofache32
Wed May 24, 2017 9:29 am
Forum: Personal Consumer Issues
Topic: Lawyers charging for asking about fees
Replies: 62
Views: 7563

Re: Lawyers charging for asking about fees

Just some follow up. Turns out the item was not a charge for asking about the lawyer's bill after all, but a completely legit charge relating to something else. :oops: Thank you for following up. Would you consider editing your original post, to add a note saying that? Many people may not read to t...
by toofache32
Sat May 20, 2017 8:09 pm
Forum: Personal Consumer Issues
Topic: Lawyers charging for asking about fees
Replies: 62
Views: 7563

Re: Lawyers charging for asking about fees

No sense in arguing. One strategy: "Of course, I'm happy to pay your bill, in full and on time. As soon as I receive it, I'll leave a review for you online." 8-) So you're recommending extortion? Are reviews that are left on Amazon website considered extortions? 8-) It's not the review. I...
by toofache32
Sat May 20, 2017 7:30 pm
Forum: Personal Consumer Issues
Topic: Lawyers charging for asking about fees
Replies: 62
Views: 7563

Re: Lawyers charging for asking about fees

Jonathan wrote:No sense in arguing. One strategy: "Of course, I'm happy to pay your bill, in full and on time. As soon as I receive it, I'll leave a review for you online." 8-)


So you're recommending extortion?
by toofache32
Wed May 17, 2017 8:25 pm
Forum: Personal Finance (Not Investing)
Topic: Challenging a Late Medical Bill
Replies: 22
Views: 1587

Re: Challenging a Late Medical Bill

[...]When I was an in-network doctor with insurance plans, my record was 18 months to get a claim adjudicated. Only after they finalized the claim was I able to know how much to bill the patient for their part. This was for a 10 hour surgery.[...] PS: I am really curious - with a name like toofache...
by toofache32
Wed May 17, 2017 7:51 pm
Forum: Personal Finance (Not Investing)
Topic: Challenging a Late Medical Bill
Replies: 22
Views: 1587

Re: Challenging a Late Medical Bill

The bill noted, "Call this number if you have any questions" so I called it. Someone picks up and states, "Hi, are you paying a bill today?" "No, I had a question about the bill." "OK, looks like your bill is due next week for services rendered last year related t...
by toofache32
Tue May 16, 2017 10:17 pm
Forum: Personal Finance (Not Investing)
Topic: Challenging a Late Medical Bill
Replies: 22
Views: 1587

Re: Challenging a Late Medical Bill

Glad to hear the baby is doing well. The real question is when was the claim adjudicated (finally approved, denied, etc). It could be that the provider has been trying to get payment from the insurance company this entire time. When I was an in-network doctor with insurance plans, my record was 18 m...
by toofache32
Tue May 16, 2017 12:51 pm
Forum: Personal Finance (Not Investing)
Topic: Doctor wants Social Security number
Replies: 48
Views: 4800

Re: Doctor wants Social Security number

Yes but you assume the insurance company always pays. Getting the insurance company to pay is getting more and more difficult these days. Many people think we just send a bill to the insurance company and they pay it. Not true at all. Something like 20-30% of them are denied for no apparent reason....
by toofache32
Tue May 16, 2017 12:31 pm
Forum: Personal Finance (Not Investing)
Topic: Doctor wants Social Security number
Replies: 48
Views: 4800

Re: Doctor wants Social Security number

I still see the request for SS on most forms when filling out paperwork at a new Doctor. I always leave it blank (have twice experienced this in the last year). I'm guessing they'd like to have it if they can as it might help them collect payment if there is a problem. It shouldn't be required and ...
by toofache32
Tue May 16, 2017 12:28 pm
Forum: Personal Finance (Not Investing)
Topic: Doctor wants Social Security number
Replies: 48
Views: 4800

Re: Doctor wants Social Security number

I still see the request for SS on most forms when filling out paperwork at a new Doctor. I always leave it blank (have twice experienced this in the last year). I'm guessing they'd like to have it if they can as it might help them collect payment if there is a problem. It shouldn't be required and ...
by toofache32
Tue May 16, 2017 12:18 pm
Forum: Personal Finance (Not Investing)
Topic: Doctor wants Social Security number
Replies: 48
Views: 4800

Re: Doctor wants Social Security number

I also pay my medical bills in full immediately. I do see where toofache is coming from though. We see the same thing in physical therapy, not so much non payment, but hesitation to pay for a $3 piece of Theraband for home exercises but they have an $800 iPhone. I understand it, but at the same tim...
by toofache32
Mon May 15, 2017 9:32 pm
Forum: Personal Finance (Not Investing)
Topic: Doctor wants Social Security number
Replies: 48
Views: 4800

Re: Doctor wants Social Security number

I still see the request for SS on most forms when filling out paperwork at a new Doctor. I always leave it blank (have twice experienced this in the last year). I'm guessing they'd like to have it if they can as it might help them collect payment if there is a problem. It shouldn't be required and ...
by toofache32
Tue May 09, 2017 10:38 pm
Forum: Personal Consumer Issues
Topic: Medical Concierge Recommendation Orlando, FL
Replies: 4
Views: 463

Re: Medical Concierge Recommendation Orlando, FL

In these days of high deductibles, Going out of network for elective treatment is often not much more expensive than going in-network.
by toofache32
Sun Apr 30, 2017 3:25 pm
Forum: Personal Consumer Issues
Topic: Deceptive Billing by Dermatologist?
Replies: 33
Views: 3467

Re: Deceptive Billing by Dermatologist?

He also coded and billed for the freezing of the two lesions he deemed precancerous even though they would have / should have fallen under the flat rate cosmetic work. If the two lesions were legitimately diagnosed as precancerous, their removal was not just cosmetic, even if they turned out not to...
by toofache32
Sat Apr 29, 2017 10:14 pm
Forum: Personal Consumer Issues
Topic: Deceptive Billing by Dermatologist?
Replies: 33
Views: 3467

Re: Deceptive Billing by Dermatologist?

Let me play the Devil's advocate. A patient goes to a dermatologist for self paid cosmetic work. During the exam the the dermatologist sees a lesion which is a possible melanoma (serious skin cancer). But because the patient was there for only the cosmetic work she disregards it. The lesion indeed ...
by toofache32
Fri Apr 28, 2017 10:45 pm
Forum: Personal Consumer Issues
Topic: How does dental insurance work (for you)?
Replies: 4
Views: 808

Re: How does dental insurance work (for you)?

Now, I see this denial of claim letter that has the following: Submitted fees --> $155.00 Accepted fees --> $55.00 Not covered --> $55.00 Patient pays --> $55.00 Guess what how much we paid? Yes, $155.00. And the rep was adamant that the oral surgeon would be billing that amount - then WHY say &quo...
by toofache32
Fri Apr 28, 2017 10:35 pm
Forum: Personal Consumer Issues
Topic: Doctor bill question
Replies: 29
Views: 2040

Re: Doctor bill question

I firmly believe NPs cause a dramatic increase in costs to the healthcare landscape. They order tests and tests and more tests that are not always necessary. I see patients referred to me from NPs and patients always wonder why I don't need to see all those test results to come to the same conclusion.
by toofache32
Fri Apr 21, 2017 9:51 pm
Forum: Personal Consumer Issues
Topic: My Doctor says I am "unusual" (declining some blood tests)
Replies: 51
Views: 7064

Re: My Doctor says I am "unusual" (declining some blood tests)

EMRs/EHRs don't talk. Just allows reviewers to read typed up reports easier vs handwritten scribble. EMRs were created so the bean counters can perform chart audits and data mine more easily. There are dozens of software out there and none of them talk to each other. There is already enough outcry ...
by toofache32
Fri Apr 21, 2017 8:55 am
Forum: Personal Finance (Not Investing)
Topic: Does Insurance Have to Pay an Out-of-Network Ambulance Bill in Full?
Replies: 46
Views: 3086

Re: Does Insurance Have to Pay an Out-of-Network Ambulance Bill in Full?

As for hospital transport - when DH needed to be transferred to a different hospital his EMS buddies were literally on hand and visiting him after a call. They offered to transport him, but the hospital insisted they had a contract with the for-profit service, and COULD NOT allow anyone else to tra...
by toofache32
Thu Apr 20, 2017 7:07 pm
Forum: Personal Finance (Not Investing)
Topic: Does Insurance Have to Pay an Out-of-Network Ambulance Bill in Full?
Replies: 46
Views: 3086

Re: Does Insurance Have to Pay an Out-of-Network Ambulance Bill in Full?

When you're in the in network hospital, what happens if the hospitalist or other doctor consulted (radiologist, etc) is out of network? As both the doctors and nurses work in shifts, the nurses might not be able to tell you who is going to be the hospitalist checking on you, and I'm not sure what y...
by toofache32
Thu Apr 20, 2017 4:54 pm
Forum: Personal Finance (Not Investing)
Topic: Does Insurance Have to Pay an Out-of-Network Ambulance Bill in Full?
Replies: 46
Views: 3086

Re: Does Insurance Have to Pay an Out-of-Network Ambulance Bill in Full?

When you're in the in network hospital, what happens if the hospitalist or other doctor consulted (radiologist, etc) is out of network? As both the doctors and nurses work in shifts, the nurses might not be able to tell you who is going to be the hospitalist checking on you, and I'm not sure what y...
by toofache32
Thu Apr 20, 2017 2:09 am
Forum: Personal Finance (Not Investing)
Topic: Does Insurance Have to Pay an Out-of-Network Ambulance Bill in Full?
Replies: 46
Views: 3086

Re: Does Insurance Have to Pay an Out-of-Network Ambulance Bill in Full?

None of this would be an issue if insurance companies paid reasonable rates to begin with. Everyone would want to be in-network.
by toofache32
Thu Apr 20, 2017 2:08 am
Forum: Personal Finance (Not Investing)
Topic: Does Insurance Have to Pay an Out-of-Network Ambulance Bill in Full?
Replies: 46
Views: 3086

Re: Does Insurance Have to Pay an Out-of-Network Ambulance Bill in Full?

In network hospital arranged transpiration for me (a patient) with their usual ambulance service to another in network facility for covered treatment. The ambulance ride was not covered by insurance. Balance billing is disallowed for in-network providers who have agreed to the insurance network's t...
by toofache32
Wed Apr 19, 2017 3:21 pm
Forum: Personal Consumer Issues
Topic: If a doctor takes your insurance, must they accept the negotiated rate?
Replies: 62
Views: 5019

Re: If a doctor takes your insurance, must they accept the negotiated rate?

Hm. I routinely get bills from medical providers for quantities above and beyond the amount paid by the insurance company on the EOB. I have no idea whether these are legit or not, or whether they would be classified as co-insurance or co-payments. We are on a PPO and always use in-network provider...
by toofache32
Wed Apr 19, 2017 1:25 pm
Forum: Personal Consumer Issues
Topic: If a doctor takes your insurance, must they accept the negotiated rate?
Replies: 62
Views: 5019

Re: If a doctor takes your insurance, must they accept the negotiated rate?

Well it seems like either the psychologist received back some paperwork from United or received a call based on my inquiry to United because my wife received an unprompted email from the Dr. saying there was an overpayment and we would be receiving a credit. I wonder if this was a "silent PPO&...
by toofache32
Wed Apr 19, 2017 10:46 am
Forum: Personal Consumer Issues
Topic: If a doctor takes your insurance, must they accept the negotiated rate?
Replies: 62
Views: 5019

Re: If a doctor takes your insurance, must they accept the negotiated rate?

Hm. I routinely get bills from medical providers for quantities above and beyond the amount paid by the insurance company on the EOB. I have no idea whether these are legit or not, or whether they would be classified as co-insurance or co-payments. We are on a PPO and always use in-network provider...
by toofache32
Wed Apr 19, 2017 10:21 am
Forum: Personal Consumer Issues
Topic: If a doctor takes your insurance, must they accept the negotiated rate?
Replies: 62
Views: 5019

Re: If a doctor takes your insurance, must they accept the negotiated rate?

Just an additional follow up...I spoke to a United and they confirmed that the doctor in network and is not allowed to charge more than the contracted rate and if she has an issue with the rate she should reach out to United. So now I'm stuck between a rock and a hard place... This is why I said to...
by toofache32
Wed Apr 19, 2017 10:12 am
Forum: Personal Consumer Issues
Topic: If a doctor takes your insurance, must they accept the negotiated rate?
Replies: 62
Views: 5019

Re: If a doctor takes your insurance, must they accept the negotiated rate?

Just an additional follow up...I spoke to a United and they confirmed that the doctor in network and is not allowed to charge more than the contracted rate and if she has an issue with the rate she should reach out to United. So now I'm stuck between a rock and a hard place... This is why I said to...
by toofache32
Wed Apr 19, 2017 9:14 am
Forum: Personal Consumer Issues
Topic: If a doctor takes your insurance, must they accept the negotiated rate?
Replies: 62
Views: 5019

Re: If a doctor takes your insurance, must they accept the negotiated rate?

Amazing how hard it is to collect after someone has already received their services. Amazing how one can expect the patient to pay, when the amount is not even known at the time of service. Bingo! The fees are known up front. The patient agrees to them in writing and has the choice to go elsewhere ...
by toofache32
Wed Apr 19, 2017 8:22 am
Forum: Personal Consumer Issues
Topic: If a doctor takes your insurance, must they accept the negotiated rate?
Replies: 62
Views: 5019

Re: If a doctor takes your insurance, must they accept the negotiated rate?

Interesting notes. It all depends on if the provider is in-network or out-of-network. The EOB was processed as in-network, but the provider is behaving like out of network. That is abysmal pay for a 90791 (typical for UHC) since even Medicare pays $130 for that code, and is probably part of the reas...
by toofache32
Tue Apr 18, 2017 10:42 pm
Forum: Personal Consumer Issues
Topic: If a doctor takes your insurance, must they accept the negotiated rate?
Replies: 62
Views: 5019

Re: If a doctor takes your insurance, must they accept the negotiated rate?

OP here with an update. Apparently we were charged $205 with the following breakdown. $50 set up fee. $155/hr rate. Wife showed the doctor an EOB which states a $75 allowed expense and the doctor said "yes $75 allowed in insurance and my rate is $155/hr". She also wouldn't provide a bill....
by toofache32
Tue Apr 18, 2017 9:38 pm
Forum: Personal Consumer Issues
Topic: Doctor fees - Insured vs uninsured patients
Replies: 27
Views: 2808

Re: Doctor fees - Insured vs uninsured patients

The standard in my location is a 15% discount for cash paying patients. This is off everything - the visit fee, blood work, procedure fee, etc. It would be expected that the patient pay in full before they leave. You can get a quote if specific testing or lab work is needed. I'm not sure if the 15%...
by toofache32
Tue Apr 18, 2017 9:56 am
Forum: Personal Consumer Issues
Topic: If a doctor takes your insurance, must they accept the negotiated rate?
Replies: 62
Views: 5019

Re: If a doctor takes your insurance, must they accept the negotiated rate?

I hear you on it being hard to collect after services have been rendered. But that said, surely it can be addressed thus: a) just like you say that the patient should walk if they don't like the practitioner, surely the practitioner could walk away from the insurance if the "estimate" the...
by toofache32
Tue Apr 18, 2017 8:47 am
Forum: Personal Consumer Issues
Topic: If a doctor takes your insurance, must they accept the negotiated rate?
Replies: 62
Views: 5019

Re: If a doctor takes your insurance, must they accept the negotiated rate?

Amazing how hard it is to collect after someone has already received their services. Amazing how one can expect the patient to pay, when the amount is not even known at the time of service. Bingo! The fees are known up front. The patient agrees to them in writing and has the choice to go elsewhere ...
by toofache32
Tue Apr 18, 2017 8:39 am
Forum: Personal Consumer Issues
Topic: If a doctor takes your insurance, must they accept the negotiated rate?
Replies: 62
Views: 5019

Re: If a doctor takes your insurance, must they accept the negotiated rate?

Amazing how hard it is to collect after someone has already received their services. Amazing how one can expect the patient to pay, when the amount is not even known at the time of service. +1! The services are rendered pending insurance payments. If the doctor cannot afford to do so, front office ...

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