Search found 843 matches

by toofache32
Fri Apr 28, 2017 10:45 pm
Forum: Personal Consumer Issues
Topic: How does dental insurance work (for you)?
Replies: 4
Views: 461

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: 1765

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: 6665

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: 2806

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: 2806

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: 2806

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: 2806

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: 2806

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: 4674

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: 4674

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: 4674

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: 4674

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: 4674

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: 4674

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: 4674

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: 4674

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: 2640

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: 4674

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: 4674

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: 4674

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 ...
by toofache32
Tue Apr 18, 2017 8:26 am
Forum: Personal Consumer Issues
Topic: If a doctor takes your insurance, must they accept the negotiated rate?
Replies: 62
Views: 4674

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 8:20 am
Forum: Personal Consumer Issues
Topic: Doctor fees - Insured vs uninsured patients
Replies: 27
Views: 2640

Re: Doctor fees - Insured vs uninsured patients

I do not understand the second sentence.* So, my question to doctors - if you charge a fee (say $100) to an uninsured patient, what is the typical mark-up of the same fee when billed through insurance? Everyone gets "billed" the same amount. But if the doctor is in-network with the patien...
by toofache32
Tue Apr 18, 2017 8:01 am
Forum: Personal Consumer Issues
Topic: Doctor fees - Insured vs uninsured patients
Replies: 27
Views: 2640

Re: Doctor fees - Insured vs uninsured patients

I am an employed physician and have no authority over the amount that a patient is charged. It is anticipated that the proportion of employed physicians will increase. I am finding it tough to believe that first sentence. If an uninsured patient comes to a doctor's office seeking treatment for a fe...
by toofache32
Mon Apr 17, 2017 10:23 pm
Forum: Personal Consumer Issues
Topic: If a doctor takes your insurance, must they accept the negotiated rate?
Replies: 62
Views: 4674

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

Also make sure to ask the office if they are in-network with your plan, don't just trust your insurance company's website. There was a doctor in my practice that moved across the country in 2007 but several insurance plans still have him listed on their websites. Insurance companies do this on purpo...
by toofache32
Mon Apr 17, 2017 10:16 pm
Forum: Personal Consumer Issues
Topic: Doctor fees - Insured vs uninsured patients
Replies: 27
Views: 2640

Re: Doctor fees - Insured vs uninsured patients

So, my question to doctors - if you charge a fee (say $100) to an uninsured patient, what is the typical mark-up of the same fee when billed through insurance? Everyone gets "billed" the same amount. But if the doctor is in-network with the patient's insurance then they contractually must...
by toofache32
Mon Apr 17, 2017 5:02 pm
Forum: Personal Consumer Issues
Topic: Insurance, doctors and writing off owed money
Replies: 21
Views: 1800

Re: Insurance, doctors and writing off owed money

NEWS FLASH: There is none. Your spouse got free care and the doctor got nothing. Acutally worse as he spent overhead taking care of your spouse AND if there is a complication he is still 100% liable. This is true and I think most people don't realize this. If the patient did not pay, then someone e...
by toofache32
Mon Apr 17, 2017 12:20 am
Forum: Personal Consumer Issues
Topic: Insurance, doctors and writing off owed money
Replies: 21
Views: 1800

Re: Insurance, doctors and writing off owed money

Common misconception. The only "write-off" for the doc is that he doesn't get the cash, so he "writes it off" his books. There is no tax deduction for him as he would have to take the deduction against income, which he never got. Donated professional services are not deductible ...
by toofache32
Fri Apr 14, 2017 10:36 pm
Forum: Personal Finance (Not Investing)
Topic: Cost of Medicare Cataract surgery?
Replies: 20
Views: 1678

Re: Cost of Medicare Cataract surgery?

An acquaintance of ours (in her early 80's) has Traditional Medicare (no supplement) and had cataract surgery (both eyes, but at two different times about a month apart). She told me that she was charged about $2,000 for each eye, outpatient but an added several hundred dollars to the hospital. Is ...
by toofache32
Sun Apr 09, 2017 10:11 pm
Forum: Personal Finance (Not Investing)
Topic: Require Access to School Records?
Replies: 100
Views: 4092

Re: Require Access to School Records?

Sorry, duplicate.
by toofache32
Sun Apr 09, 2017 10:08 pm
Forum: Personal Finance (Not Investing)
Topic: Require Access to School Records?
Replies: 100
Views: 4092

Re: Require Access to School Records?

Did you press the issue and force your student to sign the papers authorizing access? How, exactly, would you "force" your child to sign something? Time to cut the cord, IMO. How would knowing your daughter's grades be beneficial to either one of you? That is kind of what she is asking at...
by toofache32
Thu Apr 06, 2017 1:03 am
Forum: Personal Finance (Not Investing)
Topic: Legal Issue: What kind of lawyer (or do I not need one yet)?
Replies: 46
Views: 4362

Re: Legal Issue: What kind of lawyer (or do I not need one yet)?

Please don't use Google to find a lawyer. As others have said, go back to your previous attorney. Otherwise, you're going to have to pay the new attorney to get up to speed in the case, which will, at a minimum, involve reading the pleadings, etc., from the prior case. That's gonna cost you. I appr...
by toofache32
Thu Apr 06, 2017 1:00 am
Forum: Personal Consumer Issues
Topic: Medical Device/Pharma Sales Reps?
Replies: 10
Views: 1110

Re: Medical Device/Pharma Sales Reps?

I don't work in that industry but I'm a doc on the other end of transactions. I see these folks as having a hard time and feeling like used car salesmen when trying to convince me I should use their product. But there are some of my reps who provide plates and screws for my surgery and they make mor...
by toofache32
Thu Mar 30, 2017 9:34 pm
Forum: Personal Consumer Issues
Topic: Two iPhones, one iCloud account, ring just one phone
Replies: 10
Views: 686

Re: Two iPhones, one iCloud account, ring just one phone

My similar problem is that my contacts and texts show up on my wife's and kid's devices. I have a family plan where everyone has their own logins but it still happens. Apple used to be "dummy-proof" but not any more. Just when you think something is dummy-proof, they create a better dummy.
by toofache32
Wed Mar 22, 2017 12:10 pm
Forum: Personal Consumer Issues
Topic: Medical treatment in US for non US citizen
Replies: 50
Views: 3480

Re: Medical treatment in US for non US citizen

So why on earth would physicians bill higher amounts than the insurance pays?? I'm glad you asked that question. Here's why physicians bill for much higher fees than they would otherwise accept: every doctor has maybe 50-100 CPT codes they bill for commonly. They have no idea what each insurance wi...
by toofache32
Tue Mar 21, 2017 10:39 am
Forum: Personal Consumer Issues
Topic: Cost of Dental Implant
Replies: 63
Views: 5090

Re: Cost of Dental Implant

You're right that the car analogy is probably not accurate. What I was trying to convey is that not all implants are the same and there is a significant variation on how much it costs the dentist to purchase them. While you don't always get what you pay for, you will never get what you don't pay for.
by toofache32
Mon Mar 20, 2017 10:53 pm
Forum: Personal Consumer Issues
Topic: Cost of Dental Implant
Replies: 63
Views: 5090

Re: Cost of Dental Implant

I'm a little confused with the different kinds of "permanent implants." http://www.getdentalimplantstoday.com/Fees.htm This borders on making medical recommendations which is a no-no here, but I'll keep it generic and let LadyGeek clean up my post as needed: everyone talks about price but...
by toofache32
Sun Mar 19, 2017 9:24 pm
Forum: Personal Consumer Issues
Topic: Medical treatment in US for non US citizen
Replies: 50
Views: 3480

Re: Medical treatment in US for non US citizen

Toothache: I do not understand the comment about insurance companies requiring providers/hospitals to charge multiples of what they are paid when the patient is covered by insurance. In my practice there were many patients who had no insurance who negotiated payment based on the amount an insurance...
by toofache32
Sun Mar 19, 2017 8:34 pm
Forum: Personal Finance (Not Investing)
Topic: U.S. medical billing system (duplicate originals)
Replies: 8
Views: 683

Re: U.S. medical billing system (duplicate originals)

So we are expecting to pay all expenses and get reimbursed from the insurance companies (d above). The companies want original diagnosis and bills for payment though, thus the question about obtaining two copies. We're working on figuring out what exact documents the insurance companies will need, ...
by toofache32
Sun Mar 19, 2017 2:55 pm
Forum: Personal Consumer Issues
Topic: Medical treatment in US for non US citizen
Replies: 50
Views: 3480

Re: Medical treatment in US for non US citizen

Toothache: I do not understand the comment about insurance companies requiring providers/hospitals to charge multiples of what they are paid when the patient is covered by insurance. In my practice there were many patients who had no insurance who negotiated payment based on the amount an insurance...
by toofache32
Sat Mar 18, 2017 4:13 pm
Forum: Personal Consumer Issues
Topic: Cost of Dental Implant
Replies: 63
Views: 5090

Re: Cost of Dental Implant

jebmke wrote:I would have ultimately paid the bill if the insurance company did not cover it.

Most people won't pay. "That's between the doctor and the insurance company" is the common mindset.
by toofache32
Sat Mar 18, 2017 3:40 pm
Forum: Personal Consumer Issues
Topic: Cost of Dental Implant
Replies: 63
Views: 5090

Re: Cost of Dental Implant

Medical insurance very rarely pays anything for teeth. The biggest problem is finding a dentist to work on "contingency" to do the work and hope insurance pays....most (rightfully so) will require you to pay up front and it's the patient's fight to get reimbursed from THEIR insurance. I t...
by toofache32
Fri Mar 17, 2017 1:52 pm
Forum: Personal Consumer Issues
Topic: Medical treatment in US for non US citizen
Replies: 50
Views: 3480

Re: Medical treatment in US for non US citizen

I was googling and someone was sort of in similar situation and he was advised to get patient here and lease an apartment in MA on her name and then his wife may get free healthcare in MA. Not sure whether this is possible or not. Who is paying for this "free" healthcare? The rest of us? ...
by toofache32
Fri Mar 17, 2017 6:17 am
Forum: Personal Consumer Issues
Topic: Medical treatment in US for non US citizen
Replies: 50
Views: 3480

Re: Medical treatment in US for non US citizen

Who is paying for this "free" healthcare? The rest of us? This sounds like Medicaid. I had a patient step off the plane from another country and find their way to my hospital. Within about 3 days, she had a Medicaid card. I removed her cancer and after almost 2 weeks in the hospital she w...
by toofache32
Thu Mar 16, 2017 10:48 pm
Forum: Personal Consumer Issues
Topic: Medical treatment in US for non US citizen
Replies: 50
Views: 3480

Re: Medical treatment in US for non US citizen

I was googling and someone was sort of in similar situation and he was advised to get patient here and lease an apartment in MA on her name and then his wife may get free healthcare in MA. Not sure whether this is possible or not. Who is paying for this "free" healthcare? The rest of us? ...
by toofache32
Thu Mar 16, 2017 8:14 pm
Forum: Personal Consumer Issues
Topic: Cost of Dental Implant
Replies: 63
Views: 5090

Re: Cost of Dental Implant

Medical insurance very rarely pays anything for teeth. The biggest problem is finding a dentist to work on "contingency" to do the work and hope insurance pays....most (rightfully so) will require you to pay up front and it's the patient's fight to get reimbursed from THEIR insurance. I t...
by toofache32
Thu Mar 16, 2017 5:41 am
Forum: Personal Consumer Issues
Topic: Cost of Dental Implant
Replies: 63
Views: 5090

Re: Cost of Dental Implant

I had implants done and the cost was $12,000 for 3 teeth. I had an excellent dental surgeon. Here's a warning about payment plans: please look very carefully at the terms for " zero interest offers" for a limited time period. If you pay the balance before interest kicks in, no problem...a...
by toofache32
Wed Mar 15, 2017 11:43 pm
Forum: Personal Consumer Issues
Topic: Cost of Dental Implant
Replies: 63
Views: 5090

Re: Cost of Dental Implant

I just can't understand the $45k cost. Is it the labor cost to create the implant? Is it the material cost? Most cars cost less. Multiple reasons. The overhead is high. The implants and abutments/components themselves can cost up to $1000 each for the dentist to purchase. Then the lab bill is often...
by toofache32
Wed Mar 15, 2017 11:39 pm
Forum: Personal Consumer Issues
Topic: Cost of Dental Implant
Replies: 63
Views: 5090

Re: Cost of Dental Implant

Not all implant-related procedures are the same. This is like asking "how much should I pay for a car" when we don't know if it's a pickup truck or sedan. Everyone who says they got 1-2 implants for this much money is irrelevant. The procedure the OP is referring to is when a full arch of ...
by toofache32
Wed Mar 15, 2017 11:30 pm
Forum: Personal Consumer Issues
Topic: Cost of Dental Implant
Replies: 63
Views: 5090

Re: Cost of Dental Implant

I had an accident in 2016 that fractured a single front tooth below the gum line. I had no dental insurance and paid cash for a complete extraction and implant. Shouldn't that be covered by health insurance? I think insurance might pay for the extraction but not the restoration -- the restoration b...
by toofache32
Wed Mar 15, 2017 10:08 pm
Forum: Personal Finance (Not Investing)
Topic: Question for Docs/Surgeons/ARNPs
Replies: 23
Views: 2925

Re: Question for Docs/Surgeons/ARNPs

What other industry expects workers to go into their place of business at 2am, to see a customer they never met, who will likely never pay them, but can still sue them for millions? Who does this? Veterinarians do this, though the lawsuits are for smaller amounts. That's the same thing, they're doc...

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