Ob-Gyn requires prepayment of deductible for pregnancy services - is this typical?

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fossil_fuel
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Ob-Gyn requires prepayment of deductible for pregnancy services - is this typical?

Post by fossil_fuel » Fri Jun 05, 2015 4:53 pm

My family is covered by a HDHP through my employment. (It is the most economical choice for almost all situations, as the monthly premium is hugely lower than the other plans available, to the point where it nearly makes up for the difference in deductible, and then the company also kicks in a small HSA contribution on top. OOP maximums are the same).

The deductible is several thousand dollars and is applied as a single deductible for the whole family (no individual deductibles). My wife is recently pregnant with our 2nd child and we have begun seeing a new Ob-Gyn (we are new to the area). After our first visit, we received a letter with estimated costs for pregnancy care assuming an uncomplicated delivery, and were informed that we would be required to pay 1/7th of our deductible + residual coinsurance each month for the 7 months until the due date. Then, after the delivery, the insurance company would be sent a single bill with all charges for the entire pregnancy.

My issue with this is that we're going to have to initially pay the (substantial) deductible twice - first as monthly payments to the ObGyn group (which won't be initially credited towards the deductible by the insurance company since they don't receive a bill until after delivery), then to other providers for other healthcare my family will need in the intervening months, which will "actually" satisfy the deductible. Then, in 7 months when the ObGyn finally sends an invoice to the insurance co, nearly the entire bill will be covered since we will have already met our deductible, and all the payments should be refunded to us.

I understand that the ObGyn group needs to make sure that they get paid, but it seems like we're giving them an interest-free loan of thousands of dollars for several months since they only want to have to send one bill to the insurance company after all is said and done. Is this billing arrangement typical these days? For our last pregnancy 3 years ago, the ObGyn just billed insurance immediately after each prenatal visit then the hospital billed for the delivery afterwards, so we didn't have any big outlays after satisfying the deductible.

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JDCarpenter
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Re: Ob-Gyn requires prepayment of deductible for pregnancy services - is this typical?

Post by JDCarpenter » Fri Jun 05, 2015 5:15 pm

There is no typical. You should talk to the billing office, or bring it up to the doc, esp. if small group. Based on my limited knowledge from DW's practice, there can be a good amount of flexibility.

(DW is in single specialty, 40 doc group, but the 3 doc office she is in functions fairly autonomously; bigger, more centralized group/practice is going to likely be less flexible.)
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kbc1234
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Re: Ob-Gyn requires prepayment of deductible for pregnancy services - is this typical?

Post by kbc1234 » Fri Jun 05, 2015 5:17 pm

We have had 2 babies in the last 3 years at two different OBGYN's. We also have a HDHP ($5,500) and also received the estimated costs from both OBGYN's. We don't have any type of co-payment or co-insurance, just a standard HDHP where we pay the first $5,500.

We were not asked to pay anything up front at either OBGYN. If I had been asked, I would have told them to send it to my insurance company.

ne2ca28
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Re: Ob-Gyn requires prepayment of deductible for pregnancy services - is this typical?

Post by ne2ca28 » Fri Jun 05, 2015 5:37 pm

I would talk to your insurance company. This does not seem normal to me. We are on HDHP and have had to pay the for the initial visit to confirm the pregnancy (~$120 doc visit) and for various lab tests that do not fall under the prenatal wellness routine visits (~$15 or $20 each visit). The charges for the prenatal wellness visits get lumped into the delivery charge with our insurance company.

Separately, we have had to pay from ultrasounds that were outside of our doctor's office (in LA at Cedar Sinai) and for some other genetic testing. This pregnancy is actually across two plan years, so we will have to pay for all of those out of pocket (~$3000) this period and then next period will include the delivery charges. I guess the good thing is that we will have 9 months of "free" healthcare since we reached the deductible early on in the plan year.

stan1
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Re: Ob-Gyn requires prepayment of deductible for pregnancy services - is this typical?

Post by stan1 » Fri Jun 05, 2015 5:56 pm

It seems like a strategy to keep you locked into the same medical group for the duration of the pregnancy. I'd consider looking elsewhere, if possible.

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Re: Ob-Gyn requires prepayment of deductible for pregnancy services - is this typical?

Post by BruDude » Fri Jun 05, 2015 5:57 pm

I've seen it before when OBGYN services are charged as a packaged rate for someone without insurance, but not for someone with insurance. I'd look elsewhere if they won't budge, and it may be against their contract terms with the insurance company.

letsgobobby
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Re: Ob-Gyn requires prepayment of deductible for pregnancy services - is this typical?

Post by letsgobobby » Fri Jun 05, 2015 6:07 pm

from what I hear, it may be becoming a 'new normal.'

As HDHPs have proliferated, so have patients incurring large debts they can't pay off.

Practices have to keep the doors open. I've heard this quite often lately.

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Re: Ob-Gyn requires prepayment of deductible for pregnancy services - is this typical?

Post by jaj2276 » Fri Jun 05, 2015 6:10 pm

Congratulations!

My wife and I are expecting our first kid and after her initial visit to the OB-GYN, they gave us a breakdown of their expected costs. Included in that was a requirement that we pre-pay the expected out-of-pocket costs for their services given our insurance. We live in the southeastern US.

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TX_TURTLE
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Re: Ob-Gyn requires prepayment of deductible for pregnancy services - is this typical?

Post by TX_TURTLE » Fri Jun 05, 2015 7:36 pm

fossil_fuel wrote:My family is covered by a HDHP through my employment. (It is the most economical choice for almost all situations, as the monthly premium is hugely lower than the other plans available, to the point where it nearly makes up for the difference in deductible, and then the company also kicks in a small HSA contribution on top. OOP maximums are the same).

The deductible is several thousand dollars and is applied as a single deductible for the whole family (no individual deductibles). My wife is recently pregnant with our 2nd child and we have begun seeing a new Ob-Gyn (we are new to the area). After our first visit, we received a letter with estimated costs for pregnancy care assuming an uncomplicated delivery, and were informed that we would be required to pay 1/7th of our deductible + residual coinsurance each month for the 7 months until the due date. Then, after the delivery, the insurance company would be sent a single bill with all charges for the entire pregnancy.

My issue with this is that we're going to have to initially pay the (substantial) deductible twice - first as monthly payments to the ObGyn group (which won't be initially credited towards the deductible by the insurance company since they don't receive a bill until after delivery), then to other providers for other healthcare my family will need in the intervening months, which will "actually" satisfy the deductible. Then, in 7 months when the ObGyn finally sends an invoice to the insurance co, nearly the entire bill will be covered since we will have already met our deductible, and all the payments should be refunded to us.

I understand that the ObGyn group needs to make sure that they get paid, but it seems like we're giving them an interest-free loan of thousands of dollars for several months since they only want to have to send one bill to the insurance company after all is said and done. Is this billing arrangement typical these days? For our last pregnancy 3 years ago, the ObGyn just billed insurance immediately after each prenatal visit then the hospital billed for the delivery afterwards, so we didn't have any big outlays after satisfying the deductible.
First of all, congratulations! I had a similar requirement when I first relocated to the US (wife was pregnant, and our health plan was a PPO). Years later we went to the same doctor for my wife's last pregnancy, and no such requirement surfaced. I wonder if it could be related to credit history, or perhaps being a new patient.
I'm not sure your concern about paying twice is justified. Many Ob-Gyns do a lot of things 'in house' and seldom send you to a third party. You should talk with the billing office to confirm this. If you trust the doctor, I don't believe this should be a deal breaker. IMHO good doctors are hard to find.

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Re: Ob-Gyn requires prepayment of deductible for pregnancy services - is this typical?

Post by Texanbybirth » Fri Jun 05, 2015 7:47 pm

I've never heard of this, and we just had a baby in January. My wife was primary on her own insurance (PPO, Aetna) through her work, and secondary on mine (HDHP, UHC). We didn't pay anything up front, although we were given an estimate of the cost. I would investigate this further before proceeding. Call and speak with the business office, talk to your insurance company, and then call the provider's bizz office again. You're basically giving them an interest free loan in the unlikely event that y'all go through complications.

Congrats on the little one, btw! Such a blessing to you. It does stink that insurance and business can somewhat get in the way of this awesome time. :sharebeer (For you, not your wife.)

mlipps
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Re: Ob-Gyn requires prepayment of deductible for pregnancy services - is this typical?

Post by mlipps » Fri Jun 05, 2015 8:02 pm

Apparently it's a new trend. I first heard about it from this Fatwallet thread earlier this year.

http://www.fatwallet.com/forums/finance/1429992/

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Re: Ob-Gyn requires prepayment of deductible for pregnancy services - is this typical?

Post by jbmitt » Fri Jun 05, 2015 9:15 pm

My partner is an OB/GYN and many practices have become so busy where this type of billing is necessary for 'access.' They know that they have leverage and that there aren't a lot of alternatives especially considering whether you are in or out of network.

Remember that you can chose to go somewhere else and they can chose not to see you.

toofache32
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Re: Ob-Gyn requires prepayment of deductible for pregnancy services - is this typical?

Post by toofache32 » Fri Jun 05, 2015 9:57 pm

fossil_fuel wrote:I understand that the ObGyn group needs to make sure that they get paid, but it seems like we're giving them an interest-free loan of thousands of dollars for several months since they only want to have to send one bill to the insurance company after all is said and done. Is this billing arrangement typical these days? For our last pregnancy 3 years ago, the ObGyn just billed insurance immediately after each prenatal visit then the hospital billed for the delivery afterwards, so we didn't have any big outlays after satisfying the deductible.
Oh the irony and hypocrisy. Doctors who take insurance are giving unsecured interest-free loans with every patient they see since they don't get paid for months (and sometimes not at all when claims are denied). You have no problem with your doctor taking the financial risk, but you will not accept the same deal?? When the tables are turned you balk? I imagine you would raise an even bigger stink if (as an alternative) they asked for payment when you arrive to the hospital before wheeling her back for delivery? If you are an insurance patient, then you will be treated as such. Insurance patients tend to GROSSLY overestimate their value to a practice.

How else would you recommend the provider assure that he is paid by his customer other than payment up front? I'm sure the doctor will listen to your suggestions. Healthcare not like buying a car that can be repossessed. There is no recourse after service is provided and they can't put the baby back in.

I have instituted similar polices in my office (not an OBGYN). The most interesting result is that the only patients who got upset were the ones who never intended to pay to begin with.
Last edited by toofache32 on Fri Jun 05, 2015 10:12 pm, edited 1 time in total.

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wander
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Re: Ob-Gyn requires prepayment of deductible for pregnancy services - is this typical?

Post by wander » Fri Jun 05, 2015 10:03 pm

I guess the this office does not think HDHP is an insurance plan (at least it happened to a doctor office I visited a few years ago when HDHP was new. They charged me a non-return fee $50 to make sure they got paid), otherwise they know that they should send the claim to your insurance company.

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Re: Ob-Gyn requires prepayment of deductible for pregnancy services - is this typical?

Post by toofache32 » Fri Jun 05, 2015 10:09 pm

wander wrote:I guess the this office does not think HDHP is an insurance plan, otherwise they know that they should send the claim to your insurance company.
Can you elaborate? I don't understand.

The remaining deductible is determined from a call to the insurance company. That amount is required of the customer prior to services being rendered. Fortunately it can be paid monthly up until the date of delivery instead of being required all at once such as how attorneys require on their retainers.

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wander
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Re: Ob-Gyn requires prepayment of deductible for pregnancy services - is this typical?

Post by wander » Fri Jun 05, 2015 10:48 pm

toofache32 wrote:
wander wrote:I guess the this office does not think HDHP is an insurance plan, otherwise they know that they should send the claim to your insurance company.
Can you elaborate? I don't understand.

The remaining deductible is determined from a call to the insurance company. That amount is required of the customer prior to services being rendered. Fortunately it can be paid monthly up until the date of delivery instead of being required all at once such as how attorneys require on their retainers.
My HDHP does not require co-payment. If an office asked me for co-payment, I would tell them to send to the insurance as the insurance keeps track my deductible until it meets $1,500. A few years ago, I went to a doctor office in California for general checkup. They did blood test and told me to come back to see the doctor since they were not discussing over the phone. I came back and was told that I needed to pay $50 co-payment. They explained that they didn't understand the HDHP and they were not sure that they would get paid. I told them that if the insurance decided that I must paid 100%, then I would pay with check from my HSA account. They told me that there were patients who did not pay when they sent them the bill. Finally, I must paid $50. After that, they sent the bill to my insurance and got paid. I called them and told them to refund me the $50. They agreed but never sent me the check. It's been a few years and I do not have chance to go back to that office (I do not live in California). I lost my receipt so I doubt that they will "remember" me.

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Re: Ob-Gyn requires prepayment of deductible for pregnancy services - is this typical?

Post by toofache32 » Fri Jun 05, 2015 10:58 pm

wander wrote:
toofache32 wrote:
wander wrote:I guess the this office does not think HDHP is an insurance plan, otherwise they know that they should send the claim to your insurance company.
Can you elaborate? I don't understand.

The remaining deductible is determined from a call to the insurance company. That amount is required of the customer prior to services being rendered. Fortunately it can be paid monthly up until the date of delivery instead of being required all at once such as how attorneys require on their retainers.
My HDHP does not require co-payment. If an office asked me for co-payment, I would tell them to send to the insurance as the insurance keeps track my deductible until it meets $1,500. A few years ago, I went to a doctor office in California for general checkup. They did blood test and told me to come back to see the doctor since they were not discussing over the phone. I came back and was told that I needed to pay $50 co-payment. They explained that they didn't understand the HDHP and they were not sure that they would get paid. I told them that if the insurance decided that I must paid 100%, then I would pay with check from my HSA account. They told me that there were patients who did not pay when they sent them the bill. Finally, I must paid $50. After that, they sent the bill to my insurance and got paid. I called them and told them to refund me the $50. They agreed but never sent me the check. It's been a few years and I do not have chance to go back to that office (I do not live in California). I lost my receipt so I doubt that they will "remember" me.
You keep saying this is a HDHP issue, but your situation has nothing to do with the amount of your deductible. Everyone says "I promise I will pay you later." Try telling this to Best Buy as you walk out with a flat screen TV and see what happens. Your HSA is irrelevant. More commonly, I see it when patients don't understand their own insurance and assume they never have to pay anything.

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wander
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Re: Ob-Gyn requires prepayment of deductible for pregnancy services - is this typical?

Post by wander » Fri Jun 05, 2015 11:03 pm

toofache32 wrote: You keep saying this is a HDHP issue, but your situation has nothing to do with the amount of your deductible. Everyone says "I promise I will pay you later." Try telling this to Best Buy as you walk out with a flat screen TV and see what happens. Your HSA is irrelevant. More commonly, I see it when patients don't understand their own insurance and assume they never have to pay anything.
Did I say HDHP issue? I never paid anything at doctor offices with HDHP except that one office. It doesn't make sense to bring Best Buy comparison here. The HDHP is a middle man to make sure the transactions are correct. Patients cannot run away.
Last edited by wander on Fri Jun 05, 2015 11:08 pm, edited 1 time in total.

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Re: Ob-Gyn requires prepayment of deductible for pregnancy services - is this typical?

Post by jubling » Fri Jun 05, 2015 11:04 pm

We just had a boy 2 months ago. Our OB sent me a similar packet of payment stubs near the beginning of the pregnancy. The total was something like 5k that they wanted paid all 1 month before due date. I called the office and told them I had a health savings plan and didn't want to pay before the bill was due. They said in that case to ignore the payment coupons. I ended up paying them around $150 because we had already met our deductible at that point...

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Re: Ob-Gyn requires prepayment of deductible for pregnancy services - is this typical?

Post by toofache32 » Fri Jun 05, 2015 11:20 pm

wander wrote:
toofache32 wrote: You keep saying this is a HDHP issue, but your situation has nothing to do with the amount of your deductible. Everyone says "I promise I will pay you later." Try telling this to Best Buy as you walk out with a flat screen TV and see what happens. Your HSA is irrelevant. More commonly, I see it when patients don't understand their own insurance and assume they never have to pay anything.
Did I say HDHP issue? I never paid anything at doctor offices with HDHP except that one office. It doesn't make sense to bring Best Buy comparison here. The HDHP is a middle man to make sure the transactions are correct. Patients cannot run away.
I suspect there is a language barrier here. You keep referring to your medical insurance plan specifically as a high deductible health plan (HDHP). The insurance company (regardless of your deductible) is not there to make sure transactions are correct. It is there to serve itself and stay in business, just like any other middle man.

Saving$
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Re: Ob-Gyn requires prepayment of deductible for pregnancy services - is this typical?

Post by Saving$ » Fri Jun 05, 2015 11:20 pm

I no longer have an HDHP (wish I did), but my regular plan has $4k deductible. I was recently scheduled for a procedure, and the doctors office phoned to say I must pay for the procedure at least 3 weeks prior, or they would cancel the appointment. I told them they needed to mail me an invoice stating exactly what I was paying, as I don't give my credit card out over the phone. I received a form letter stating I had to pay for the procedure beforehand, and to contact the business office, but no specific amount. They called again and I again told them to put the amount in writing. When I went in for the procedure, my appointment had NOT been cancelled, but they required me to visit the business office and pay prior to signing me in for the procedure. I was given a written cost at the business office, so I paid.

Two weeks later I received an invoice for an additional several hundred. I'm waiting for the EOB from the insurance before I pay that....

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Re: Ob-Gyn requires prepayment of deductible for pregnancy services - is this typical?

Post by stlutz » Fri Jun 05, 2015 11:38 pm

The insurance company may not pay bills that are submitted many months after the fact, depending upon their contract with the provider.

You've been through this before, but anyone who has had a major medical issue knows that providers will bill them incorrectly and all errors will be in their favor. I would decline this scam arrangement.

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Re: Ob-Gyn requires prepayment of deductible for pregnancy services - is this typical?

Post by toofache32 » Fri Jun 05, 2015 11:48 pm

stlutz wrote:The insurance company may not pay bills that are submitted many months after the fact, depending upon their contract with the provider.

You've been through this before, but anyone who has had a major medical issue knows that providers will bill them incorrectly and all errors will be in their favor. I would decline this scam arrangement.
Yes you are correct that paying at the time services are rendered certainly sounds like a scam. Please answer this...in your job, do you require payment when services are provided? Or do you give unsecured interest-free loans?

Who else here is in a business that allows this....provide services and just hope you get paid. The amount billed to insurance companies for a given procedure is the same every time.

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Re: Ob-Gyn requires prepayment of deductible for pregnancy services - is this typical?

Post by ResearchMed » Fri Jun 05, 2015 11:56 pm

toofache32 wrote:
stlutz wrote:The insurance company may not pay bills that are submitted many months after the fact, depending upon their contract with the provider.

You've been through this before, but anyone who has had a major medical issue knows that providers will bill them incorrectly and all errors will be in their favor. I would decline this scam arrangement.
Yes you are correct that paying at the time services are rendered certainly sounds like a scam. Please answer this...in your job, do you require payment when services are provided? Or do you give unsecured interest-free loans?

Who else here is in a business that allows this....provide and just hope you get paid. The amount billed to insurance companies for a given procedure is the same every time.
Who else "provides services and 'just hope you get paid'"?

Let's see: termite prevention treatment, landscaper, gas and electric bills... everyone who sends us a monthly bill OR a bill whenever the services have been provided (for non-monthly/etc., non-regular interval services)...
... AND ALL OF OUR MEDICAL AND DENTAL PROVIDERS (small offices or hospitals alike), after taking down information from health insurance card.
(They typically don't know if our deductible has been met yet. Some require a nominal co-pay up front, but most don't even do that; we get a bill next month, following any services for which there is a co-pay that was outstanding. This is because once OOP is met, there's no more co-pay for us to deal with for the rest of the year.)

The list of "bills" continues... all of them for services already provided.

RM
This signature is a placebo. You are in the control group.

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Re: Ob-Gyn requires prepayment of deductible for pregnancy services - is this typical?

Post by toofache32 » Sat Jun 06, 2015 12:07 am

ResearchMed wrote:
toofache32 wrote:
stlutz wrote:The insurance company may not pay bills that are submitted many months after the fact, depending upon their contract with the provider.

You've been through this before, but anyone who has had a major medical issue knows that providers will bill them incorrectly and all errors will be in their favor. I would decline this scam arrangement.
Yes you are correct that paying at the time services are rendered certainly sounds like a scam. Please answer this...in your job, do you require payment when services are provided? Or do you give unsecured interest-free loans?

Who else here is in a business that allows this....provide and just hope you get paid. The amount billed to insurance companies for a given procedure is the same every time.
Who else "provides services and 'just hope you get paid'"?

Let's see: termite prevention treatment, landscaper, gas and electric bills... everyone who sends us a monthly bill OR a bill whenever the services have been provided (for non-monthly/etc., non-regular interval services)...
... AND ALL OF OUR MEDICAL AND DENTAL PROVIDERS (small offices or hospitals alike), after taking down information from health insurance card.
(They typically don't know if our deductible has been met yet. Some require a nominal co-pay up front, but most don't even do that; we get a bill next month, following any services for which there is a co-pay that was outstanding. This is because once OOP is met, there's no more co-pay for us to deal with for the rest of the year.)

The list of "bills" continues... all of them for services already provided.

RM
And of all those service providers you list, which one is OK to stiff in our culture? That's my point. Doctors get paid last. People don't dare miss paying their cell phone bill, but they have no problem ignoring doctors bills. The other service providers can use the threat of sending your account to collections, but medical bills are less and less able to affect credit.

http://www.nerdwallet.com/blog/health/2 ... lls-focus/

http://www.consumerfinance.gov/blog/her ... it-report/

http://www.npr.org/sections/health-shot ... to-ratings
Last edited by toofache32 on Sat Jun 06, 2015 12:46 am, edited 1 time in total.

stlutz
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Re: Ob-Gyn requires prepayment of deductible for pregnancy services - is this typical?

Post by stlutz » Sat Jun 06, 2015 12:28 am

And of all those service providers you list, which one is OK to stiff in our culture?
Are you saying doctors are the only businesses that ever get screwed by customers? I suggest you talk more with other business people.

But let's be serious here. How many people on Bogleheads do you think don't pay their bills? The OP certainly wasn't talking about doing so. So, all of this venting is way off topic.

I can count on the electric company, the lawncare service, the house painter etc. to all bill me correctly. The only flat out incorrect bills I've ever received are from medical offices. For Bogleheads who pay their bills on time, I'm simply advising to be careful about non-standard billing arrangements--i.e. anything different from the provider bills the insurance, I then receive a bill from the provider and an EOB from the insurance company, I verify they match, and I pay.

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Re: Ob-Gyn requires prepayment of deductible for pregnancy services - is this typical?

Post by obgyn65 » Sat Jun 06, 2015 12:30 am

Not typical.
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Re: Ob-Gyn requires prepayment of deductible for pregnancy services - is this typical?

Post by ResearchMed » Sat Jun 06, 2015 12:31 am

toofache32 wrote:
ResearchMed wrote:
toofache32 wrote:
stlutz wrote:The insurance company may not pay bills that are submitted many months after the fact, depending upon their contract with the provider.

You've been through this before, but anyone who has had a major medical issue knows that providers will bill them incorrectly and all errors will be in their favor. I would decline this scam arrangement.
Yes you are correct that paying at the time services are rendered certainly sounds like a scam. Please answer this...in your job, do you require payment when services are provided? Or do you give unsecured interest-free loans?

Who else here is in a business that allows this....provide and just hope you get paid. The amount billed to insurance companies for a given procedure is the same every time.
Who else "provides services and 'just hope you get paid'"?

Let's see: termite prevention treatment, landscaper, gas and electric bills... everyone who sends us a monthly bill OR a bill whenever the services have been provided (for non-monthly/etc., non-regular interval services)...
... AND ALL OF OUR MEDICAL AND DENTAL PROVIDERS (small offices or hospitals alike), after taking down information from health insurance card.
(They typically don't know if our deductible has been met yet. Some require a nominal co-pay up front, but most don't even do that; we get a bill next month, following any services for which there is a co-pay that was outstanding. This is because once OOP is met, there's no more co-pay for us to deal with for the rest of the year.)

The list of "bills" continues... all of them for services already provided.

RM
And of all those service providers you list, which one is OK to stiff in our culture? That's my point. Doctors get paid last. People don't dare miss paying their cell phone bill, but they have no problem ignoring doctors bills. The other service providers can use the threat of sending your account to collections, but medical bills are less and less able to affect credit.

http://www.consumerfinance.gov/blog/her ... it-report/

http://www.npr.org/sections/health-shot ... to-ratings
Who, exactly, is saying that is it "OK to stiff" anyone at all?

We are in a major metro area, and have used a pretty wide variety of medical and dental providers, including an occasional one that is NOT covered by our plan.

And we've had the occasional "billing snafu" wherein a PAID BILL (or one that should have been sent to insurer but the provider did NOT do that "somehow") got sent to collections.
It was annoying to sort that out, but we took the time, even for small amounts, on principle (and principal, although this wasn't "worth our time", typically).
A few times a major bill was "just" coded incorrectly - nothing that we had control over.
And more related to your specialty (I take it), and mentioned elsewhere on BH Forum, on occasion the insurance "fight' was that part of the major dental procedure needed to be paid by the medical, not dental, coverage, but the dental provider's billing office simply could not manage to do that without a lot of, dare I say it, toothpulling... or at least far too much handholding.

But my point in the above is that clearly, bills ARE being sent to collections when they aren't paid.
Surely our often large-scale providers in our major metro area aren't alone in this.
Why is this different from bills from any other provider?

I get it that people need medical/dental services in ways they don't need landscapers.
But they also need heat and electricity, and water... and these also get billed after the fact.

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Re: Ob-Gyn requires prepayment of deductible for pregnancy services - is this typical?

Post by wander » Sat Jun 06, 2015 6:41 am

stlutz wrote:
Are you saying doctors are the only businesses that ever get screwed by customers? I suggest you talk more with other business people.

But let's be serious here. How many people on Bogleheads do you think don't pay their bills? The OP certainly wasn't talking about doing so. So, all of this venting is way off topic.

I can count on the electric company, the lawncare service, the house painter etc. to all bill me correctly. The only flat out incorrect bills I've ever received are from medical offices. For Bogleheads who pay their bills on time, I'm simply advising to be careful about non-standard billing arrangements--i.e. anything different from the provider bills the insurance, I then receive a bill from the provider and an EOB from the insurance company, I verify they match, and I pay.
+1. I can't say it better myself.

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Re: Ob-Gyn requires prepayment of deductible for pregnancy services - is this typical?

Post by likegarden » Sat Jun 06, 2015 8:29 am

Why would a doctor's office send a bill directly to a patient and ask for immediate payment when the patient has insurance? Doctor's rates are negotiated between doctor's offices and insurance companies. The deductible is not between you and the doctor, but between the insurance company and you! Sorry, we have regular medical insurance and not HDHP. Are HDHP people getting screwed to have to pay the way overpriced initial numbers hospitals initially send out, like 8 times the final price an insurance would pay?

I think the proper way would be to send any bill to the insurance company, they would tell you what they usually would pay to that doctor or hospital for that service, and you would pay that amount to the doctor / hospital up front, and that then would count as part of the deductible on your HDHP insurance. You have insurance to be protected against overcharging by a doctor / hospital office. I.e. the bill for various tests of a person in my family was $900 recently, insurance paid only $85, and we did pay nothing.

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Re: Ob-Gyn requires prepayment of deductible for pregnancy services - is this typical?

Post by N1CKV » Sat Jun 06, 2015 8:58 am

I know nothing about Ob-Gyn, but my experiences as a patient for spinal issues with a HDHP:

*Dr.'s office visit - They ask if I have met my deductible, I say no. They admit that they don't know what exactly I will owe, so they tell me they'll bill insurance and my share will be billed after they get a response.

*Sent for MRI - MRI clinic never asked anything other than for a copy of my insurance card, they would bill insurance and bill me my balance later.

*Sent for injections (specialty outpatient hospital) - they called me about two weeks before, asked for insurance info. Said they'd call back. Called back with total and advised that I had not reached my deductible and the total would not put me over. I would be required to pay half when I showed up, I would be billed for the other half after they filed insurance to assure rate was 100% correct (or I would be billed corrected balance).

I would tell this office that they can bill insurance as we go along if they would like, however I would be exceeding my deductible due to other medical expenses beyond this clinic. It's their choice to hold bills until the end. The world does not revolve around them. If they would like to see my H.S.A. statement to know I have adequate funds for services requested I wouldn't mine showing it to them (I'm not giving a copy).
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Re: Ob-Gyn requires prepayment of deductible for pregnancy services - is this typical?

Post by toofache32 » Sat Jun 06, 2015 11:36 am

likegarden wrote:Why would a doctor's office send a bill directly to a patient and ask for immediate payment when the patient has insurance?
The patient is billed for THEIR portion of the payment. Insurance does not pay for everything. :annoyed In the old days, providers would just send a bill to the patient after insurance paid and the patient's portion had been determined by the insurance company. But in the old days, people paid their bills too. A previous poster said talking about not paying the bills is off-topic and not related to this discussion. But it has everything to do with this discussion because it's the reason why we are having this discussion....the OBGYN scenario is a response to people not paying their bills, so they simply get paid up front.
likegarden wrote:Doctor's rates are negotiated between doctor's offices and insurance companies. The deductible is not between you and the doctor, but between the insurance company and you!
Absolutely incorrect. PAYMENT of the deductible IS between the doctor and the patient. The doctor is collecting the patient's portion and the insurance will pay their share. The insurance company will not tell the doctor or the patient how much they will pay, so we simply collect our regular fees up to the amount of the remaining deductible. If patients object to this they are invited to find care somewhere else.
likegarden wrote:Sorry, we have regular medical insurance and not HDHP. Are HDHP people getting screwed to have to pay the way overpriced initial numbers hospitals initially send out, like 8 times the final price an insurance would pay?
There is more of an incentive to collect up front from patients with high deductibles since so many people cannot afford their deductibles these days. Remember, cell phones and electricity gets paid first, doctors get paid last. How else should doctors respond to this trend?

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Re: Ob-Gyn requires prepayment of deductible for pregnancy services - is this typical?

Post by fossil_fuel » Sat Jun 06, 2015 3:34 pm

Thanks for the input everyone. I sent a query to my insurance company to double check that this is allowable under the terms of the plan. If so, I'll contact the provider's billing office and see if we can come to an understanding regarding when they submit the claims. If they won't budge, we'll probably just go along with it - this provider has a reputation for better patient care than the other in-network providers in my area (unfortunately they also have a reputation for billing issues).

toofache32 wrote:
Oh the irony and hypocrisy. Doctors who take insurance are giving unsecured interest-free loans with every patient they see since they don't get paid for months (and sometimes not at all when claims are denied). You have no problem with your doctor taking the financial risk, but you will not accept the same deal?? When the tables are turned you balk? I imagine you would raise an even bigger stink if (as an alternative) they asked for payment when you arrive to the hospital before wheeling her back for delivery? If you are an insurance patient, then you will be treated as such. Insurance patients tend to GROSSLY overestimate their value to a practice.

How else would you recommend the provider assure that he is paid by his customer other than payment up front? I'm sure the doctor will listen to your suggestions. Healthcare not like buying a car that can be repossessed. There is no recourse after service is provided and they can't put the baby back in.

I have instituted similar polices in my office (not an OBGYN). The most interesting result is that the only patients who got upset were the ones who never intended to pay to begin with.
I could be OK with paying beforehand - if they required payment immediately before each appointment and prior to the delivery I would be fine with it, as long as they billed our insurance immediately after each service so the amount I paid could be counted toward the deductible. My issue is that they want to wait 7 months and bill insurance only at the end, so I have to meet my deductible twice and then wait for a refund. I do appreciate your snark though.

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Re: Ob-Gyn requires prepayment of deductible for pregnancy services - is this typical?

Post by retiredjg » Sat Jun 06, 2015 3:46 pm

So what happens if you pay the doctor up front and then you have the baby while in another city/state? Or you are forced to go to a hospital that the doctor does not practice at?

I can understand paying up front for the services you are getting up front.

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Re: Ob-Gyn requires prepayment of deductible for pregnancy services - is this typical?

Post by toofache32 » Sat Jun 06, 2015 3:53 pm

retiredjg wrote:So what happens if you pay the doctor up front and then you have the baby while in another city/state? Or you are forced to go to a hospital that the doctor does not practice at?

I can understand paying up front for the services you are getting up front.
I suppose you would then be due a refund for any services you did not receive from the doctor you pre-paid, but I would read the contract first. This whole scenario sounds similar to how attorneys require a retainer, but I'm not sure how that works. Can any attorneys here comment?

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Re: Ob-Gyn requires prepayment of deductible for pregnancy services - is this typical?

Post by LadyGeek » Sat Jun 06, 2015 3:55 pm

In reference to some earlier posts, please stay focused on the OP's situation. Ranting about the payment priorities of physicians vs. everyone else is off-topic.
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Re: Ob-Gyn requires prepayment of deductible for pregnancy services - is this typical?

Post by archbish99 » Sat Jun 06, 2015 4:05 pm

If not typical, at least common. Our plan allows for the case where an ob-gyn bills a single price for all pre-natal care and the delivery. (Pre-natal care is preventative, so they assume one-third is the pre-natal and pay it before applying the rest to the deductible.)

Our ob did this, and had an estimate that had to be paid by month seven, IIRC. It was irksome to have that outstanding for several months, but I was expecting the opposite outcome from you -- their estimate was only a few hundred because we'd already met the deductible, but the baby was due in January. It turned out that the hospital got there first and ate the deductible, so their amount was spot on.

You might go ahead and pay the minimum they'll take, but when you're close to your deductible, ask them to refresh the estimate from the insurance company and then argue you've already paid more than that, possibly requesting a refund at that point.
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Re: Ob-Gyn requires prepayment of deductible for pregnancy services - is this typical?

Post by jlawrence01 » Sat Jun 06, 2015 11:56 pm

Last month, I went to the dentist for a filling. At the end of the visit, I was presented with a completed, correct bill, and I paid it immediately after the service was rendered. And I received the usual 5% cash discount for cash payment.

I have yet to see a physician who could present me with a bill immediately, even when I was self pay. I would wait for six to eight weeks for billing to be sent to me. It is often longer when insurance is involved.

I would not pre-pay ANY medical services until they are rendered.

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Re: Ob-Gyn requires prepayment of deductible for pregnancy services - is this typical?

Post by inspector00 » Sun Jun 07, 2015 12:24 am

I was recently in a similar situation as the OP where I was told I'd have to pay the full deductible of my high deductible health plan before the delivery. It wasn't a formal situation where it had to be a certain amount every month or anything but it was expected that the full amount be paid ahead of birth. This was ridiculous to me since my deductible was over $6000, the doctor said their delivery charge was $4000 even though it was around $1100 when looking at the negotiated rate through the cost estimator. When I called an insurance representative he said this is becoming more and more common since people don't pay their bills after the baby is born. There's no upside for you since best case scenario you're waiting for a refund, but there's nothing you can do other than negotiate with the billing office or pick another provider.

Ultimately I couldn't talk my biling office out of it though I'll admit I really didn't try hard enough and was told to just pay what I can as we went to appointments until the full amount was due before delivery. I never paid a dime in that office and was never asked about it by anyone even as we had weekly visits towards the end of the pregnancy. About a month after my wife gave birth we got the expected bill for delivery of about $1200 after it went through insurance the way a high deductible plan is supposed to work.

One more thing, keep a close eye on all the bills you receive, I got a $180 bill for my daughter that the hospital never submitted through insurance.

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Re: Ob-Gyn requires prepayment of deductible for pregnancy services - is this typical?

Post by toofache32 » Sun Jun 07, 2015 12:32 am

As I said previously, this is a response to the huge number of patients that don't pay their bills after the fact. Certainly no Boglehead would do this, :oops: but this is the reality we are left with after so many deadbeats go through the system. Now everyone pays the price. If you don't like it, you should shop around for another provider. Again I ask, what is a better way for doctors to protect themselves (especially when the insurance company will not tell anyone up front how much they will pay)....they would love to hear alternatives.

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Re: Ob-Gyn requires prepayment of deductible for pregnancy services - is this typical?

Post by 555 » Sun Jun 07, 2015 2:04 am

toofache32 wrote:As I said previously, this is a response to the huge number of patients that don't pay their bills after the fact. Certainly no Boglehead would do this, :oops: but this is the reality we are left with after so many deadbeats go through the system. Now everyone pays the price. If you don't like it, you should shop around for another provider. Again I ask, what is a better way for doctors to protect themselves (especially when the insurance company will not tell anyone up front how much they will pay)....they would love to hear alternatives.
Yes, but medical billers send out huge trumped charges to anyone and everyone just to see who they can get money out of. They don't and won't offer any kind of explanation. It's all about bringing in revenue, and there's little or no connection to actual service provided or to amounts legitimately owed.

If you're completely reasonable and say "Sure I'd be glad to promptly pay in full as soon as you completely explain precisely how these charges were calculated" the medical office will say "Now we're adding a 10% `asking too many questions' surcharge and pay right now or we're sending it to collections."

This is why it is now widely recognized that having someone claim you have an unpaid medical bill is approximately zero evidence that you are a person who ever fails to pay legitimate bills.

OP, this is the context you have to keep in mind. If you overpay up front it will be very difficult to get it back, since they'll view your overpayment as making up for someone else's underpayment. You have to get into the minds of these medical billing offices and realize how they think.

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Re: Ob-Gyn requires prepayment of deductible for pregnancy services - is this typical?

Post by ne2ca28 » Sun Jun 07, 2015 3:01 am

If you have to pay upfront, I would try to do it with a credit card. If you have any issues with the doctor's office for some reason (not saying you will - I don't want to get yelled at), you will likely have better luck getting money back through credit card company than a bank with a check/debit card. Nothing is guaranteed with a pregnancy, so I would have a hard time paying up front, especially this far ahead of time and if prenatal visits are preventative and supposed to be covered. Maybe they can pay you interest on your 'deposit' like a landlord is required to do.

I wish the best for you. The billing practices and insurance issues are so confusing these days. I have an HDHP plan. Wife had a new blood test for genetics, sex of the baby, down syndrome. The testing company submitted a bill to my insurance for $4400 and was out of network. Insurance EOB said I may have to pay all of it. I got a bill 3 mos later and I ended up paying $25. I had no correspondence with the company, thats just what happened. What the....? Its like its monopoly money sometimes. So if its common in the industry for these types of games to be played, expect confusion.

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Re: Ob-Gyn requires prepayment of deductible for pregnancy services - is this typical?

Post by 8foot7 » Sun Jun 07, 2015 10:21 am

When my ex-wife was pregnant with my son in 2008/2009 we ran into this. I obliged although I strongly disliked the notion of prepaying for a delivery beginning in the 3rd month of pregnancy (!) and in the end we had several insurance snafus to sort out even though at the time we had normal (not HDHP) PPO insurance and everyone was in network. We ended up getting a refund, of course, but it took a while. I would recommend exercising your power of walking to another OBGYN if there is no flexibility here. I wouldn't have minded paying for each service as soon as it was over, the claim had been filed and the deductible estimate updated accordingly but like most other posters have stated, these guys just held onto the money and didn't finalize the insurance claim until the end, making for much more work for me.

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Re: Ob-Gyn requires prepayment of deductible for pregnancy services - is this typical?

Post by toofache32 » Sun Jun 07, 2015 12:41 pm

555 wrote:
toofache32 wrote:As I said previously, this is a response to the huge number of patients that don't pay their bills after the fact. Certainly no Boglehead would do this, :oops: but this is the reality we are left with after so many deadbeats go through the system. Now everyone pays the price. If you don't like it, you should shop around for another provider. Again I ask, what is a better way for doctors to protect themselves (especially when the insurance company will not tell anyone up front how much they will pay)....they would love to hear alternatives.
Yes, but medical billers send out huge trumped charges to anyone and everyone just to see who they can get money out of. They don't and won't offer any kind of explanation. It's all about bringing in revenue, and there's little or no connection to actual service provided or to amounts legitimately owed.

If you're completely reasonable and say "Sure I'd be glad to promptly pay in full as soon as you completely explain precisely how these charges were calculated" the medical office will say "Now we're adding a 10% `asking too many questions' surcharge and pay right now or we're sending it to collections."

This is why it is now widely recognized that having someone claim you have an unpaid medical bill is approximately zero evidence that you are a person who ever fails to pay legitimate bills.

OP, this is the context you have to keep in mind. If you overpay up front it will be very difficult to get it back, since they'll view your overpayment as making up for someone else's underpayment. You have to get into the minds of these medical billing offices and realize how they think.
The "trumped up charges" are the actual fees of the office before insurance tells everyone what their allowed fee is. Be glad your doctors still agree to the discounted fees. As for your billing difficulties, remember this is because of YOUR 3rd party you bring into the mix. If you want someone else to pay for your care then they get to make the rules. As for "calculating" the fees, it's very simple....there is a CPT code for each procedure, and every CPT code has a fee. Ask for a "walkout statement".

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Re: Ob-Gyn requires prepayment of deductible for pregnancy services - is this typical?

Post by mikep » Sun Jun 07, 2015 2:33 pm

We have an HDHP and my wife's obgyn tried to do the same thing. The pregnancy overlapped calendar years so it also made planning difficult. In any case, I asked my insurer if they were allowed to do this and they said that no one is allowed to bill in advance for services per the provider's contract with the insurer. If they did this, they would be in violation of their contract with my insurer. The obgyn office checked with our insurer on the contract details and then backed down. We didn't pay a cent to anyone until after the delivery and the claims cycled through the insurance system.

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Re: Ob-Gyn requires prepayment of deductible for pregnancy services - is this typical?

Post by retiredjg » Sun Jun 07, 2015 2:41 pm

mikep wrote: In any case, I asked my insurer if they were allowed to do this and they said that no one is allowed to bill in advance for services per the provider's contract with the insurer. If they did this, they would be in violation of their contract with my insurer.
This is what I would have expected more people to say. I wonder if other people have just not asked?

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Re: Ob-Gyn requires prepayment of deductible for pregnancy services - is this typical?

Post by 8foot7 » Sun Jun 07, 2015 7:03 pm

toofache32 wrote:
The "trumped up charges" are the actual fees of the office before insurance tells everyone what their allowed fee is. Be glad your doctors still agree to the discounted fees. As for your billing difficulties, remember this is because of YOUR 3rd party you bring into the mix. If you want someone else to pay for your care then they get to make the rules. As for "calculating" the fees, it's very simple....there is a CPT code for each procedure, and every CPT code has a fee. Ask for a "walkout statement".
So a dose of Ibuprofen costs $400? Actual hospital charge. I think not.

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Re: Ob-Gyn requires prepayment of deductible for pregnancy services - is this typical?

Post by clutchied » Sun Jun 07, 2015 7:08 pm

for our PPO, No. 1st kid $200

for our HDHP? Yes. 2nd kid $3000.


having access to the best healthcare. I'm not sure you can really put a price on that.

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Re: Ob-Gyn requires prepayment of deductible for pregnancy services - is this typical?

Post by apc12 » Sun Jun 07, 2015 7:36 pm

Congratulations on your baby!

My wife and I went through a similar situation about 3 weeks ago. We are expecting our first and the physician group told us they would not continue to see us unless we either made payments on a payment plan or paid the total physician bill for a "normal delivery" upfront.

I attempted to negotiate and asked for a discount upfront by paying in full but they wouldn't hear it. That may be something to look into.

We are having the baby at the hospital where I am employed. The employer owns the insurance company. I called around to ask the other three large OB practices that use this hospital for deliveries and they told me that it is now a hospital policy, and subsequently a policy for all of the office groups, to require the patients to pay the physicians up front because so many people don't pay their bills.

In response to one of the above questions, I did ask what happens if we are out of state on vacation or something and have the baby at another hospital. They said they would refund us, but I'm not sure the speed at which that would occur of course.

I don't agree with it as we have now locked our delivery into a group of providers we have not really met yet, what if we don't like some of the MDs? But to answer your question this appears to be typical for a major city in North Carolina if that helps.

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Re: Ob-Gyn requires prepayment of deductible for pregnancy services - is this typical?

Post by bayview » Sun Jun 07, 2015 7:54 pm

toofache32 wrote:
555 wrote:
toofache32 wrote:As I said previously, this is a response to the huge number of patients that don't pay their bills after the fact. Certainly no Boglehead would do this, :oops: but this is the reality we are left with after so many deadbeats go through the system. Now everyone pays the price. If you don't like it, you should shop around for another provider. Again I ask, what is a better way for doctors to protect themselves (especially when the insurance company will not tell anyone up front how much they will pay)....they would love to hear alternatives.
Yes, but medical billers send out huge trumped charges to anyone and everyone just to see who they can get money out of. They don't and won't offer any kind of explanation. It's all about bringing in revenue, and there's little or no connection to actual service provided or to amounts legitimately owed.

If you're completely reasonable and say "Sure I'd be glad to promptly pay in full as soon as you completely explain precisely how these charges were calculated" the medical office will say "Now we're adding a 10% `asking too many questions' surcharge and pay right now or we're sending it to collections."

This is why it is now widely recognized that having someone claim you have an unpaid medical bill is approximately zero evidence that you are a person who ever fails to pay legitimate bills.

OP, this is the context you have to keep in mind. If you overpay up front it will be very difficult to get it back, since they'll view your overpayment as making up for someone else's underpayment. You have to get into the minds of these medical billing offices and realize how they think.
The "trumped up charges" are the actual fees of the office before insurance tells everyone what their allowed fee is. Be glad your doctors still agree to the discounted fees. As for your billing difficulties, remember this is because of YOUR 3rd party you bring into the mix. If you want someone else to pay for your care then they get to make the rules. As for "calculating" the fees, it's very simple....there is a CPT code for each procedure, and every CPT code has a fee. Ask for a "walkout statement".
OK, I object to the highlighted statement. Providers enter into contractual agreements with third party insurers, so please don't act as if we should be grateful for the "discounted fees", as if you are doing us some sort of favor. They are what you agreed to accept as payment when you accept patients with XYZ insurance and are thus a part of your cost of doing business. Consumers are responsible for finding out if their providers take XYZ insurance (and believe me, this isn't always easy to do), but once it's established that the provider does take that insurance plan, the provider must go along with the rules, just as the consumer must cough up any co-pays or deductibles.

I work in healthcare, and I know perfectly well how CPT code (and D-code) billing work. There's the silly money figure that is attached to each code, and there's the real-world payment in contrast. If you want to take only uninsured patients and try to collect what you bill per procedure code, good luck with that.

As a federal employee, I have to untangle the medical vs dental copays every year (thank you BCBS, not), but everyone gets paid in the end. I don't dodge my legitimate debts, and I don't appreciate being treated as a deadbeat.
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