Can dispute an expensive medical bill
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Can dispute an expensive medical bill
Our ophthalmologist retired last year and we tried a new practice. I had a routine eye exam covered by my Blue Cross Anthem vision insurance. Great experience.
However, the practice does not participate in husband's vision insurance network and he used his United health high deductible medical plan. He asked upfront how much it would cost specifically and was told it was $30. He went ahead and the dr. did ultrasound and front photography ?? on both eyes that after insurance adjustments cost $281.
Here we are: we had the service performed but obviously that was not we were looking for. Is it too late to dispute?
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Updates:
I called United again regarding vision benefit under medical plan. Somehow, the representative said United will pay for the bill. I suspect that some exams are considered as preventative tests and therefore zero deductibles.
I get lucky on this case. However, I still have not found a definitive route to dispute unwanted tests.
Is 281 expensive? To me, unwanted expenses are expensive regardless of absolute amounts:)
Last, I appreciate all the replies here (some sound very professional) that provide me a lot of different angles. Medical consumerism is the way to go.
However, the practice does not participate in husband's vision insurance network and he used his United health high deductible medical plan. He asked upfront how much it would cost specifically and was told it was $30. He went ahead and the dr. did ultrasound and front photography ?? on both eyes that after insurance adjustments cost $281.
Here we are: we had the service performed but obviously that was not we were looking for. Is it too late to dispute?
--------------------------
Updates:
I called United again regarding vision benefit under medical plan. Somehow, the representative said United will pay for the bill. I suspect that some exams are considered as preventative tests and therefore zero deductibles.
I get lucky on this case. However, I still have not found a definitive route to dispute unwanted tests.
Is 281 expensive? To me, unwanted expenses are expensive regardless of absolute amounts:)
Last, I appreciate all the replies here (some sound very professional) that provide me a lot of different angles. Medical consumerism is the way to go.
Last edited by Betterself on Fri Aug 25, 2017 8:30 am, edited 2 times in total.
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Re: Can dispute an expensive medical bill
You asked up front about the cost of that "routine eye exam", correct?Betterself wrote: ↑Thu Aug 24, 2017 2:10 pm Our ophthalmologist retired last year and we tried a new practice. I had a routine eye exam covered by my Blue Cross Anthem vision insurance. Great experience.
However, the practice does not participate in husband's vision insurance network and he used his United health high deductible medical plan. He asked upfront how much it would cost specifically and was told it was $30. He went ahead and the dr. did ultrasound and front photography ?? on both eyes that after insurance adjustments cost $281.
Here we are: we had the service performed but obviously that was not we were looking for. Is it too late to dispute?
Did you also ask about the price of these other scans before giving the OK for those?
RM
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Re: Can dispute an expensive medical bill
FYI, ultrasound and photos are not part of a routine eye exam. They're done for very specific reasons due to abnormalities found on a routine clinical exam. If your ophthalmologist says otherwise, you need to find a new doctor.
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Re: Can dispute an expensive medical bill
Sounds stupid but he assumed the routine exam included the services at that point.
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Re: Can dispute an expensive medical bill
Lesson learned.climber2020 wrote: ↑Thu Aug 24, 2017 2:19 pm FYI, ultrasound and photos are not part of a routine eye exam. They're done for very specific reasons due to abnormalities found on a routine clinical exam. If your ophthalmologist says otherwise, you need to find a new doctor.
What should we do now? can I still dispute the bill?
Re: Can dispute an expensive medical bill
Did they ask if he wanted the additional tests? Or just perform the additional tests as if they were part of the routine eye exam?Betterself wrote: ↑Thu Aug 24, 2017 2:22 pmLesson learned.climber2020 wrote: ↑Thu Aug 24, 2017 2:19 pm FYI, ultrasound and photos are not part of a routine eye exam. They're done for very specific reasons due to abnormalities found on a routine clinical exam. If your ophthalmologist says otherwise, you need to find a new doctor.
What should we do now? can I still dispute the bill?
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Re: Can dispute an expensive medical bill
Dr. just performed tests and my husband assumed these are included in routine exam. However, this is a she says he says situation.
Re: Can dispute an expensive medical bill
If your husband asked for routine eye exam and was quoted a price of $30 and the tests were provided with no further explanation as if they were part of the exam, I would ask for the charges to be waived.Betterself wrote: ↑Thu Aug 24, 2017 2:28 pmDr. just performed tests and my husband assumed these are included in routine exam. However, this is a she says he says situation.
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Re: Can dispute an expensive medical bill
But how? I talked to the lady there she said she could do nothing at this point. I am waiting for the office manager to call me back.
Re: Can dispute an expensive medical bill
Talk to the office manager. If no satisfaction over the phone, write a letter to the doctor. Don't pay the bill. So, it has been confirmed that the tests were actually performed and it wasn't just a mis-coding?Betterself wrote: ↑Thu Aug 24, 2017 2:35 pmBut how? I talked to the lady there she said she could do nothing at this point. I am waiting for the office manager to call me back.
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Re: Can dispute an expensive medical bill
Will do. Thanks for the advice. Tests were done.
Re: Can dispute an expensive medical bill
I would ask the reason that the tests were performed, since they would normally only be done as the result of some eye problem like cataracts. Before escalating make sure your husband wasn't told of some eye problem and didn't actually indicate permission.
Re: Can dispute an expensive medical bill
Typically a doctors office "should" inform you that additional tests aren't part of your visit and will cost extra but with the wide variety of plans and coverage the doctor may not know that. optometrists and dentists are usually pretty good about that. Medical doctors offices not as much. At this point it is either OP eating it or doctor eating costs. I'd ask for a "courtesy" given since you weren't told the charges were extra.rkhusky wrote: ↑Thu Aug 24, 2017 2:48 pmI would ask the reason that the tests were performed, since they would normally only be done as the result of some eye problem like cataracts. Before escalating make sure your husband wasn't told of some eye problem and didn't actually indicate permission.
Re: Can dispute an expensive medical bill
Definitely dispute it by saying that the additional costs were not told up front (but make sure that is the case!).
My eye doc always tells me which tests are going to cost more and which tests insurance will not (or even just may not) cover. This is why she gets my business every year. (well that plus she is just an awesome doc).
Think about the few thousand people the doc sees every year and gouging them by a couple hundred dollars of unneeded tests. Makes for a good bonus at the end of the year if only a few people complain about it.
My eye doc always tells me which tests are going to cost more and which tests insurance will not (or even just may not) cover. This is why she gets my business every year. (well that plus she is just an awesome doc).
Think about the few thousand people the doc sees every year and gouging them by a couple hundred dollars of unneeded tests. Makes for a good bonus at the end of the year if only a few people complain about it.
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Re: Can dispute an expensive medical bill
Oh dear lord. I am all for calling out other docs for inappropriate billing, but there is NOTHING wrong here. As long as you had the routine eye exam for x dollars that was discussed in advance nothing wrong was done. My guess is during the routine exam the doc. said something like, "Looks like something is off' or "I see something there and we need to do more". Your spouse said yes or even allowed it without saying no (which legally means yes). He had the extra done and now you want to get out of paying for it. Just man up and pay for what was done. If you want to have full control you have it. Just say no next time. Of course, then you may get billed for another office visit again. But that is your choice.Betterself wrote: ↑Thu Aug 24, 2017 2:22 pmLesson learned.climber2020 wrote: ↑Thu Aug 24, 2017 2:19 pm FYI, ultrasound and photos are not part of a routine eye exam. They're done for very specific reasons due to abnormalities found on a routine clinical exam. If your ophthalmologist says otherwise, you need to find a new doctor.
What should we do now? can I still dispute the bill?
Who in the WORLD thinks getting an ultrasound done is a "routine" thing?? Think about ALL the eye exams you have done in your life did ever include an ultrasound? Nope. That should have been pretty common sense based on having a lifetime of eye exams done up to this point in your life.
Good luck.
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Re: Can dispute an expensive medical bill
There are unfortunately a lot of doctors who do unnecessary tests on every single patient they see regardless of whether or not they legitimately need them. We have a few of those here where I live. A lot of patients don't know; they have no medical training and put their trust in the professional to do the right thing. Which is a problem when the doctor is an unethical bum.staythecourse wrote: ↑Thu Aug 24, 2017 3:12 pm
Oh dear lord. I am all for calling out other docs for inappropriate billing, but there is NOTHING wrong here. As long as you had the routine eye exam for x dollars that was discussed in advance nothing wrong was done. My guess is during the routine exam the doc. said something like, "Looks like something is off' or "I see something there and we need to do more". Your spouse said yes or even allowed it without saying no (which legally means yes). He had the extra done and now you want to get out of paying for it. Just man up and pay for what was done. If you want to have full control you have it. Just say no next time. Of course, then you may get billed for another office visit again. But that is your choice.
Who in the WORLD thinks getting an ultrasound done is a "routine" thing?? Think about ALL the eye exams you have done in your life did ever include an ultrasound? Nope. That should have been pretty common sense based on having a lifetime of eye exams done up to this point in your life.
Good luck.
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Re: Can dispute an expensive medical bill
No argument here. There are terrible and/ or unethical doctors just like in any occupation. If that happens just call the state medical board and file a complaint. They will investigate it and will let you know if there is anything wrong with what he/ she is doing.climber2020 wrote: ↑Thu Aug 24, 2017 3:24 pmThere are unfortunately a lot of doctors who do unnecessary tests on every single patient they see regardless of whether or not they legitimately need them. We have a few of those here where I live. A lot of patients don't know; they have no medical training and put their trust in the professional to do the right thing. Which is a problem when the doctor is an unethical bum.staythecourse wrote: ↑Thu Aug 24, 2017 3:12 pm
Oh dear lord. I am all for calling out other docs for inappropriate billing, but there is NOTHING wrong here. As long as you had the routine eye exam for x dollars that was discussed in advance nothing wrong was done. My guess is during the routine exam the doc. said something like, "Looks like something is off' or "I see something there and we need to do more". Your spouse said yes or even allowed it without saying no (which legally means yes). He had the extra done and now you want to get out of paying for it. Just man up and pay for what was done. If you want to have full control you have it. Just say no next time. Of course, then you may get billed for another office visit again. But that is your choice.
Who in the WORLD thinks getting an ultrasound done is a "routine" thing?? Think about ALL the eye exams you have done in your life did ever include an ultrasound? Nope. That should have been pretty common sense based on having a lifetime of eye exams done up to this point in your life.
Good luck.
Good luck.
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Re: Can dispute an expensive medical bill
If additional costs weren't disclosed it was not informed consent. I would ask that they waive it or I'd file a complaint with the governing board.
Re: Can dispute an expensive medical bill
I would be suspicious of an ophthalmologist that charges only $30 for a routine exam. My ophthalmologist billed my medicare advantage plan $120 and they paid the $85.50 that medicare allows for a routine exam.
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Re: Can dispute an expensive medical bill
This is only useful if the doctor owns the practice which is getting more and more rare these days. I had a patient call me recently to complain about a bill after I treated him through my clinic job where I am an employee just like the front desk lady. I'm not sure why he thought I had anything to do with the billing. I told him I'm like an Airline Pilot....I fly the plane but I certainly don't own it or have any say in ticket prices.rkhusky wrote: ↑Thu Aug 24, 2017 2:40 pmTalk to the office manager. If no satisfaction over the phone, write a letter to the doctor. Don't pay the bill. So, it has been confirmed that the tests were actually performed and it wasn't just a mis-coding?Betterself wrote: ↑Thu Aug 24, 2017 2:35 pmBut how? I talked to the lady there she said she could do nothing at this point. I am waiting for the office manager to call me back.
Re: Can dispute an expensive medical bill
Seems like most people want to jump to the conclusion that the doctor must simply be unethical and even an unethical bum. Why does everyone presume the doctor made a mistake. Perhaps the front staff made a mistake on the specifics of the particular insurance company. Vision insurance and medical eye care have significant quirks on what is covered on a "vision" plan and what is covered on a "medical" plan. Maybe the front staff made a mistake on the insurance coverage / what's not covered, etc. Insurance is a complex maze and I think people often expect healthcare offices to specifically know every single quirk to one's particular insurance with all the variations that often come with insurance coverages/co-payments, individual/family deductibles etc. Know my mom's eye exam has a separate charge (usually about $30) for the actual glasses check (refraction) as it's not a covered service from Medicare, and is charged for additional retinal scans for legitimate reasons. Maybe the doctor wasn't an unethical bum, but instead had been an outstanding doctor having additional tests done to help further evaluate for things like glaucoma / macular degeneration using the latest scanning technology because he/she felt it was in the patient's best interest? Maybe the doctor before this exam should or could of considered these additional tests. I doubt the doctor him/herself was scrutinizing the patient's insurance plan to figure out how he/she could milk the patient for every last dollar, but more likely doing testing he/she felt was actually in the patient's best interest. Maybe there was poor communication on why tests were felt needed, or maybe there was poor understanding from the patient? Sure, there can always be a possibility of the doctor being an unethical bum, but strange how many jump to that opinion.climber2020 wrote: ↑Thu Aug 24, 2017 3:24 pmThere are unfortunately a lot of doctors who do unnecessary tests on every single patient they see regardless of whether or not they legitimately need them. We have a few of those here where I live. A lot of patients don't know; they have no medical training and put their trust in the professional to do the right thing. Which is a problem when the doctor is an unethical bum.staythecourse wrote: ↑Thu Aug 24, 2017 3:12 pm
Oh dear lord. I am all for calling out other docs for inappropriate billing, but there is NOTHING wrong here. As long as you had the routine eye exam for x dollars that was discussed in advance nothing wrong was done. My guess is during the routine exam the doc. said something like, "Looks like something is off' or "I see something there and we need to do more". Your spouse said yes or even allowed it without saying no (which legally means yes). He had the extra done and now you want to get out of paying for it. Just man up and pay for what was done. If you want to have full control you have it. Just say no next time. Of course, then you may get billed for another office visit again. But that is your choice.
Who in the WORLD thinks getting an ultrasound done is a "routine" thing?? Think about ALL the eye exams you have done in your life did ever include an ultrasound? Nope. That should have been pretty common sense based on having a lifetime of eye exams done up to this point in your life.
Good luck.
You can take the statement quoted above and make some small changes and you get:
"There are unfortunately a lot of FILL IN THE JOB/PROFESSION who do unnecessary TESTS/SERVICES on every single CUSTOMER/CLIENT they see regardless of whether or not they legitimately need them. We have a few of those here where I live. A lot of CUSTOMERS don't know; they have no FILL IN TYPE OF SERVICE training and put their trust in the professional to do the right thing. Which is a problem when the FILL IN THE JOB/PROFESSION is an unethical bum".
Feel free to put in one's profession in the above.
Is there just a disdain for doctors/healthcare providers on this site?
My advice, go talk to the office/billing department for clarification. Also, personally call your insurance company (a long process typically) and ask for actual clarification about one's insurance coverage before you get any healthcare.
Re: Can dispute an expensive medical bill
Yes, this site is surprisingly hostile to physicians. The only occupation more derided on this website than physicians are whole life insurance salesmen. I'm not even sure why this site continues to allow any discussion about healthcare costs or charges at physician offices since they all end up in the same place.IMO wrote: ↑Thu Aug 24, 2017 11:35 pmSeems like most people want to jump to the conclusion that the doctor must simply be unethical and even an unethical bum. Why does everyone presume the doctor made a mistake. Perhaps the front staff made a mistake on the specifics of the particular insurance company. Vision insurance and medical eye care have significant quirks on what is covered on a "vision" plan and what is covered on a "medical" plan. Maybe the front staff made a mistake on the insurance coverage / what's not covered, etc. Insurance is a complex maze and I think people often expect healthcare offices to specifically know every single quirk to one's particular insurance with all the variations that often come with insurance coverages/co-payments, individual/family deductibles etc. Know my mom's eye exam has a separate charge (usually about $30) for the actual glasses check (refraction) as it's not a covered service from Medicare. Maybe the doctor wasn't an unethical bum, but instead had been an outstanding doctor having additional tests done to help further evaluate for things like glaucoma / macular degeneration using the latest scanning technology because he/she felt it was in the patient's best interest? Maybe the doctor before this exam should or could of considered these additional tests. I doubt the doctor him/herself was scrutinizing the patient's insurance plan to figure out how he/she could milk the patient for every last dollar, but more likely doing testing he/she felt was actually in the patient's best interest. Maybe there was poor communication on why tests were felt needed, or maybe there was poor understanding from the patient? Sure, there can always be a possibility of the doctor being an unethical bum, but strange how many jump to that opinion.climber2020 wrote: ↑Thu Aug 24, 2017 3:24 pmThere are unfortunately a lot of doctors who do unnecessary tests on every single patient they see regardless of whether or not they legitimately need them. We have a few of those here where I live. A lot of patients don't know; they have no medical training and put their trust in the professional to do the right thing. Which is a problem when the doctor is an unethical bum.staythecourse wrote: ↑Thu Aug 24, 2017 3:12 pm
Oh dear lord. I am all for calling out other docs for inappropriate billing, but there is NOTHING wrong here. As long as you had the routine eye exam for x dollars that was discussed in advance nothing wrong was done. My guess is during the routine exam the doc. said something like, "Looks like something is off' or "I see something there and we need to do more". Your spouse said yes or even allowed it without saying no (which legally means yes). He had the extra done and now you want to get out of paying for it. Just man up and pay for what was done. If you want to have full control you have it. Just say no next time. Of course, then you may get billed for another office visit again. But that is your choice.
Who in the WORLD thinks getting an ultrasound done is a "routine" thing?? Think about ALL the eye exams you have done in your life did ever include an ultrasound? Nope. That should have been pretty common sense based on having a lifetime of eye exams done up to this point in your life.
Good luck.
You can take the statement quoted above and make some small changes and you get:
"There are unfortunately a lot of FILL IN THE JOB/PROFESSION who do unnecessary TESTS/SERVICES on every single CUSTOMER/CLIENT they see regardless of whether or not they legitimately need them. We have a few of those here where I live. A lot of CUSTOMERS don't know; they have no FILL IN TYPE OF SERVICE training and put their trust in the professional to do the right thing. Which is a problem when the FILL IN THE JOB/PROFESSION is an unethical bum".
Feel free to put in one's profession in the above.
Is there just a disdain for doctors/healthcare providers on this site?
My advice, go talk to the office/billing department for clarification. Also, personally call your insurance company (a long process typically) and ask for actual clarification about one's insurance coverage before you get any healthcare.
Re: Can dispute an expensive medical bill
I think this is really a problem that is quite specific to the medical industry - the fact that the real cost for the patients is often not known before or at time of service. This simply should not be legal except in case of emergency when someone is unconscious or the situation is very time-critical, and it's not possible to wait on patient to sign up and agree to costs.Erwin007 wrote: ↑Thu Aug 24, 2017 11:51 pm Yes, this site is surprisingly hostile to physicians. The only occupation more derided on this website than physicians are whole life insurance salesmen. I'm not even sure why this site continues to allow any discussion about healthcare costs or charges at physician offices since they all end up in the same place.
One can debate all day long whether it's the fault of physicians, providers, or insurance companies. But one thing is for certain, this sort of problem isn't the fault of the patient.
Re: Can dispute an expensive medical bill
I can confirm three things:
1) I have never had an ultrasound done on my eye
2) No doctor would perform an ultrasound without asking for my permission first.
3) Routine eye exams don't cost $30.
1) I have never had an ultrasound done on my eye
2) No doctor would perform an ultrasound without asking for my permission first.
3) Routine eye exams don't cost $30.
Re: Can dispute an expensive medical bill
$30 is about what I get charged for a prescription for glasses.
I can't imagine assuming an ultrasound is part of any routine exam.
I can't imagine assuming an ultrasound is part of any routine exam.
Re: Can dispute an expensive medical bill
Expensive?? $281 sounds like a bargain for the services received.
Re: Can dispute an expensive medical bill
Agreed. Methinks the OP needs to redefine what an expensive medical bill really is.
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Re: Can dispute an expensive medical bill
These days, any amount of money is too much. Someone complains regardless.
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Re: Can dispute an expensive medical bill
Exactly the reason I am a specialist not in-network with ANY medical insurance in my private practice. Insurance patients are the most entitled bunch and forget that it's THEIR insurance, not the doctors. Argue over copays they agreed to. Now I practice how it should be....it's YOUR insurance company so therefore it's YOUR fight to get reimbursed by your blessed insurance company. The PATIENT is their customer, not me.Erwin007 wrote: ↑Thu Aug 24, 2017 11:51 pmYes, this site is surprisingly hostile to physicians. The only occupation more derided on this website than physicians are whole life insurance salesmen. I'm not even sure why this site continues to allow any discussion about healthcare costs or charges at physician offices since they all end up in the same place.IMO wrote: ↑Thu Aug 24, 2017 11:35 pmSeems like most people want to jump to the conclusion that the doctor must simply be unethical and even an unethical bum. Why does everyone presume the doctor made a mistake. Perhaps the front staff made a mistake on the specifics of the particular insurance company. Vision insurance and medical eye care have significant quirks on what is covered on a "vision" plan and what is covered on a "medical" plan. Maybe the front staff made a mistake on the insurance coverage / what's not covered, etc. Insurance is a complex maze and I think people often expect healthcare offices to specifically know every single quirk to one's particular insurance with all the variations that often come with insurance coverages/co-payments, individual/family deductibles etc. Know my mom's eye exam has a separate charge (usually about $30) for the actual glasses check (refraction) as it's not a covered service from Medicare. Maybe the doctor wasn't an unethical bum, but instead had been an outstanding doctor having additional tests done to help further evaluate for things like glaucoma / macular degeneration using the latest scanning technology because he/she felt it was in the patient's best interest? Maybe the doctor before this exam should or could of considered these additional tests. I doubt the doctor him/herself was scrutinizing the patient's insurance plan to figure out how he/she could milk the patient for every last dollar, but more likely doing testing he/she felt was actually in the patient's best interest. Maybe there was poor communication on why tests were felt needed, or maybe there was poor understanding from the patient? Sure, there can always be a possibility of the doctor being an unethical bum, but strange how many jump to that opinion.climber2020 wrote: ↑Thu Aug 24, 2017 3:24 pmThere are unfortunately a lot of doctors who do unnecessary tests on every single patient they see regardless of whether or not they legitimately need them. We have a few of those here where I live. A lot of patients don't know; they have no medical training and put their trust in the professional to do the right thing. Which is a problem when the doctor is an unethical bum.staythecourse wrote: ↑Thu Aug 24, 2017 3:12 pm
Oh dear lord. I am all for calling out other docs for inappropriate billing, but there is NOTHING wrong here. As long as you had the routine eye exam for x dollars that was discussed in advance nothing wrong was done. My guess is during the routine exam the doc. said something like, "Looks like something is off' or "I see something there and we need to do more". Your spouse said yes or even allowed it without saying no (which legally means yes). He had the extra done and now you want to get out of paying for it. Just man up and pay for what was done. If you want to have full control you have it. Just say no next time. Of course, then you may get billed for another office visit again. But that is your choice.
Who in the WORLD thinks getting an ultrasound done is a "routine" thing?? Think about ALL the eye exams you have done in your life did ever include an ultrasound? Nope. That should have been pretty common sense based on having a lifetime of eye exams done up to this point in your life.
Good luck.
You can take the statement quoted above and make some small changes and you get:
"There are unfortunately a lot of FILL IN THE JOB/PROFESSION who do unnecessary TESTS/SERVICES on every single CUSTOMER/CLIENT they see regardless of whether or not they legitimately need them. We have a few of those here where I live. A lot of CUSTOMERS don't know; they have no FILL IN TYPE OF SERVICE training and put their trust in the professional to do the right thing. Which is a problem when the FILL IN THE JOB/PROFESSION is an unethical bum".
Feel free to put in one's profession in the above.
Is there just a disdain for doctors/healthcare providers on this site?
My advice, go talk to the office/billing department for clarification. Also, personally call your insurance company (a long process typically) and ask for actual clarification about one's insurance coverage before you get any healthcare.
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Re: Can dispute an expensive medical bill
DELETED prior (just saw OPs update).
I've had cases whereby routine vision exam is covered under a "Vision" part of a policy while other work is covered under a "Medical" part of a policy and sometimes the two sides inside of a insurance company aren't talking to each other if a particular procedure lands in claims on the wrong side of the line. Perhaps that is what happened here and why they are now covering it.
I've had cases whereby routine vision exam is covered under a "Vision" part of a policy while other work is covered under a "Medical" part of a policy and sometimes the two sides inside of a insurance company aren't talking to each other if a particular procedure lands in claims on the wrong side of the line. Perhaps that is what happened here and why they are now covering it.
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Re: Can dispute an expensive medical bill
Yes, you were quoted $30.Betterself wrote: ↑Thu Aug 24, 2017 2:10 pm Is 281 expensive? To me, unwanted expenses are expensive regardless of absolute amounts:)
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Re: Can dispute an expensive medical bill
OK, time to douse the torches and return the pitchforks to the barns!DaftInvestor wrote: ↑Fri Aug 25, 2017 8:37 am DELETED prior (just saw OPs update).
I've had cases whereby routine vision exam is covered under a "Vision" part of a policy while other work is covered under a "Medical" part of a policy and sometimes the two sides inside of a insurance company aren't talking to each other if a particular procedure lands in claims on the wrong side of the line. Perhaps that is what happened here and why they are now covering it.
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Re: Can dispute an expensive medical bill
Actually, I think it IS their fault. Mind you I am not only a physician, but a patient as well when my wife, I, or my kids go to the doctor so I am saying this unbiased as I am on both sides of the argument. Folks think doctors don't understand which is ridiculous since they are patients through the same healthcare system as well.
The PATIENT is the one who has the insurance and not the physician so it is THEIR responsibility to pay all bills. Unless, it is an emergency situation then one ALWAYS has the option of saying, "Is this extra beyond what I was already quoted for XYZ?" If it is just say no, leave the office, find out the billing codes for whatever they want to do, call your insurance, and then decide if you want to pay the cost. The reason it is not done is: 1. You will have to pay another copay again, 2. You waste time and folks want things all done ASAP, and 3. It is a lot of work and no one wants to do extra work.
Folks may say that is not fair, but then is it fair to the provider to do this work for you? They certainly don't get paid for it and in fact they would lose money as they are paying those employees for extra work that is not generating revenue. So is one advocating a private business should do work for free?
In the end it is YOUR health, YOUR Insurance, and YOUR consent that get xyz done by physician. So if it is not the responsibility of the patient then whose is it? There is NO POINT arguing if it is a bad system. Doctors and patients alike would agree. The difference is that patients actually think it is the doctor who is making it opaque. It is the insurance company and legislative laws. If you don't like it either: 1. Write to your congressman or 2. Vote with your feet and get care done outside the U.S. where it is out of pocket and you pay X for Y service.
What is NOT right is to get a service done and then post on a forum on how to get out of paying for it. That is just sad.
Good luck.
"The stock market [fluctuation], therefore, is noise. A giant distraction from the business of investing.” |
-Jack Bogle
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Re: Can dispute an expensive medical bill
I scanned some of the replies above on both sides of the issue.
First, it may well be that the receptionist quoted incorrectly.Typically, $30-40 is the price for the refraction, the measurement of a spectacle prescription. Most people think that this and a quick look at the eye with a light is a "routine eye exam". It is not.
Now there are "glasses places", which advertise low prices, but I think even Costco charges about $60 for their optometrist eye exam. So the initial quote was poor information, sounds like maybe the front desk person is not making things clear. You can't get an exam from an ophthalmologist, to rule out disease, including a dilated examination, and a measurement for glasses for $30. Just think how much office time it takes for some people to decide "which is better, lens one or lens 2?"
As far as additional tests, you could look on the insurance adjustment form you received (even though you paid, I know, having a high deductible, that the one advantage is that the insurance company still reprices all fees, so people yelling about a $4000 surgeon bill for a hernia, never also mention that the insurance company knocked it down to $1500). The form will have codes for the disease suspected or noted. Maybe the optic nerve looked suspicious for glaucoma, or the retina looked suspicious for macular degeneration. The ultrasound and other tests would help distinguish.
Certainly the problem often is that in some offices, the doctor does not explain why the tests are being done, what he/she suspects,why it is recommended. Then at that point you can ask if it is covered by insurance. No doctor can guarantee that, but they can give you an idea. In the end, don't expect the doctor to be on the hook for the test. If you don't want to pay, he/she can document refusal in the chart, and will then not be liable if indeed there was a disease process suspected.
Having said that, I know that in many offices, primarily optometry I am sad to say, patients get photos of their retina, or visual field tests as a matter of routine, and these are added to the "routine eye exam fee". So often these offices participate in many low priced vision plans, which cover the glasses measurement part, but then the exam gets tests added as a matter of routine and these tests are then billed on the medical part of your insurance,or you pay if deductible not met.
Bottom line, call the doctors office, be nice, ask for explanation of the reason for the tests, ie what the doctor suspected. Don't be prosecutorial, it never gets you anywhere. You don't know that you have been ripped off, call with an open inquiring mind and maybe you will get an answer. If you are not satisfied, just get copies of the tests and find another ophthalmologist.
First, it may well be that the receptionist quoted incorrectly.Typically, $30-40 is the price for the refraction, the measurement of a spectacle prescription. Most people think that this and a quick look at the eye with a light is a "routine eye exam". It is not.
Now there are "glasses places", which advertise low prices, but I think even Costco charges about $60 for their optometrist eye exam. So the initial quote was poor information, sounds like maybe the front desk person is not making things clear. You can't get an exam from an ophthalmologist, to rule out disease, including a dilated examination, and a measurement for glasses for $30. Just think how much office time it takes for some people to decide "which is better, lens one or lens 2?"
As far as additional tests, you could look on the insurance adjustment form you received (even though you paid, I know, having a high deductible, that the one advantage is that the insurance company still reprices all fees, so people yelling about a $4000 surgeon bill for a hernia, never also mention that the insurance company knocked it down to $1500). The form will have codes for the disease suspected or noted. Maybe the optic nerve looked suspicious for glaucoma, or the retina looked suspicious for macular degeneration. The ultrasound and other tests would help distinguish.
Certainly the problem often is that in some offices, the doctor does not explain why the tests are being done, what he/she suspects,why it is recommended. Then at that point you can ask if it is covered by insurance. No doctor can guarantee that, but they can give you an idea. In the end, don't expect the doctor to be on the hook for the test. If you don't want to pay, he/she can document refusal in the chart, and will then not be liable if indeed there was a disease process suspected.
Having said that, I know that in many offices, primarily optometry I am sad to say, patients get photos of their retina, or visual field tests as a matter of routine, and these are added to the "routine eye exam fee". So often these offices participate in many low priced vision plans, which cover the glasses measurement part, but then the exam gets tests added as a matter of routine and these tests are then billed on the medical part of your insurance,or you pay if deductible not met.
Bottom line, call the doctors office, be nice, ask for explanation of the reason for the tests, ie what the doctor suspected. Don't be prosecutorial, it never gets you anywhere. You don't know that you have been ripped off, call with an open inquiring mind and maybe you will get an answer. If you are not satisfied, just get copies of the tests and find another ophthalmologist.
- eye.surgeon
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Re: Can dispute an expensive medical bill
I'm an ophthalmologist. A few thoughts...
1. If I see an abnormality on your routine eye exam, I will do an appropriate test. No, my secretary didn't predict in her crystal ball that you would need it. But you do. Immediately assuming that your doctor is somehow scamming you is a bit of a leap. I have more government agencies than I can count poring through your chart looking for the slightest error, you think I'm going to risk my practice and compromise my integrity for a $40 test? I'm trying to help you and at the same time keep you from suing me for missing your glaucoma.
2. Choosing to see a doctor outside of your insurance network is your decision and your responsibility, not the doctors.
3. If you're looking for a $30 exam, there's probably a wal-mart near you.
4. You chose a high-deductible plan. Presumably you did this because you prefer lower premiums to lower deductibles. FYI-- you will have high deductibles with a high deductible plan. Remember that euphoric feeling when you got that low premium bill in the mail? Save up that feeling for when you pay high co-pays.
1. If I see an abnormality on your routine eye exam, I will do an appropriate test. No, my secretary didn't predict in her crystal ball that you would need it. But you do. Immediately assuming that your doctor is somehow scamming you is a bit of a leap. I have more government agencies than I can count poring through your chart looking for the slightest error, you think I'm going to risk my practice and compromise my integrity for a $40 test? I'm trying to help you and at the same time keep you from suing me for missing your glaucoma.
2. Choosing to see a doctor outside of your insurance network is your decision and your responsibility, not the doctors.
3. If you're looking for a $30 exam, there's probably a wal-mart near you.
4. You chose a high-deductible plan. Presumably you did this because you prefer lower premiums to lower deductibles. FYI-- you will have high deductibles with a high deductible plan. Remember that euphoric feeling when you got that low premium bill in the mail? Save up that feeling for when you pay high co-pays.
"I would rather be certain of a good return than hopeful of a great one" |
Warren Buffett
Re: Can dispute an expensive medical bill
IMO the responsibility goes both ways - it's not only the patient who should ask if a procedure is extra, but a provider that should disclose that fact as well.staythecourse wrote: ↑Fri Aug 25, 2017 11:41 am The PATIENT is the one who has the insurance and not the physician so it is THEIR responsibility to pay all bills. Unless, it is an emergency situation then one ALWAYS has the option of saying, "Is this extra beyond what I was already quoted for XYZ?" If it is just say no, leave the office, find out the billing codes for whatever they want to do, call your insurance, and then decide if you want to pay the cost. The reason it is not done is: 1. You will have to pay another copay again, 2. You waste time and folks want things all done ASAP, and 3. It is a lot of work and no one wants to do extra work.
Many (if not most) providers have contracts with the insurance company also, so it's not just the patient who has the insurance.
I'm not advocating anyone do anything for free, only that there needs to be price transparency upfront. Surely that is no the only way. See below.Folks may say that is not fair, but then is it fair to the provider to do this work for you? They certainly don't get paid for it and in fact they would lose money as they are paying those employees for extra work that is not generating revenue. So is one advocating a private business should do work for free?
Somehow, my Kaiser HMO has figured out how to do all that I'm asking properly. Fixed copays are always disclosed and paid upfront for any medical procedure when I go into the doctor's office, pharmacy, surgeon, lab, injection clinic, imaging , you name it. There is no billing surprise later on.In the end it is YOUR health, YOUR Insurance, and YOUR consent that get xyz done by physician. So if it is not the responsibility of the patient then whose is it? There is NO POINT arguing if it is a bad system. Doctors and patients alike would agree. The difference is that patients actually think it is the doctor who is making it opaque. It is the insurance company and legislative laws. If you don't like it either: 1. Write to your congressman or 2. Vote with your feet and get care done outside the U.S. where it is out of pocket and you pay X for Y service.
What is NOT right is to get a service done and then post on a forum on how to get out of paying for it. That is just sad.
Good luck.
Oh, and they will reimburse me for emergency medical expenses abroad, too (and have, many times).
Re: Can dispute an expensive medical bill
That still requires current information to be available about who is in the network and who is not.eye.surgeon wrote: ↑Fri Aug 25, 2017 3:42 pm 2. Choosing to see a doctor outside of your insurance network is your decision and your responsibility, not the doctors.
The information from both providers and insurance companies is sometimes not correct. It also changes over time, and many times one is not informed of the change. For example, I have been seeing a dentist who was in my network for years. Suddenly, it wasn't. How did I find out ? Through an EOB. Not because either insurance company nor the provider notified me of the change in their contracts.
At least for medical procedures, I know anytime I go into a Kaiser medical office, the provider is in network. Never a surprise there.
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Re: Can dispute an expensive medical bill
madbrain wrote: ↑Fri Aug 25, 2017 5:58 pm
Many (if not most) providers have contracts with the insurance company also, so it's not just the patient who has the insurance.
I think that is the genuine misconception on the patient's part. I am not sure what they think the contract is the physician has with the insurance company. The contract is for Physician A to charge X amount for visit/ procedure Y to any patient with that insurer. That is it. There is NOTHING in it that says you have to get the pricing of x, y, or z for the patient. That is NOT the responsibility of the physician or their office. IF they do it they are just trying to be nice, but it is NOT the expectation or the law or part of our contracts.
I do agree, as I have ALWAYS agreed, that price transparency SHOULD be there. But have NO CLUE why the patients would think it is because of the physicians. It is SOLELY due to legislature coming up with their regulations and health care laws AND/ OR the insurers.
I have NEVER/ RARELY ever seen a comment on this board (which is made up of likely as intelligent of a group of folks you will find on any forum) ever blame the system on the insurers or their congressman, but PLENTY of comments on blaming the physician for stuff that is NOT their responsibility.
Good luck.
"The stock market [fluctuation], therefore, is noise. A giant distraction from the business of investing.” |
-Jack Bogle
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Re: Can dispute an expensive medical bill
I think that is the genuine misconception on the patient's part. I am not sure what they think the contract is the physician has with the insurance company. The contract is for Physician A to charge X amount for visit/ procedure Y to any patient with that insurer. That is it. There is NOTHING in it that says you have to get the pricing of x, y, or z for the patient. That is NOT the responsibility of the physician or their office. IF they do it they are just trying to be nice, but it is NOT the expectation or the law or part of our contracts.madbrain wrote: ↑Fri Aug 25, 2017 5:58 pmIMO the responsibility goes both ways - it's not only the patient who should ask if a procedure is extra, but a provider that should disclose that fact as well.staythecourse wrote: ↑Fri Aug 25, 2017 11:41 am The PATIENT is the one who has the insurance and not the physician so it is THEIR responsibility to pay all bills. Unless, it is an emergency situation then one ALWAYS has the option of saying, "Is this extra beyond what I was already quoted for XYZ?" If it is just say no, leave the office, find out the billing codes for whatever they want to do, call your insurance, and then decide if you want to pay the cost. The reason it is not done is: 1. You will have to pay another copay again, 2. You waste time and folks want things all done ASAP, and 3. It is a lot of work and no one wants to do extra work.
Many (if not most) providers have contracts with the insurance company also, so it's not just the patient who has the insurance.
I'm not advocating anyone do anything for free, only that there needs to be price transparency upfront. Surely that is no the only way. See below.Folks may say that is not fair, but then is it fair to the provider to do this work for you? They certainly don't get paid for it and in fact they would lose money as they are paying those employees for extra work that is not generating revenue. So is one advocating a private business should do work for free?
Somehow, my Kaiser HMO has figured out how to do all that I'm asking properly. Fixed copays are always disclosed and paid upfront for any medical procedure when I go into the doctor's office, pharmacy, surgeon, lab, injection clinic, imaging , you name it. There is no billing surprise later on.In the end it is YOUR health, YOUR Insurance, and YOUR consent that get xyz done by physician. So if it is not the responsibility of the patient then whose is it? There is NO POINT arguing if it is a bad system. Doctors and patients alike would agree. The difference is that patients actually think it is the doctor who is making it opaque. It is the insurance company and legislative laws. If you don't like it either: 1. Write to your congressman or 2. Vote with your feet and get care done outside the U.S. where it is out of pocket and you pay X for Y service.
What is NOT right is to get a service done and then post on a forum on how to get out of paying for it. That is just sad.
Good luck.
Oh, and they will reimburse me for emergency medical expenses abroad, too (and have, many times).
I do agree, as I have ALWAYS agreed, that price transparency SHOULD be there. But have NO CLUE why the patients would think it is because of the physicians. It is SOLELY due to legislature coming up with their regulations and health care laws AND/ OR the insurers.
I have NEVER/ RARELY ever seen a comment on this board (which is made up of likely as intelligent of a group of folks you will find on any forum) ever blame the system on the insurers or their congressman, but PLENTY of comments on blaming the physician for stuff that is NOT their responsibility.
To answer your Kaiser question they are an HMO and are THEIR OWN insurer. So when you go there it is like going directly to BCBS or Humana or Cigna and asking them for their rates. That is my point go to your insurer and ask. All of the folks who go to Kaiser HAVE to go to Kaiser (is my understanding). That is not a good thing. My aunt was just diagnosed with breast cancer and their system and treatment plan is HORRIBLE and a complete joke to what the "normal" is anywhere else. Guess why? To control cost. The biggest problem is she doesn't even know any better because she can't go out of the system. Don't assume price transparency and cheaper cost is BETTER or more efficient care.
Good luck.
"The stock market [fluctuation], therefore, is noise. A giant distraction from the business of investing.” |
-Jack Bogle
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Re: Can dispute an expensive medical bill
I agree totally with the doctor here. Except to qualify on point #4, one of the great benefits of a high deductible plan is that if it is with a major insurance company, most physicians accept that insurance (sometimes signed "take it or leave it" contracts, or they agree to be a provider for United, Humana or another because, unfortunately, their competitors have already done it, ie "herd mentality").eye.surgeon wrote: ↑Fri Aug 25, 2017 3:42 pm I'm an ophthalmologist. A few thoughts...
1. If I see an abnormality on your routine eye exam, I will do an appropriate test. No, my secretary didn't predict in her crystal ball that you would need it. But you do. Immediately assuming that your doctor is somehow scamming you is a bit of a leap. I have more government agencies than I can count poring through your chart looking for the slightest error, you think I'm going to risk my practice and compromise my integrity for a $40 test? I'm trying to help you and at the same time keep you from suing me for missing your glaucoma.
2. Choosing to see a doctor outside of your insurance network is your decision and your responsibility, not the doctors.
3. If you're looking for a $30 exam, there's probably a wal-mart near you.
4. You chose a high-deductible plan. Presumably you did this because you prefer lower premiums to lower deductibles. FYI-- you will have high deductibles with a high deductible plan. Remember that euphoric feeling when you got that low premium bill in the mail? Save up that feeling for when you pay high co-pays.
So whether you have a high or low deductble plan, the "sticker price" charges from the doctor or hospital are often reduced or in insurance lingo "repriced",and the insurance payment of, say 80% of the repriced fee is made, and you are responsible for say,20%. So in an example, you get a bill from the hospital for a knee replacement, and the sticker price total is $40,000 (you think that is outrageous, remember that the hospital is providing tons of unnpaid care to people walking in off the street, or the "undocumented" who lost their way somehow at the border and are in UCSan Diego ER with an illness. You are paying for that). The sticker price gets cut to maybe $18,000, the insurance pays 80% of that, or $14,400, and you are responsible for the balance of $5600. Now if you have an annual $2000 deductible not yet satisfied,the insurance in this case will pay $16,000 and you pay $7600, and the latter is deductible, so if you are in the 25% tax bracket, you actually are paying $5500, since you save $1900 in taxes.
With that deal I will take the high deductible any day. Remember though that the physician is not required to sign with any insurance company, his/her relationship is with you only, if they don't participate in an insurance plan you have. It is your responsibility, not theirs, to make sure you are insured, or in some cases,you may be willing to pay on your own if you want a certain physician.
Get a Health Savings Account,you deduct the contributions, invest them tax deferred, and pay the high deductible if you wish from that fund.HSA funds can be withdrawn tax free to pay deductibles, but not premiums. I prefer to pay the high deductible just like I pay my car mechanic for a bill of $1500 -$2500 for a major repair, out of after tax income, and let my HSA contributions grow in a two fund 50/50 portfolio. Nice and simple.
Remember, the costs in health care from physician services, whether you pay or insurance pay, are much less than the major costs, which are incurred when you are in a hospital. A hospital is not an expensive hotel room, that is the most stupid comparison on earth.Catastrophic health insurance with high deductible makes the most sense for most people. People always say they want protection from becoming bankrupt from a health problem, but then they go ahead and pay a high premium for a low deductible plan that pays for a visit to the doctor for the flu.
And it is the latter seduction of "free" healthcare that leads down the road of a system which denies you advanced procedures and rations the big stuff which really matters.Everyone in Britain gets a National Health Service Health Card. It's just that, a piece of paper. Just don't break your hip.