No bill to me - but found strange things on my health plan records

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dm200
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No bill to me - but found strange things on my health plan records

Post by dm200 » Thu Oct 11, 2018 5:40 pm

I was looking at my Kaiser online account - verifying medical records, tests, office visits, etc. Under "claims and billing", I found a record that a Physician I had never heard of had a 'claim' of over $100 ( 2 'services') for a week ago today. No record of an office visit by me and this did not generate a bill. A search and phone call confirms that this Physician is an OB/GYN - and I am (and always have been) a male - now on Medicare. No financial concerns for me - but makes me wonder what else "strange" might be in my medical records that I have not seen. :confused

The call center rep was equally confused and could not explain it - so it is being researched.

jebmke
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Re: No bill to me - but found strange things on my health plan records

Post by jebmke » Thu Oct 11, 2018 5:45 pm

I guess I should look. Since I only go once every two years for a physical I haven't paid much attention. But it probably pays to look and report something in case it is Medicare fraud -- seems like the responsible thing to do.
When you discover that you are riding a dead horse, the best strategy is to dismount.

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dm200
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Re: No bill to me - but found strange things on my health plan records

Post by dm200 » Thu Oct 11, 2018 6:14 pm

jebmke wrote:
Thu Oct 11, 2018 5:45 pm
I guess I should look. Since I only go once every two years for a physical I haven't paid much attention. But it probably pays to look and report something in case it is Medicare fraud -- seems like the responsible thing to do.
There was also a similar "claim" in August for almost $200 citing my Primary care physician. The day noted was the same day I got a second Shingles shot from a Registered nurse - took no more than 5 minutes and I never saw the Physician. They are also researching this one as well.

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Re: No bill to me - but found strange things on my health plan records

Post by FloRidaRocky » Thu Oct 11, 2018 6:24 pm

I used to really like Kaiser 10 years ago but lately I have seen similar shenanigans. My Kaiser healthcare plan had a $30 copay for office visits. I was having some knee problems so I scheduled a visit. I was basically told by the doctor to not engage in the activity that caused me knee pain (cycling). Wow, I'm glad I scheduled this visit because I wouldn't be able to come up with that treatment plan on my own. Anyhow I got the bill later. So much for $30 copay, there were added fees I had to pay out of pocket. The entire bill was around $500, fortunately for me, Kaiser paid $370 of it and I was left with forking over another $100.
There's something fishy about a company that is basically providing services under their own insurance, like maybe they have some financial incentive to inflate the bill so it looks like your insurance is providing more value than it actually is.
I am so sick of playing "doctor bill roulette" with private healthcare that I just go to the VA because it seems like they are less driven by profits and less likely to shaft me for out of pocket expenses.

2015
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Re: No bill to me - but found strange things on my health plan records

Post by 2015 » Thu Oct 11, 2018 8:42 pm

dm200 wrote:
Thu Oct 11, 2018 5:40 pm
...No financial concerns for me - but makes me wonder what else "strange" might be in my medical records that I have not seen. :confused

...
I thought Kaiser had EMR. My former physician had them for many years and I always had online access. Now PCP (starting soon) I'm not so sure, but I'm not really concerned, as I track my own health in an excel spreadsheet. In fact, the new PCP's office already has all of these vaccinations and tests that are "overdue" when in fact I've had them all (despite detailing them all explicitly in the new patient paperwork). I plan to take the excel spreadsheet with me to be incorporated one way or another into my records.

Not on Medicare yet, but once I do you can bet I'll be checking the EOB's.

sport
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Re: No bill to me - but found strange things on my health plan records

Post by sport » Thu Oct 11, 2018 9:01 pm

I like my Medicare Advantage Plan in this regard. The co-pay for an office visit covers everything that happens during that visit. The insurance charges vary, but the co-pay is all that I am responsible for. It is $15 for the primary care dr. and $25 for any other dr. Sometimes there is a "facility charge" in addition to the dr. bill. However, my responsibility is still only the co-pay.

brennok
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Re: No bill to me - but found strange things on my health plan records

Post by brennok » Thu Oct 11, 2018 9:19 pm

dm200 wrote:
Thu Oct 11, 2018 6:14 pm
jebmke wrote:
Thu Oct 11, 2018 5:45 pm
I guess I should look. Since I only go once every two years for a physical I haven't paid much attention. But it probably pays to look and report something in case it is Medicare fraud -- seems like the responsible thing to do.
There was also a similar "claim" in August for almost $200 citing my Primary care physician. The day noted was the same day I got a second Shingles shot from a Registered nurse - took no more than 5 minutes and I never saw the Physician. They are also researching this one as well.
Many offices will bill a 99211 which is essentially a nurse visit usually with a quick workup/vitals and the immunization along with the administration fee. Shingles also tends to be a more expensive immunization so $200 doesnt sound out of line off the top of my head.

Rotarman
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Re: No bill to me - but found strange things on my health plan records

Post by Rotarman » Fri Oct 12, 2018 7:26 am

brennok wrote:
Thu Oct 11, 2018 9:19 pm
dm200 wrote:
Thu Oct 11, 2018 6:14 pm
jebmke wrote:
Thu Oct 11, 2018 5:45 pm
I guess I should look. Since I only go once every two years for a physical I haven't paid much attention. But it probably pays to look and report something in case it is Medicare fraud -- seems like the responsible thing to do.
There was also a similar "claim" in August for almost $200 citing my Primary care physician. The day noted was the same day I got a second Shingles shot from a Registered nurse - took no more than 5 minutes and I never saw the Physician. They are also researching this one as well.
Many offices will bill a 99211 which is essentially a nurse visit usually with a quick workup/vitals and the immunization along with the administration fee. Shingles also tends to be a more expensive immunization so $200 doesnt sound out of line off the top of my head.
Shingrix vaccine is about $150 dollars. The facility is allowed to charge 6% markup (fridge/electricity costs and assuming the risk of power outage or theft) so $9. So they get $41 dollars for setting up the appointment, overhead, billing your insurance, etc. Doesnt seem that crazy to me.

OnTrack2020
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Re: No bill to me - but found strange things on my health plan records

Post by OnTrack2020 » Fri Oct 12, 2018 7:29 am

We had an EOB years ago for an eye doctor visit for my son. The thing is, during that time period, he never had an appointment with an eye doctor.

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dm200
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Re: No bill to me - but found strange things on my health plan records

Post by dm200 » Fri Oct 12, 2018 9:46 am

FloRidaRocky wrote:
Thu Oct 11, 2018 6:24 pm
I used to really like Kaiser 10 years ago but lately I have seen similar shenanigans. My Kaiser healthcare plan had a $30 copay for office visits. I was having some knee problems so I scheduled a visit. I was basically told by the doctor to not engage in the activity that caused me knee pain (cycling). Wow, I'm glad I scheduled this visit because I wouldn't be able to come up with that treatment plan on my own. Anyhow I got the bill later. So much for $30 copay, there were added fees I had to pay out of pocket. The entire bill was around $500, fortunately for me, Kaiser paid $370 of it and I was left with forking over another $100.
There's something fishy about a company that is basically providing services under their own insurance, like maybe they have some financial incentive to inflate the bill so it looks like your insurance is providing more value than it actually is.
I am so sick of playing "doctor bill roulette" with private healthcare that I just go to the VA because it seems like they are less driven by profits and less likely to shaft me for out of pocket expenses.
Rarely, if ever, have my wife or I received such added bills from Kaiser.

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GoldStar
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Re: No bill to me - but found strange things on my health plan records

Post by GoldStar » Fri Oct 12, 2018 9:49 am

I had a relative who told me that they had something similar happen. It turned out that someone with a similar name lived in the same city and their office had mis-filed.
I'd call the physicians office and ask them about it.

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dm200
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Re: No bill to me - but found strange things on my health plan records

Post by dm200 » Fri Oct 12, 2018 9:50 am

2015 wrote:
Thu Oct 11, 2018 8:42 pm
dm200 wrote:
Thu Oct 11, 2018 5:40 pm
...No financial concerns for me - but makes me wonder what else "strange" might be in my medical records that I have not seen. :confused

...
I thought Kaiser had EMR. My former physician had them for many years and I always had online access. Now PCP (starting soon) I'm not so sure, but I'm not really concerned, as I track my own health in an excel spreadsheet. In fact, the new PCP's office already has all of these vaccinations and tests that are "overdue" when in fact I've had them all (despite detailing them all explicitly in the new patient paperwork). I plan to take the excel spreadsheet with me to be incorporated one way or another into my records.

Not on Medicare yet, but once I do you can bet I'll be checking the EOB's.
This is not an EOB and I was not billed anything. Just part of the "claims" area of the web site I can review when I log in. Yes - kaiser has extensive electronic medical records. While the electronic and centralized medical records are wonderful, sometimes there is so much information a Physician can be overwhelmed by the sheer volume and I sometimes need to point out something he/she missed.

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dm200
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Re: No bill to me - but found strange things on my health plan records

Post by dm200 » Fri Oct 12, 2018 9:52 am

Rotarman wrote:
Fri Oct 12, 2018 7:26 am
brennok wrote:
Thu Oct 11, 2018 9:19 pm
dm200 wrote:
Thu Oct 11, 2018 6:14 pm
jebmke wrote:
Thu Oct 11, 2018 5:45 pm
I guess I should look. Since I only go once every two years for a physical I haven't paid much attention. But it probably pays to look and report something in case it is Medicare fraud -- seems like the responsible thing to do.
There was also a similar "claim" in August for almost $200 citing my Primary care physician. The day noted was the same day I got a second Shingles shot from a Registered nurse - took no more than 5 minutes and I never saw the Physician. They are also researching this one as well.
Many offices will bill a 99211 which is essentially a nurse visit usually with a quick workup/vitals and the immunization along with the administration fee. Shingles also tends to be a more expensive immunization so $200 doesnt sound out of line off the top of my head.
Shingrix vaccine is about $150 dollars. The facility is allowed to charge 6% markup (fridge/electricity costs and assuming the risk of power outage or theft) so $9. So they get $41 dollars for setting up the appointment, overhead, billing your insurance, etc. Doesnt seem that crazy to me.
I also had a flu shot in October on the day this stuff appeared as well. The most puzzling thing (to me and the member services rep) is the Physician cited is an OB/GYN.

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Re: No bill to me - but found strange things on my health plan records

Post by likegarden » Fri Oct 12, 2018 10:13 am

I learned this year to always compare the entries on Explanation of Benefits of the insurance company with my own records. (the same as always check the monthly statement of the credit card company with actual bills paid). I went to an outpatient visit at a hospital for colonoscopy and paid $200 copay. My insurance card showed hospital outpatient $200. But my insurance EoB showed 0. Insurance said that for colonoscopy I would have to pay no copay. That's confusing, but I accepted getting those $200 back after insurance man had to argue about that with the hospital.

Rotarman
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Re: No bill to me - but found strange things on my health plan records

Post by Rotarman » Fri Oct 12, 2018 10:24 am

dm200 wrote:
Fri Oct 12, 2018 9:52 am
Rotarman wrote:
Fri Oct 12, 2018 7:26 am
brennok wrote:
Thu Oct 11, 2018 9:19 pm
dm200 wrote:
Thu Oct 11, 2018 6:14 pm
jebmke wrote:
Thu Oct 11, 2018 5:45 pm
I guess I should look. Since I only go once every two years for a physical I haven't paid much attention. But it probably pays to look and report something in case it is Medicare fraud -- seems like the responsible thing to do.
There was also a similar "claim" in August for almost $200 citing my Primary care physician. The day noted was the same day I got a second Shingles shot from a Registered nurse - took no more than 5 minutes and I never saw the Physician. They are also researching this one as well.
Many offices will bill a 99211 which is essentially a nurse visit usually with a quick workup/vitals and the immunization along with the administration fee. Shingles also tends to be a more expensive immunization so $200 doesnt sound out of line off the top of my head.
Shingrix vaccine is about $150 dollars. The facility is allowed to charge 6% markup (fridge/electricity costs and assuming the risk of power outage or theft) so $9. So they get $41 dollars for setting up the appointment, overhead, billing your insurance, etc. Doesnt seem that crazy to me.
I also had a flu shot in October on the day this stuff appeared as well. The most puzzling thing (to me and the member services rep) is the Physician cited is an OB/GYN.
I'm just guessing here, but it's possible that the physician overseeing/billing for your vaccination is that OB/GYN doctor. I get my vaccinations through a facility and only ever see the nurse, but the charge to my insurance is from an occupational health physician (whom I have never seen because I just get the vaccines).

sport
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Re: No bill to me - but found strange things on my health plan records

Post by sport » Fri Oct 12, 2018 10:47 am

There is nothing new about mistakes in medical billing. Some examples:
1. I went to an office visit, paid my copay, it was never submitted to insurance.
2. I went to an office visit, it was submitted to insurance, but I was never billed for the copay.
3. I went to an office visit, it was submitted to insurance twice, for two different dates.
4. DW went to the dentist and it was submitted to DD's dental insurance.
5. DW went to a no copay yearly checkup and it was submitted to insurance as an office visit.

123
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Re: No bill to me - but found strange things on my health plan records

Post by 123 » Fri Oct 12, 2018 11:20 am

It's possible that there's no mistake at all. Do you get ongoing maintenance perscriptions from Kaiser? Maybe it was a review of your medical history or lab test history in connection with (what looks to you like) an automatic renewal of perscription refills. Such a review might not depend too much on the medical specialty of the physician, and some medical specialists routinely handle a wide variety of general patients as well at times.
The closest helping hand is at the end of your own arm.

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dm200
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Re: No bill to me - but found strange things on my health plan records

Post by dm200 » Fri Oct 12, 2018 11:22 am

123 wrote:
Fri Oct 12, 2018 11:20 am
It's possible that there's no mistake at all. Do you get ongoing maintenance perscriptions from Kaiser? Maybe it was a review of your medical history or lab test history in connection with (what looks to you like) an automatic renewal of perscription refills. Such a review might not depend too much on the medical specialty of the physician, and some medical specialists routinely handle a wide variety of general patients as well at times.
Yes - could be, I suppose. But an OB/GYN? Of course, they are licensed to practice medicine.

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Shackleton
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Re: No bill to me - but found strange things on my health plan records

Post by Shackleton » Fri Oct 12, 2018 11:34 am

Are you in one of the states that is legislating gender neutrality? :D
“Superhuman effort isn't worth a damn unless it achieves results.” ~Ernest Shackleton

inbox788
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Re: No bill to me - but found strange things on my health plan records

Post by inbox788 » Fri Oct 12, 2018 12:36 pm

GoldStar wrote:
Fri Oct 12, 2018 9:49 am
I had a relative who told me that they had something similar happen. It turned out that someone with a similar name lived in the same city and their office had mis-filed.
I'd call the physicians office and ask them about it.
They would never admit this, but today's version of misfiling is computer error. There are many ways these errors are introduced, from simple data entry or corrupt data to incorrect programming. Many are corrected when the run a backup or patch, and the "problem" just disappears and makes you look crazy like you're seeing things that aren't there.

OP, give your GYN a call and ask for the pabst beer results!

Image

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DaftInvestor
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Re: No bill to me - but found strange things on my health plan records

Post by DaftInvestor » Fri Oct 12, 2018 12:42 pm

inbox788 wrote:
Fri Oct 12, 2018 12:36 pm
GoldStar wrote:
Fri Oct 12, 2018 9:49 am
I had a relative who told me that they had something similar happen. It turned out that someone with a similar name lived in the same city and their office had mis-filed.
I'd call the physicians office and ask them about it.
They would never admit this, but today's version of misfiling is computer error. There are many ways these errors are introduced, from simple data entry or corrupt data to incorrect programming. Many are corrected when the run a backup or patch, and the "problem" just disappears and makes you look crazy like you're seeing things that aren't there.

OP, give your GYN a call and ask for the pabst beer results!
Data entry errors are user errors; not computer errors; and probably the majority of what is happening.

In any case, OP: I don't understand why, instead of spending time here typing, you didn't just pick up the phone and call the OB/GYN with the information so they could fix it? I certainly wouldn't want false information in my records.

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dm200
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Re: No bill to me - but found strange things on my health plan records

Post by dm200 » Fri Oct 12, 2018 12:51 pm

Shackleton wrote:
Fri Oct 12, 2018 11:34 am
Are you in one of the states that is legislating gender neutrality? :D
A few years ago - had symptoms where I got a mammogram. The radiology folks first looked a little surprised to see a guy for a mammogram. All was ok, though.

sport
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Re: No bill to me - but found strange things on my health plan records

Post by sport » Fri Oct 12, 2018 2:33 pm

sport wrote:
Fri Oct 12, 2018 10:47 am
There is nothing new about mistakes in medical billing. Some examples:
1. I went to an office visit, paid my copay, it was never submitted to insurance.
2. I went to an office visit, it was submitted to insurance, but I was never billed for the copay.
3. I went to an office visit, it was submitted to insurance twice, for two different dates.
4. DW went to the dentist and it was submitted to DD's dental insurance.
5. DW went to a no copay yearly checkup and it was submitted to insurance as an office visit.
6. Today I received a bill for a copay that I had already paid at the time of service.

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dodecahedron
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Re: No bill to me - but found strange things on my health plan records

Post by dodecahedron » Fri Oct 12, 2018 2:39 pm

brennok wrote:
Thu Oct 11, 2018 9:19 pm
Many offices will bill a 99211 which is essentially a nurse visit usually with a quick workup/vitals and the immunization along with the administration fee. Shingles also tends to be a more expensive immunization so $200 doesnt sound out of line off the top of my head.
I got my shingles shots (the new ones introduced early this year, which require two shots within a 2 to 6 month period) from the pharmacist at the local supermarket. It cost me nothing but the charge to my HMO was $200 for each shot.

Later on got a flu shot at same place. Again free to me but this time it only cost my HMO $40.
Last edited by dodecahedron on Fri Oct 12, 2018 2:44 pm, edited 1 time in total.

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dm200
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Re: No bill to me - but found strange things on my health plan records

Post by dm200 » Fri Oct 12, 2018 2:42 pm

dodecahedron wrote:
Fri Oct 12, 2018 2:39 pm
brennok wrote:
Thu Oct 11, 2018 9:19 pm
Many offices will bill a 99211 which is essentially a nurse visit usually with a quick workup/vitals and the immunization along with the administration fee. Shingles also tends to be a more expensive immunization so $200 doesnt sound out of line off the top of my head.
I got my shingles shots (the new ones introduced early this year, which require two shots within a 2 to 6 month period) from the pharmacist at the local supermarket. It cost me nothing but the charge to my HMO was $200 for each shot.
Wow - seems like a lot! Then, again, I understand shingles is quite a painful/miserable experience. That's why I got the two shots.

toofache32
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Re: No bill to me - but found strange things on my health plan records

Post by toofache32 » Fri Oct 12, 2018 11:55 pm

2015 wrote:
Thu Oct 11, 2018 8:42 pm
dm200 wrote:
Thu Oct 11, 2018 5:40 pm
...No financial concerns for me - but makes me wonder what else "strange" might be in my medical records that I have not seen. :confused

...
I thought Kaiser had EMR. My former physician had them for many years and I always had online access. Now PCP (starting soon) I'm not so sure, but I'm not really concerned, as I track my own health in an excel spreadsheet. In fact, the new PCP's office already has all of these vaccinations and tests that are "overdue" when in fact I've had them all (despite detailing them all explicitly in the new patient paperwork). I plan to take the excel spreadsheet with me to be incorporated one way or another into my records.

Not on Medicare yet, but once I do you can bet I'll be checking the EOB's.
The EMR is usually the source of these errors. A date of birth or SS# or name or something was entered wrong. EMRs do not eliminate errors. They simply trade one type of error for another type of error.

2015
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Re: No bill to me - but found strange things on my health plan records

Post by 2015 » Sat Oct 13, 2018 10:44 am

toofache32 wrote:
Fri Oct 12, 2018 11:55 pm
2015 wrote:
Thu Oct 11, 2018 8:42 pm
dm200 wrote:
Thu Oct 11, 2018 5:40 pm
...No financial concerns for me - but makes me wonder what else "strange" might be in my medical records that I have not seen. :confused

...
I thought Kaiser had EMR. My former physician had them for many years and I always had online access. Now PCP (starting soon) I'm not so sure, but I'm not really concerned, as I track my own health in an excel spreadsheet. In fact, the new PCP's office already has all of these vaccinations and tests that are "overdue" when in fact I've had them all (despite detailing them all explicitly in the new patient paperwork). I plan to take the excel spreadsheet with me to be incorporated one way or another into my records.

Not on Medicare yet, but once I do you can bet I'll be checking the EOB's.
The EMR is usually the source of these errors. A date of birth or SS# or name or something was entered wrong. EMRs do not eliminate errors. They simply trade one type of error for another type of error.
Point is I have access to EMR's (to an extent) and can check for inconsistencies. Which I do regardless of records form.

2015
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Re: No bill to me - but found strange things on my health plan records

Post by 2015 » Sat Oct 13, 2018 10:45 am

dm200 wrote:
Fri Oct 12, 2018 9:50 am
2015 wrote:
Thu Oct 11, 2018 8:42 pm
dm200 wrote:
Thu Oct 11, 2018 5:40 pm
...No financial concerns for me - but makes me wonder what else "strange" might be in my medical records that I have not seen. :confused

...
I thought Kaiser had EMR. My former physician had them for many years and I always had online access. Now PCP (starting soon) I'm not so sure, but I'm not really concerned, as I track my own health in an excel spreadsheet. In fact, the new PCP's office already has all of these vaccinations and tests that are "overdue" when in fact I've had them all (despite detailing them all explicitly in the new patient paperwork). I plan to take the excel spreadsheet with me to be incorporated one way or another into my records.

Not on Medicare yet, but once I do you can bet I'll be checking the EOB's.
This is not an EOB and I was not billed anything. Just part of the "claims" area of the web site I can review when I log in. Yes - kaiser has extensive electronic medical records. While the electronic and centralized medical records are wonderful, sometimes there is so much information a Physician can be overwhelmed by the sheer volume and I sometimes need to point out something he/she missed.
I thought so. I couldn't imagine Kaiser not having EMR's.

PaunchyPirate
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Re: No bill to me - but found strange things on my health plan records

Post by PaunchyPirate » Sun Oct 14, 2018 8:43 am

I had the second half of the shingles vaccination at an appointment at the end of August. My insurance was charged $30.05 for "Immunization" and $200 for "Preventive Med". These were reduced to $19.97 and $168 by insurance plan agreements. My cost was $0. These charges were the exact same 4 months prior for the first half of the vaccination.

It does seem wrong that these charges were for a nurse taking 1 minute to prep and give me the shot. At the same appointment, I spent 15 minutes with my Doctor and that was billed at $153 (reduced to $106.24 by the insurance plan agreement). My cost was the $20 copay.

InMyDreams
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Re: No bill to me - but found strange things on my health plan records

Post by InMyDreams » Sun Oct 14, 2018 9:39 am

likegarden wrote:
Fri Oct 12, 2018 10:13 am
I learned this year to always compare the entries on Explanation of Benefits of the insurance company with my own records. (the same as always check the monthly statement of the credit card company with actual bills paid). I went to an outpatient visit at a hospital for colonoscopy and paid $200 copay. My insurance card showed hospital outpatient $200. But my insurance EoB showed 0. Insurance said that for colonoscopy I would have to pay no copay. That's confusing, but I accepted getting those $200 back after insurance man had to argue about that with the hospital.
If this was a screening colonoscopy, it is covered 100% if you have an ACA-compliant insurance plan. It is considered to be part of one of the 10 essential benefits.

and it sure seems like the hospital should have known that...

InMyDreams
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Re: No bill to me - but found strange things on my health plan records

Post by InMyDreams » Sun Oct 14, 2018 9:50 am

PaunchyPirate wrote:
Sun Oct 14, 2018 8:43 am
I had the second half of the shingles vaccination at an appointment at the end of August. My insurance was charged $30.05 for "Immunization" and $200 for "Preventive Med". These were reduced to $19.97 and $168 by insurance plan agreements. My cost was $0. These charges were the exact same 4 months prior for the first half of the vaccination.

It does seem wrong that these charges were for a nurse taking 1 minute to prep and give me the shot. At the same appointment, I spent 15 minutes with my Doctor and that was billed at $153 (reduced to $106.24 by the insurance plan agreement). My cost was the $20 copay.
It took my electrician about 15 minutes to diagnose and fix my electrical problem. He charged me $110.

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dm200
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Re: No bill to me - but found strange things on my health plan records

Post by dm200 » Sun Oct 14, 2018 10:23 am

InMyDreams wrote:
Sun Oct 14, 2018 9:39 am
likegarden wrote:
Fri Oct 12, 2018 10:13 am
I learned this year to always compare the entries on Explanation of Benefits of the insurance company with my own records. (the same as always check the monthly statement of the credit card company with actual bills paid). I went to an outpatient visit at a hospital for colonoscopy and paid $200 copay. My insurance card showed hospital outpatient $200. But my insurance EoB showed 0. Insurance said that for colonoscopy I would have to pay no copay. That's confusing, but I accepted getting those $200 back after insurance man had to argue about that with the hospital.
If this was a screening colonoscopy, it is covered 100% if you have an ACA-compliant insurance plan. It is considered to be part of one of the 10 essential benefits.
and it sure seems like the hospital should have known that...
Very strange - the two types .. and how they are (or are not) fully covered. I have one every five years - due to family history. Due for the next one in 2019.

toofache32
Posts: 1381
Joined: Sun Mar 04, 2012 6:30 pm

Re: No bill to me - but found strange things on my health plan records

Post by toofache32 » Sun Oct 14, 2018 1:24 pm

PaunchyPirate wrote:
Sun Oct 14, 2018 8:43 am
I had the second half of the shingles vaccination at an appointment at the end of August. My insurance was charged $30.05 for "Immunization" and $200 for "Preventive Med". These were reduced to $19.97 and $168 by insurance plan agreements. My cost was $0. These charges were the exact same 4 months prior for the first half of the vaccination.

It does seem wrong that these charges were for a nurse taking 1 minute to prep and give me the shot. At the same appointment, I spent 15 minutes with my Doctor and that was billed at $153 (reduced to $106.24 by the insurance plan agreement). My cost was the $20 copay.
I'm sure she can take longer next time if you ask. What do you think the shot should have cost? How much did it cost them to buy the medicine and supplies?

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