Okay. Ohhhhhhkay. Now I’m mad (re: health care)

[KansDem]

Last January, I had an appointment with my doctor for an exam and to have some tests. After presenting my insurance card to the front-office staff, who ran it through their computer, I was told my co-pay would be $20. I paid.

Yesterday, I received a bill from the medical group who owns the office. It summarizes the amounts paid, both what I paid (the $20 co-pay) and what my insurance paid (office visit and the tests). However, it says I owe $10 since the co-pay was supposed to be $30.

I mean, the doctor’s office staff ran my card and told me the amount of the co-pay; I didn’t tell them! I simply complied and gave them what they asked for! Now they want me to pay them more?! It’s their f**king system, not mine! I wasn't the who screwed up!!

I thought :wtf:. Can they do this? I mean, if your mechanic calls you and says, “Hey, I undercharged you on your last tune-up. I need another $10!” or the grocer calls you and says, “Hey, we undercharged you on your last bag of groceries. You owe us $10,” would you feel compelled to run $10 over to your mechanic or the grocer? Or would you say “T.S., Eliot. Seller beware!” I imagine in order to keep a good customer, my mechanic or the grocer would see the error of their ways and absorb the costs. But not the medical group. I suppose they would just say "Don't like the way we do business? Go to another doctor! But you still owe us the $10."

[LisaM]

1. I just had stitches taken out after dental surgery

and I got a bill for $40! For taking out stitches? How can they charge for that? I don't understand why it wasn't part of the surgery costs (which were high).

[KansDem]

3. Amazing

I too would think removal of stitches would be part of the overall cost of the surgery. That's like buying a pair of shoes and having to pay extra for the laces.

[tsuki]

27. You mean, you don't pay extra for the laces? Don't give

corporate America any new ideas.

:crazy:

[Donnachaidh]

10. We were charged $40 to REMOVE a wristcast

It's unbelievable the way people are getting nickeled and dimed to DEATH on things that should be included in the total cost.

[annabanana]

23. you could have just soaked it in a tub of water... for the cost of

the water!

[Warpy]

18. It IS part of the surgical cost

although they might have changed the rules for insurance companies. Post op office visits for stitch removal and wound checks are not supposed to be in addition to the doctor's fee for surgery.

Insurance companies always lowball the docs, though, so maybe the docs have had to start charging for separate office visits.

They don't charge ME, but some of the first words out of my mouth when I go to the doctor are "no insurance."

[El Supremo]

2. Happens all the time.

My card states what the co-payments are for various circumstances.

[KansDem]

5. Yes, but they told me what my co-pay was based on my insurance information.

If they made the mistake, then they should absorb the costs.

[El Supremo]

7. I've got a bridge to sell you.

They have hundreds of insurance companies to deal with. You think they have someone who updates all than information? No, the insurance companies tell the providers what to do.

BTW, what does your policy say? You got it somewhere?

[Coyote_Bandit]

4. Know what?

I haven't seen a doctor in over 10 years. Haven't had routine preventative health care in over 15 years. You have access to health care. I don't. And I'd be happy to pay a $30 co-pay instead of a $20 co-pay for the privilege.

As they say, pain depends on point of view.

[KansDem]

8. It's the principle here...

Sorry you don't have health care, but if these companies can get away with this kind of shoddy business practice, then where will it end? Will they eventually say, "If you don't like the way we do business...tough. Cancel your policy!"

After all, they're the ones who brought health-care into the forefront of "for-profit" capitalism. Not me!

[Coyote_Bandit]

26. So.....

who exactly are you hacked off at? The doctor's office or the insurance company? Unless you were included in that phone conversation between them you simply do not know what was said. Period. In either event you are making assumptions. And it is wrong to assume that billing and collections in the health care system is a simple and straight forward as you desire. Hasn't been for quite some time.

Your fees are governed by contract - your policy. It is your responsibility to know what coverage that policy does and does not provide. Including the amount of the co-pay for various services rendered by various providers.

FWIW, there are statutes in most states that prohibit multiple fee schedules for medical services and yet publications such as the Wall Street Journal have long since documented that as a common practice. Even the folks charged with enforcing the law don't even bother to put forth an effort. Uninsured folks are charged higher fees for the same exact medical services when compared to insured folks. Are you outraged about that? Outraged enough to do something about it?

Do you think your insurer or your doctors office or your employer care about whether your principles are offended? They do not care whether they adhere to statutory provisions regarding medical fees. Your doctor sees uninsured folks everyday and he sees folks who have to choose between eating and taking necessary medications. He knows just how fortunate you are. Your employer is bearing significant costs to provide that health care insurance to you. They could cut you and every other employee lose you know. Good luck affording your own coverage. And your insurer knows there either is or will be something wrong with you - and that you are infinitely expendable.

This isn't about the $10. It's about loss of control over health care billing - and the fear that accompanies it. Guess what? You are not being singled out and picked on. What happened to you is quite common. And it could have been much worse as some of the posts in this thread demonstrate.

I'd offer to send you $10 but I don't think you'd be the least bit grateful given that this is a matter of principle and all.

Good luck jousting at that windmill.

[Ilsa]

37. I see what you mean. It's like they informed you of your

responsibility and you met it. But we are responsible for anything the insurance doesn't pay, so I think that is why they can rip for another ten.

Too many people have their fingers in the health care pie and they are trying to pull out all the cherries for themselves.

[KansDem]

41. FINALLY, someone who understands the issue here...

Right, they informed me of my responsibility and I met it. But to read what other posters on this thread have been saying, it's up to me to be a f**king "healthcare administrator" to oversee the medical office to make certain no mistakes are made.

It's all about "responsibility" and the office was irresponsible in quoting me one co-pay then asking for an increased co-pay three months after I'd paid the quoted co-pay. But some on this thread think I'm trying to rip them off!

You're a breath of fresh air this a flatulence of drivel...:hi:

[Ilsa]

43. Yep, I think they are trying to rip you off. "Our surgery rates went up

from $7,000 for that breast reduction to $9,000 for it. Nevermind that you had it six months ago. Since your insurance didn't pay for three months we are grandfathering your surgery in to the new rate." I know that's hyperbole, but still, it's the same principle.

Tell them no and hell no.

[godai]

6. Health insurance rules are a nightmare. Check your provider.

There must be a set co-pay and sounds like it is $30. Maybe this changed from $20 recently. The doctor can't change more than the established co-pay. There's so much waste in the system. A lot(all?) of doctors require you to visit the office (copay and office visit $$) just to get a renewal on a prescription. There's really no need for this. The patient should decide when to visit.

I found with my plan that the co-pay was lower ($10) with standard coverage, compared to the higher (more expensive) coverage ($20). A lot of the normal benefits are the same but the co-pay is lower. I think this is to encourage visits to a doctor before things get worse and are more expensive to treat but I was surprised by this, since the monthly rates are much less with standard coverage.

[napi21]

9. Call our ins. provider and ask THEM for an explaination. But don't

get yourself too excited! My hubby has to have liver tests every 3 months because he takes Lipitor all the time. The co-pay for the office visit IS $25 as stated, but THEN we get a bill in the mail for the "non-covered portion" of the tests, lab fees etc.

He was hospitalized last Sept. for a suspected heart attack. The total of all the un-covered charges for all the different services was $2,500 and the only reason it stopped there was because he policy has a cap of $2,500 on out of pocket annual payments!

[Horse with no Name]

11. My copay to see my PCP is $20

It is $30 to see anyone else.
For some reason, I see a specialist that should cost me $30 but only costs me $20.
I am sure that the office made a legitimate mistake when they only collected $20.
Be thankful that they still will file on your insurance.
Some offices are starting to get away from it.

[nashville_brook]

12. your copay is set by your insurance co -- it's sometimes even printed on your card.

maybe they were surprised by the increase too.

[TooBigaTent]

13. Another reason why universal health CARE is needed - not mandatory INSURANCE.

[MountainLaurel]

24. Amen n/t

[lapfog_1]

14. $10...

my case was $10,000.

I have a congenital heart defect and eventually (after a number of ER visits to have my heart "reset"), I finally found a heart surgeon who could fix it.

My insurance was contacted and numerous details worked out in advance of my surgery.

The total amount was going to be about $35,000, and my contribution was to be around $1500, which I paid up front.

Months after my surgery I received a bill for a little over $10,250. Apparently, unknown to me and to my insurance company, another assistant surgeon was added to my team and this was his bill (my doctor swears that this was allowed by my insurance and that he contacted them about this in advance). My insurance refused to pay. So... I ended up paying an additional $1500, my insurance paid for a "consultation fee" of $2000 and the surgeon ended up eating the rest of his fee.

And within weeks, my insurance dropped me like a hot potato.

Being self employed, I've checked with other insurance and HMOs... HAH! The BEST that I've found is Blue Cross, who ONLY wants $900 a month WITH a $5,000 deductible! Which I can't afford. So I've been without for 12 years now. Scared to death of getting cancer or something... but I simply can't afford $900 a month. Even getting a "regular job" with insurance isn't a real solution, as I've been told that anything that happens with my heart again... the insurance will simply walk away stating "pre-existing conditions" and what not.

Anyway, sorry about your $10 additional copay... but count your blessings.

[ceile]

15. Something similar happened to me.

At the dentist, I was told how much my visit and any extra work would cost. I was there once a week for 4 weeks. It wasn't until after all the work was done (I had already paid the original cost I was quoted) that they sent me a bill saying they did not accept my insurance. My bill had gone from $35 to over $400. I sent them a nasty letter w/ a copy of the original invoice, stating that at no time over those 4 weeks was I told they did not accept my insurance and that I was not paying for their mistake. Never heard from them again.

[panAmerican]

16. With all due respect, you are responsible for knowing your copay.

If your insurance has increased copays for the new plan year, they tell you, not your doctor's office. I suspect what the doctor's office may have had is information they compiled on various plans and saved it in a spreadsheet for quick reference. Something like that in no way affects your responsibility for the proper amount.

[KansDem]

20. The first three things out of their mouths anymore are...

"Where's your insurance card; where's your I.D.; where's your co-pay?"

I give them the first two and then they tell me what my co-pay is, and I pay it. If they screwup, it's their fault, not mine. And I'm sure as hell am not going to tell them, "Oh, I believe your undercharging me. Here's an additional $10 to set the record straight." I'm the "customer" here, not the "supervisor" of their obviously f**ked-up system!

[RadiationTherapy]

21. What whiny nonsense! Pay the $10!

It's called a mistake and many people make them. The person made a mistake, so you want to profit by $10!? Nice pirate capitalism.

Grow up and pay your price. You don't like it, find another provider who does not ever make mistakes.

[KansDem]

22. Yes, THEY made the mistake, NOT I

Therefore, THEY absorb the costs of THEIR mistake, NOT I. You got a problem with that?

Talk about "pirate capitalism."

[panAmerican]

25. Dude, don't fight your doctor over 10 bucks

I've been on the other end of the line when they call and plead with the insurance company to obtain medical procedure authorizations. Do you want your doctor to be focused on that call, or to be thinking about how you stiffed him or her?

Even while I worked for the health insurance industry many years ago, I advocated for patients and helped them and their doctors navigate the roadblocks of getting claims paid in a timely manner, and in such a way that they didn't have to go through the onerous appeal procedures.

I assure you, you should be thankful that it's a $10 issue because without insurance, you'd be on the hook for a lot more. Now pay them, and go have a nice day! :bounce:

[RadiationTherapy]

28. Yeah. I have a big problem with it.

Dishonesty in business is a huge problem on all levels. This whole "I am going to benefit from someone else's oversight" nonsense is bullshit. And your false sense of indignation is laughable.

Go find a different doctor.

And trying to be all "NOW I am upset about health care in this country" because of your $10 measley, mouldy, fucking IRRELEVANT dollars that was MISTAKENLY not charged to you is beyond the ridiculous.

Meet my brother who has had no health care since receiving MEGA DOSES of radiation at age 22.

Meet my friend who is a wheelchair with a degenerative condition and in the same uininsured and uncared for lot.

Fuck it. I ain't getting banned over your $10, but I would certainly laugh in your face at the bar.

[KansDem]

29. Name for me *one* other business where you can buy a product or service...

...and have that business come back to you after the deal is done and inform you that you were undercharged and you needed to pay more. Name one other business other than "health care."

[RadiationTherapy]

31. I suppose there may not be one.

Look, if someone ACCIDENTALLY undercharged you $10 and then they tried to get you to pay the amount you were SUPPOSED to pay and that got you on the health care reform bandwagon, then I say welcome.

Honesty is honesty, man. They weren't dishonest; they didn't misrepresent; they made a mistake. It is YOUR OWN IGNORANCE of your plan and copayment that caused this to happen.

C'mon; admit it. You knew it was supposed to be $30 and you kept your mouth shut hoping they wouldn't notice their $10 mistake.

Whatever. Good to have someone who "cares" on board for HC reform.

[KansDem]

33. Where ever the hell did you get THAT notion?

You knew it was supposed to be $30 and you kept your mouth shut hoping they wouldn't notice their $10 mistake

It was their system that charged me the $20, not the $30. I didn't really believe I had to play the role of a goddamn "health-care administrator" each time I go to my doctor. I have enough of a time playing "patient."

And I resent the charge I was bamboozling them!

And yes, it's f**king time for HC reform. Different policies with different companies requiring different co-pays and differing coverage leads to confusion and unfair practices. If we had universal-payer where EVERYBODY had the same coverage, or at least the same basic coverage (if you wanted "concierge service" then pay extra--I know I wouldn't), then crap like this wouldn't happen.

[RadiationTherapy]

34. If you knew your business this would not have happened.

Your co-pay is $30 bucks, dude. Not whatever the 40+ hour per week, exhausted, never takes a vacation, receptionist who glanced at an out of date photocopy and gave you wrong information.

If you get $10 extra change at the grocery store, do you keep it??

[KansDem]

35. "If you get $10 extra change at the grocery store, do you keep it??"

Of course not. And if the front-office staff said, "Oh, KansDem, I see that your co-pay is really $30, not $20," I would've said, "That's o.k." and paid the extra ten. But this was 3 months later!

I suppose if 3 months after you make a purchase at the grocery store you realize you were undercharged $10, you'd hurry back to that store and offer to make-up the difference?

Give me a break!

[RadiationTherapy]

32. butbutbut it's THEEEEEIIIRRR fault!!

It's MYYYYYYY ten dollars.

fucking pathetic.

[KansDem]

39. Tell me about it...!!!

fucking pathetic.

You REALLY don't understand the principle here, do you? I thought at first you were kidding...

I'd like to see you close a home-mortgage loan...

Bank: "Well, Mr. RadiationTherapy, the papers are signed and you have your loan!"
RadiationTherapy: Oh, swell!
Bank: "Oh, but wait. I see we made a mistake and the cost of your house is several thousand dollars more than we negotiated. You'll have to kick in the difference!"
RadiaitonTherapy: Oh, that's all right. I don't mind.
Bank: "Just sign these rewritten contracts for the increased amount and we'll all done!"
RadiationTherapy: Oh, O.K. I want to do what's right!
Bank: "Oh, don't worry! We're doing it 'right' to you!"

HAHAHA!!! That would be hilarious!

edited for spelling

[RadiationTherapy]

44. your analogy scales things up quite a bit, doesn't it?

I just don't relate. It is a matter of perspective and not principle to me.

I am sorry I said you were whiny. I was projecting in light of having a bit of a whiner today myself.
I hope this resolves for you.

[XOKCowboy]

17. Hey be thankful.. You have insurance

I know it's the principle and it sounds just like today's insurance companies. I had to quit my job last year and go freelance. I'm doing really well but getting health insurance at 54 yrs old is nearly impossible. At my age you bet I have pre-existing conditions. None will be covered. Even with the PECs the coverage is horribly expensive.

We need universal health care not universal health insurance coverage. I'm doubting it'll ever happen though. Big Pharma and the insurance industry have too much money and influence for that to happen.

[SammyWinstonJack]

19. K&R!

[csziggy]

30. Try having coverage from a different state!

My husband's employer has insurance through BC/BS - easy insurance to get treatment, yes? Well, his employer has it with BC/BS of California, we're in Florida. For some reason recently we've begun to get bills for additional co-pay or something (it is in the insurance variation of legalese, neither of which I understand) for visits a year or more ago.

I pay whatever the doctor's offices ask me to at the visits, pay whatever I am billed for when they come. But to get upcharges for some unintelligible reason a year or more later is irritating to say the least.

But I will not rock the boat - I know we are lucky to have insurance at our ages - it is one of the main reasons my husband works. We were both self-employed for 25 years with no insurance. When I had my shoulder rebuilt after an injury, that was over $10,000 out of pocket. Six weeks after my husband went to work I messed up my left knee. Out of pocket was $500. When he left that job we paid for COBRA - well worth it since when I had a hysterectomy my out of pocket was $50. My knee operation (on the other knee) last year was $2000 out of pocket.

My surgeon has told me when I can't take it anymore he will do knee replacements on both knees. So my dear husband is planning to work until that is done - unless universal health care is passed so he can retire. After that, who knows?

[TexanDem]

36. Same thing happened to me...

I was self pay. I paid what the desk asked for, $60, as they had done in the past. The next month I got a bill for an additional $30, saying they should have charged me $90. I wrote back a nice note indicating I paid what they asked for, was seen by the doctor, and I would not be paying the difference. Well, that was in 2002, and I still get a computer generated bill every month for that $30. It's a matter of principle!!

[KansDem]

42. Good for you!!!

Some on this thread would accuse you of trying to take advantage of the US corporate-health care system...as if that was possible.

And it is a matter of principle! :thumbsup:

[Jacobin]

38. Consider yourself extremely fortunate

I see people all day long who are filing bankruptcy petitions because either they didn't have health insurance, they had health insurance but the company decided not to cover because it was a 'pre-existing condition' or they had health insurance but the coverage was so spotty and the treatment so expensive that they ended up with $100,000 not covered.

Come back when you've lost your home and your possessions because your health is so bad you can't work and you can't pay your bills.

I will then share in your outrage.

[KansDem]

40. So you too will overlook principle?

Many posters on this thread have stated your sentiment: that I should be "grateful" that I have insurance and that I shouldn't "rock the boat" over a measly $10. When does it become "principle" to you? $15? $25? $50? $100? $1,000? At what amount?

Universal health-care should be a national-security issue. When that's achieved and universal-health care is available, we can all have "principles" again...

[Lil Missy]

45. Oh for gawds sakes. Pay the fucking $10.00

It was an honest mistake, and you still OWE the money.

Are you willing to have this sent to collections and have your credit record ruined over this? For this twisted "principle" you seem to claim?

Jeezus Christ, learn how and when to choose your battles. I wish my life and problems were so simple and boring.

Pay the fucking $10 and move on.