Medical charges

[rapmarks]

On Friday evening I received a message from health provider that i will have to pay $500 before seeing my provider for a post op appointment on Monday morning . I called this morning, and new policy is to pay in full before appointments. Not copay but entire bill before insurance whittles it down. So I have three post op appointments and a fine needle aspiration scheduled for the next three weeks. This means I will have to pay around $5000 and wait for that money to be returned. When I had surgery in February, I had to prepay anticipated copay, and it took me six months to get that back. What do people living paycheck to paycheck do?

 

[davidvel]

Not go to these types of doctors.

 

[clifffaith]

Wow, that’s outrageous, and it seems flat out wrong for medical procedures.

 

[zentraveler]

On Friday evening I received a message from health provider that i will have to pay $500 before seeing my provider for a post op appointment on Monday morning . I called this morning, and new policy is to pay in full before appointments. Not copay but entire bill before insurance whittles it down. So I have three post op appointments and a fine needle aspiration scheduled for the next three weeks. This means I will have to pay around $5000 and wait for that money to be returned. When I had surgery in February, I had to prepay anticipated copay, and it took me six months to get that back. What do people living paycheck to paycheck do?

This means that your medical practitioner, or their group, has decided to "opt-out' of direct insurance payments and become "out of network" practitioner or office. They get paid in full, by you, and you get whatever the insurance will pay for "out of network" practitioners. In the in-network system, but practitioners take the "haircut" on their services fees and agrees to the amount the insurance will pay them. The out of network system means that you take the "haircut" rather than them, and what you get in reimbursement is often much lower than the cost of the copay.

The advantage of being in-network for the practitioner is a ready supply of insured patients. The disadvantage is income as the insurance companies pay a fixed and usually lower rate than the practitioner wants to get for their services.

The fix for you is to switch to an in-network practitioner or office. Getting health care from out of network offices is most often more expensive, and unless they submit the bills for you, very cumbersome.

In some specialties like psychiatry, most practitioners are out of network. Insurance companies have such low regard for mental health that their reimbursements to psychiatrists are often pitifully low so most are out of network. Lately more and dental and medical specialties have left insurance coverage which is a real shock to people as you found out.

 

[zentraveler]

Not go to these types of doctors.

Exactly. They stick to in-network practices for medical or dental care.

 

[zentraveler]

Wow, that’s outrageous, and it seems flat out wrong for medical procedures.

It is not wrong; it is their business and livelihood, and they can structure it as they want. IMHO it is really sad that our health care and insurance/payment system is so screwed up that it has come to this.

[There are whole conversations that can be had about this, insurance company executives pay, "middlemen" like pharmacy benefit management companies etc. A real can of worms.]

 

[rapmarks]

Realize that on sept 18 they did not have this policy and on sept 23 they did. This is a post surgery visit and I am on Medicare

 

[zentraveler]

Realize that on sept 18 they did not have this policy and on sept 23 they did. This is a post surgery visit and I am on Medicare

That does, indeed seem wrong, maybe not illegal, but wrong/unethical. They should’ve notified you with enough time to make other arrangements, and actually, the whole thing sounds strange. Check with their office and tell them to let you know what’s going on. I wonder if there’s been some kind of mistake made.

 

[rapmarks]

They did not ask for money at the appointment.

 

[VacationForever]

It sucks and they do it because they can. Hence, people are opting for Supplement plans like Plan F and G.

 

[Talent312]

I'd find another surgeon/practice that accepts Medicare or is in-network.
They just don't want to be tied to the limits on their bills as set by either.
.

 

[rapmarks]

I'd find another surgeon/practice that accepts Medicare or is in-network.
They just don't want to be tied to the limits on their bills as set by either.
.

This is a hospital. There is really no selection. Specialists come once a month,
now I have to decide whether to fly back to Florida or stay here, as it appears cancer has spread to lymph nodes and I am facing more surgery and radiation. Last month my insurance notified me my oncologist in Florida is now out of network, and recommended ordinary ent. That would kill me iff faster.

 

[dago]

I'd find another surgeon/practice that accepts Medicare or is in-network.
They just don't want to be tied to the limits on their bills as set by either.
.

For this reason is why I opted for a supplement plan. This is not the first time I have heard/seen this type of thing happen

 

[zentraveler]

This is a hospital. There is really no selection. Specialists come once a month,
now I have to decide whether to fly back to Florida or stay here, as it appears cancer has spread to lymph nodes and I am facing more surgery and radiation. Last month my insurance notified me my oncologist in Florida is now out of network and recommended ordinary ent. That would kill me iff faster.

Most insurances have ways to appeal certain decisions and at times offer "single case agreements" for certain situations where no one in network is available/appropriate. I was able to appeal for one for a patient of mine years ago and it had to do with his clinical situation and his need not to interrupt treatment with me.

I know you don't want to hassle with this, but you might at least call your insurance again and ask about appealing and a single case agreement. Is there another hospital in the area? Believe me I know that all of this is a hassle when you are in serious need of treatment and a continuity of care- now, not next month or next year.

 

[4TimeAway]

Most insurances have ways to appeal certain decisions and at times offer "single case agreements"

It could be they are even "in network" and pulling this. I've had to complain to the Department of Insurance to get it correct. Under threats of fines of $1,500 a day the health insurance company pressured the doctor to return the money.

I've seen it all, but agree its worth a couple 30 mintue calls and a call to your secondary insurance.

Note: Some Hospitals are using out of network doctors, even though the hospital is in network. To me this is a scam, but I see it happening more and more. There is little you can do to fight it other than changing Drs.

 

[Superchief]

Realize that on sept 18 they did not have this policy and on sept 23 they did. This is a post surgery visit and I am on Medicare

Is it possible that the practice left the network? In Cincinnati, there are several disputes going on between Mercy Health and Anthem and there have been threats that Mercy will no longer be in network. These are two of the largest hospital systems and insurers in our area.

 

[zentraveler]

Is it possible that the practice left the network? In Cincinnati, there are several disputes going on between Mercy Health and Anthem and there have been threats that Mercy will no longer be in network. These are two of the largest hospital systems and insurers in our area.

I would bet that’s entirely possible. And if the OP has other healthcare systems in her area, that might be an option. Or a university hospital. But having to change and tire systems in the middle of cancer treatment seems completely unreasonable.

 

[rapmarks]

I would bet that’s entirely possible. And if the OP has other healthcare systems in her area, that might be an option. Or a university hospital. But having to change and tire systems in the middle of cancer treatment seems completely unreasonable.

We had one plan for five years, the promise was in and out of network we’re paid the same and it was kept. Then they switched to what they said was even better, it’s not, and we are switching again in January. I have had two doctors this summer say they would not see me because of my health record. The one I saw recently said nothing was wrong,but he was wrong, and fortunately I pursued the issue.

 

[jd2601]

This hits a nerve with me. My surgeon was not sure what he would do until they got into the surgery. This practice requires prepayment. Their clinic would not scheduled until I paid. I inquired how they would know what to bill. They required payment on anything potential. I requested multiple times a refund on what was not done. This went on for 6 months until I finally had a follow up with surgeon. I did receive a refund a week after getting surgeon involved. I really wonder if this practice is legal and makes you wonder about our healthcare.

This was an in network provider at an in network hospital.

 

[amycurl]

"No way to prevent this situation," says only developed nation where this kind of thing currently happens.

 

[4TimeAway]

I have a client almost flew to Colombia for a dermatology appointment to remove skin cancer. In Los Angeles they cancelled the appointment and wouldn't reschedule for 2 months.

 

[isisdave]

Realize that on sept 18 they did not have this policy and on sept 23 they did. This is a post surgery visit and I am on Medicare

Did y'all note that rapmarks reported they didn't ask for payment today?

I'm pretty sure that to do so is not allowed under Medicare, if the provider "accepts Medicare."
Most commercial insurers would not permit that from an in-network provider, except when it is known that the deductible has not been met.
Even when I know that I'm going to have a $20 copay after Medicare Supplement, no one asks for it until "the dust settles" although they will accept it if I offer.

 

[rapmarks]

Did y'all note that rapmarks reported they didn't ask for payment today?

I'm pretty sure that to do so is not allowed under Medicare, if the provider "accepts Medicare."
Most commercial insurers would not permit that from an in-network provider, except when it is known that the deductible has not been met.
Even when I know that I'm going to have a $20 copay after Medicare Supplement, no one asks for it until "the dust settles" although they will accept it if I offer.

And I reached my out of pocket max for the calendar year in mid February

 

[dago]

Even when I know that I'm going to have a $20 copay after Medicare Supplement, no one asks for it until "the dust settles" although they will accept it if I offer.

Why are there signs at the doctor's office indicating the co-pay is expected at time of appointment? I never have a co-pay, so I never pay any attention to it. Apparently, it's not enforced.

 

[Talent312]

DW has Plan F, so no bills at all... I have Plan G, so the Part B deductible.

My first few appointments each year are subject to the deductible.
But at check-out, they waive me off and say, "We'll let Medicare tell us."
A few months later, I get a bill for the deductible... fair enuff.
---------------------
Recently, a hospital came up with a bill of $51K+ for DW's ER visit.
They were hoping, no doubt, to cash in on our auto-PIP coverage.
They got $8K out of Allstate. Now they'll have settle for Medicare. Ha!