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Medical charges ordeal - comment
Old 02-19-2019, 05:23 PM   #1
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Medical charges ordeal - comment

I had two visits to see Dr. XXX who was recommended by My_Insurance as in-network doctor.

First visit focused on getting a referral to have my low back X-Ray and MRI done and the second was about discussing the tests results. Both visits took under 15 minutes and no additional tests or procedures done during those visits. (I paid for X-Ray and MRI out-of-pocket)

Prior to my visits I did my best to make sure verify that there would be no additional charges.

I reached out to my insurance provider My_Insurance (via website and asked a rep in chat) prior to scheduling visits and they told me that Dr. XXX's name is on my network providers list and $20 copay is expected with no additional fees or charges.

I also asked Dr. XXX’s stuff the same question during my appointment setup time and got the same answer.

If My_Insurance would have suggested any additional “facility” changes, I could simply find a specialist somewhere else, who did not have extra charges as it was not my goal to see this particular specialist.

My_Insurance claims they "... quoted correctly that the provider is in network and claims were processed as in network. My_Insurance has no way of knowing that a facility is going to bill separate charges in addition to what the doctor will bill.”

Two doctors visits resulted in $20 copay x 2 plus $166 plus $99 - $305 !!!


My_Insurance is paid by my employer and self-insured, that is is not under my state jurisdiction.



I don't plan pay those charged, but want to get this group's wisdom on possible negative impact if I go thru collection process etc...



Maybe some advise on how to fight this, would be helpful



Thx
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Old 02-19-2019, 05:37 PM   #2
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Is the $166 and the $99 the full charge or is that a discount off of charges? I understand that is what they billed you, but is that the full charge or did they give you a discounted price?

If it's not discounted, I think you'll have a good chance of success to get the amount reduced. Assuming it is a discounted number, I think you should pay it and move on. While it's understandable how you feel, it's unlikely you would have been able to get the service anywhere without a facility fee. It's very common. In Michigan, most any facility even remotely associated with a hospital will charge the facility fee. The providers that don't are completely independent from a hospital and usually go so far as to advertise as much.

Still, with an x-ray and an MRI, there are two parts. The professional piece (the Dr reading and interpreting the results) and the equipment piece. You learned a medical billing lesson for not too much. Next time you will ask better questions, like, what will the total cost of this service to me? Please put that in writing. Between your insurer and the provider, they should be able to do that. The error might be in not knowing if you've hit any deductible or co-pay maxes, but that should go in the right direction if they are incorrect on that point.
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Old 02-19-2019, 05:42 PM   #3
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Is the $166 and the $99 the full charge or is that a discount off of charges? I understand that is what they billed you, but is that the full charge or did they give you a discounted price?

If it's not discounted, I think you'll have a good chance of success to get the amount reduced. Assuming it is a discounted number, I think you should pay it and move on. While it's understandable how you feel, it's unlikely you would have been able to get the service anywhere without a facility fee. It's very common. In Michigan, most any facility even remotely associated with a hospital will charge the facility fee. The providers that don't are completely independent from a hospital and usually go so far as to advertise as much.

Still, with an x-ray and an MRI, there are two parts. The professional piece (the Dr reading and interpreting the results) and the equipment piece. You learned a medical billing lesson for not too much. Next time you will ask better questions, like, what will the total cost of this service to me? Please put that in writing. Between your insurer and the provider, they should be able to do that. The error might be in not knowing if you've hit any deductible or co-pay maxes, but that should go in the right direction if they are incorrect on that point.



It is a full charge.


Just not to confuse things, X-Ray and MRI were not part of the bill. I actually paid it out of pocket because it was cheaper then insurance deductible.


When would you negotiate discount? After they submit to collection ?
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Old 02-19-2019, 05:56 PM   #4
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That exact situation happened to me a few years ago. I called the doctor's billing department and explained the situation to them and they agreed to write off the entire amount of the charge.

I would try that first, and put something in writing responding to the invoice. But I would not ignore it and let it go to collections. You need to demonstrate that you attempted to resolve the dispute in good faith. Just document the conversations that took place and request the charges be written off. Let them respond next.
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Old 02-19-2019, 05:57 PM   #5
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Once your insurance company processes the claim the amount you will be responsible for will be greatly reduced.
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Old 02-19-2019, 06:04 PM   #6
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That exact situation happened to me a few years ago. I called the doctor's billing department and explained the situation to them and they agreed to write off the entire amount of the charge.



I would try that first, and put something in writing responding to the invoice. But I would not ignore it and let it go to collections. You need to demonstrate that you attempted to resolve the dispute in good faith. Just document the conversations that took place and request the charges be written off. Let them respond next.


I have everything documented and got thru all appeals.
Up to the state insurance commissioner. The problem with commissioner is that my company is self-insured. So I’m thinking what steps to take.
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Old 02-19-2019, 06:41 PM   #7
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Medical doctors mark'em up, take what the insurance company pays and marks off the difference--not including your deductible and co-pay. Insurance companies and especially Medicare work in mysterious ways. (My doctor absolutely refuses to see Medicaid patients.)

Doctors shoot for the stars--hoping someone will pay'em more than they're supposed to be paid. And I'm often appalled at the pittance Medicare pays for minor testing and other charges. No wonder our doctors are working into their 70's--without ER in sight.
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Old 02-19-2019, 06:43 PM   #8
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What kind of Dr was Dr XXX? Was he/she a radiologist? Or was this simply a primary care doctor or specialist who just referred you to the facility that did the X ray and MRI?

I have never been charged a facility charge by a doctor who wasn't doing some procedure on me and who had, say, an office operating room (and the one time that occurred it was for a plastic surgeon and nothing was covered by insurance any way).

For just an ordinary primary care doctor or specialist who was just doing an office visit and exam I have never been charged a facility charge.

So -- did the doctor do any kind of procedure? Was it just an office visit/exam? This just sounds odd to me if it is. I mean if I go to see a doctor who is just a regular doctor I wouldn't even think to ask if there was a facility charge.
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Old 02-19-2019, 06:50 PM   #9
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What kind of Dr was Dr XXX? Was he/she a radiologist? Or was this simply a primary care doctor or specialist who just referred you to the facility that did the X ray and MRI?



I have never been charged a facility charge by a doctor who wasn't doing some procedure on me and who had, say, an office operating room (and the one time that occurred it was for a plastic surgeon and nothing was covered by insurance any way).



For just an ordinary primary care doctor or specialist who was just doing an office visit and exam I have never been charged a facility charge.



So -- did the doctor do any kind of procedure? Was it just an office visit/exam? This just sounds odd to me if it is. I mean if I go to see a doctor who is just a regular doctor I wouldn't even think to ask if there was a facility charge.


That was an orthopedist
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Old 02-19-2019, 06:53 PM   #10
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Once your insurance company processes the claim the amount you will be responsible for will be greatly reduced.


I’m not worried about the amount, I think to pay for something you did not get is wrong. And entire medical billing sounds like you get a sandwich 🥪 and then find out that it cost $200

Is it right ? Aren’t we paying those charges actually encourage them ?
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Old 02-19-2019, 07:08 PM   #11
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That was an orthopedist

Did the doctor just do an exam? Was there an X ray or other procedure done at the doctor's office?

OK -- apparently this is increasingly common when the doctor works for a clinic owned by a hospital even if the office is no where near the hospital. Does a hospital own the practice?

https://www.the-alliance.org/uploade...TA114-0116.pdf

https://clearhealthcosts.com/blog/20...-need-to-know/
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Old 02-19-2019, 07:10 PM   #12
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Did the doctor just do an exam? Was there an X ray or other procedure done at the doctor's office?


Only exam and 2d time review of results

X-ray and MRI were done by other provider
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Old 02-19-2019, 07:28 PM   #13
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When would you negotiate discount? After they submit to collection ?
This VVVV

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That exact situation happened to me a few years ago. I called the doctor's billing department and explained the situation to them and they agreed to write off the entire amount of the charge.

I would try that first, and put something in writing responding to the invoice. But I would not ignore it and let it go to collections. You need to demonstrate that you attempted to resolve the dispute in good faith. Just document the conversations that took place and request the charges be written off. Let them respond next.
You don't want it to go to collection. It's just not worth it. Start negotiating asap (first bill) and if after a verbal conversation if you do not get this resolved, then make sure what you do is in writing.

The problem is that it doesn't seem that the provider of the service being billed is one of the entities you discussed the potential bill with. In other words, they're not the ones that wronged you. Still, if it's the full charge, see what the bill is after it's processed and hopefully it will not be big enough for you to be concerned about. If it stays at the full charge, try for 50% reduction if they won't write it off completely. 50% is not at all uncommon. You should probably start at 75%. In my case, I got a bill for $125 (the full charge) that I knew the insurance would pay $18 for. So it took a bit of work, but they finally accepted the $18.
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Old 02-19-2019, 07:32 PM   #14
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You don't want it to go to collection.

Why not?

Got your other point.
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Old 02-19-2019, 08:14 PM   #15
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Once it goes to collection, you're no longer dealing with the provider. You're dealing with a collection agency that will have no incentive to work with you. It will be a legal black and white at that point. You got a service, you got a bill, there was technically nothing wrong with the transaction . . . You'll lose. You'll also spend a lot of time to save $265. Is your time worth nothing?
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Old 02-19-2019, 11:09 PM   #16
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Only exam and 2d time review of results

X-ray and MRI were done by other provider
Then I bet it is the situation I posted the links on. Apparently the facility charge is common when the practice is owned by someone else, particularly if it is owned by a hospital. If the provider didn't disclose this to you maybe you could get them to at least reduce it. I gave links to a couple of articles about these charges but there are a lot more articles out there so it might be worthwhile to look at them and see what suggestions are given.
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Old 02-20-2019, 08:16 AM   #17
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Once it goes to collection, you're no longer dealing with the provider. You're dealing with a collection agency that will have no incentive to work with you. It will be a legal black and white at that point. You got a service, you got a bill, there was technically nothing wrong with the transaction . . . You'll lose. You'll also spend a lot of time to save $265. Is your time worth nothing?

Well I will try.
Not sure if hospital will be willing to reduce the bill.

Also I was thinking that negotiating with collections might be easier. Wrong ?

What will "You'll lose" look like ? Credit history negative record? Assuming I did not pay.
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Old 02-20-2019, 08:26 AM   #18
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Explanation of Benefits. My very first go to for any medical bill. I get that very quickly after an appointment of any kind. It explains everything. The actual invoice from the hospital/doctor usually follows a month later.
You will see the discounted rate, what the doc/hospital/tests/meds charged. From the Explanation of Benefits you can negotiate, it does not pay to negotiate from the invoice from the provider.
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Old 02-20-2019, 08:31 AM   #19
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Well I will try.
Not sure if hospital will be willing to reduce the bill.

Also I was thinking that negotiating with collections might be easier. Wrong ?

What will "You'll lose" look like ? Credit history negative record? Assuming I did not pay.
The hospital is way more likely to work with you than the collection agency. For a last ditch request, ask them to give you the Medicare rate. Start with asking for it to be forgiven, but hold on the Medicare rate.

I’m not sure on the credit report. I’ve heard that they keep a different set of books for medical financial issues versus consumer credit. Still, I think it’s pretty easy and the collection company will likely do it, to put a lien on your assets or garnish your wages. They’ll have to get a judgement, but they do that all the time so it’s not sweat off their back. Just don’t think you want to go down that rode. Oh, you will also likely be “asked” to come to court to talk to the judge. Just not worth it IMHO.
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Old 02-20-2019, 08:33 AM   #20
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What will "You'll lose" look like ? Credit history negative record? Assuming I did not pay.
You should look into possible late fees that you could be charged if the bill is not paid on time.
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