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Old 07-28-2011, 11:47 AM   #101
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Glad the retina surgery was successful for you Silver. I have a question for you as I have similar insurance deductible and could face same situation down the road concerning payment costs. You said the cash cost to you was $4223, but contracted rate from UH is $2940. I thought one of advantages of HD insurance was getting the insurance discount price for out of cost to you. Did you ask to pay the contracted rate instead of what they charged you? Did you try for more of a cash discount by paying upfront? There appears to be a level of negotiating like buying a car when having high deductibles and paying with cash. I haven't had to do this and fear I might not be prepared for it.
I did ask to pay only the contracted rate. I was told that since I had an exclusion rider on all complications related to cataract surgery, that insurance coverage is not applicable and that I needed to pay 100% of the charges at the time of service. I then asked for a cash-pay discount and was told they did not give any discounts for cash pay. This was right after the procedure, which was brutal, and I uncharacteristically gave up. My choices at that time were to just walk out the door and not be able to have any follow up of the surgery, or pay.

I then contacted UHC who stated that the contracted rate was $2940, and even with the exclusion, this amount was all that I was obligated to pay. UHC stated that they have no control over any amount already paid to the provider.

I contacted the surgeon's office, who have refused any refund stating that because of the exclusions I am considered self-pay and required to pay all charges. I have spoken to the practice manager, and this is their position at this point. I am continuing to try and negotiate with her.

I guess the answer is if you don't need follow-up care with that physician, just keep walking out the door after the appointment so that the office has to bill the insurance.
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Old 07-28-2011, 12:25 PM   #102
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Originally Posted by Silver View Post
I did ask to pay only the contracted rate. I was told that since I had an exclusion rider on all complications related to cataract surgery, that insurance coverage is not applicable and that I needed to pay 100% of the charges at the time of service. I then asked for a cash-pay discount and was told they did not give any discounts for cash pay. This was right after the procedure, which was brutal, and I uncharacteristically gave up. My choices at that time were to just walk out the door and not be able to have any follow up of the surgery, or pay.

I then contacted UHC who stated that the contracted rate was $2940, and even with the exclusion, this amount was all that I was obligated to pay. UHC stated that they have no control over any amount already paid to the provider.

I contacted the surgeon's office, who have refused any refund stating that because of the exclusions I am considered self-pay and required to pay all charges. I have spoken to the practice manager, and this is their position at this point. I am continuing to try and negotiate with her.

I guess the answer is if you don't need follow-up care with that physician, just keep walking out the door after the appointment so that the office has to bill the insurance.

Wow.... kind of crappy IMO.... you can always take them to small claims, but that is a hassel...

You can see about reporting them to the state board or whatever it is called and also go to some of the sites that rate docs and put in your two cents...
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Old 07-28-2011, 01:35 PM   #103
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I contacted the surgeon's office, who have refused any refund stating that because of the exclusions I am considered self-pay and required to pay all charges. I have spoken to the practice manager, and this is their position at this point. I am continuing to try and negotiate with her.
Silver, You might want to try talking to the physician instead of the practice manager. THe practice manager is following the rules set down by the physician. Only the physician can probably change it. A long time ago (before HMOs) I went to a dermatologist who burned a "pre-cancerous" lesion off my face. The only trouble was he missed some of it but you couldn't really tell until it healed. My insurance had a deductible before it would kick in. WHen I went back, his office tried to charge me for removing the remainder of the lesion.

After discussing it with him, he admitted he missed it and I didn't have to pay the additional fee. I do remember his initial reply when I complained about paying the additional fee was, "What's the big deal. You have insurance, don't you?"
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Old 07-28-2011, 01:41 PM   #104
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Quote:
Originally Posted by Silver

I did ask to pay only the contracted rate. I was told that since I had an exclusion rider on all complications related to cataract surgery, that insurance coverage is not applicable and that I needed to pay 100% of the charges at the time of service. I then asked for a cash-pay discount and was told they did not give any discounts for cash pay. This was right after the procedure, which was brutal, and I uncharacteristically gave up. My choices at that time were to just walk out the door and not be able to have any follow up of the surgery, or pay.

I then contacted UHC who stated that the contracted rate was $2940, and even with the exclusion, this amount was all that I was obligated to pay. UHC stated that they have no control over any amount already paid to the provider.

I contacted the surgeon's office, who have refused any refund stating that because of the exclusions I am considered self-pay and required to pay all charges. I have spoken to the practice manager, and this is their position at this point. I am continuing to try and negotiate with her.

I guess the answer is if you don't need follow-up care with that physician, just keep walking out the door after the appointment so that the office has to bill the insurance.
Tough break. I would be upset about this, too. I learned I will definitely submit claim even though I'm on the hook for cost, and will make sure I know what the contracted rate is and won't pay a penny more, because it doesn't look like they want to give any money back.
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