M Paquette
Moderator Emeritus
We've seen the same "discounting" with our insurance. But you'll find better overall odds of getting a reasonable financial outcome at a casino . . .
My wife went in for a routine physical. We called the insurance company beforehand to make sure that it was 100% covered and that the physician was approved. The insurance company gave us the OK on both. Afterwards we get billed $200 from the physician who was trying to charge for an "office visit" in addition to the routine physical. And then we receive a bill for $600 because the lab work was done by an "out of network" provider even though she went to an in-network physician for the physical. They're trying to get $800 from us for something we were told in advance wouldn't cost us a thing.
Any other company pulling that kind of crap would be shut down for fraud.
Been there, done this, survived the walletectomy.
I used to have PPO coverage through United Healthcare. Then, coincidentally right after their last CEO left with a 1.5 gigabuck golden parachute, they decided to get a little more... competitive. They dropped what they were willing to reimburse physicians and labs. Our doctor of over 20 years told us he couldn't accept that insurance any more, so we had to find a new one.
The only doctor within 15 miles that would take UHC had his office in a strip mall, where he saw his mostly Medicare clientele. Call him Dr. Nick... He worked with Quest Diagnostics for lab services, which was handy because they had a walk-in facility four doors down. Guess what major lab service just stopped working with UHC?
So, now we had to find a lab service that Dr. Nick could work with, and that would work with UHC. I learned way too much about medical labs and processes, and eventually identified the Stanford Clinical Lab as one that would work. They were convenient to... well... nowhere. Only a 2 hour drive. Each way. Dr. Nick would draw the blood and write up the paperwork, then I'd pop it in my little cooler and go for a drive.
I heard similar stories from others about hospitals. That is, the hospital was in the plan, the physician or surgeon was in, but the hospital's lab (Quest managed) and anesthesiologist were out.
During the next open enrollment period I switched to the top-rated HMO. This whole do-it-yourself thing was a little too much for me.