ACA plan not accepted - but gave me Medicare rate

[LastOfTheBoomers]

Went for my yearly skin check at my Dermatologist- I had different insurance this year - I could swear I checked out all my docs before I picked one - but alas during check-in they said it wasn’t accepted - she wrote a big Self Pay on the form.
The doc asked me about the self pay - and I told him the story - he did the standard check and then said - “I’ll tell them to charge you the Medicare rate”
Last year with insurance I paid 150, this year with the Medicare rate I paid 80

So do I look for a new dermatologist that accepts my plan - or see if he keeps giving me the Medicare rate?

Has this happened to anybody else?

 

[Dash man]

Went for my yearly skin check at my Dermatologist- I had different insurance this year - I could swear I checked out all my docs before I picked one - but alas during check-in they said it wasn’t accepted - she wrote a big Self Pay on the form.
The doc asked me about the self pay - and I told him the story - he did the standard check and then said - “I’ll tell them to charge you the Medicare rate”
Last year with insurance I paid 150, this year with the Medicare rate I paid 80

So do I look for a new dermatologist that accepts my plan - or see if he keeps giving me the Medicare rate?

Has this happened to anybody else?

Sounds like you need to verify the rate before your next appointment. If he gave you the Medicare rate he must want to keep you as a pat.

 

[zinger1457]

With my ACA plan I need to get my PCP to authorize a visit to the Dermatologist so the insurance company pre-approves the visit. Last time to avoid the hassle of having to see my PCP first, and because I have an HDHP so would be paying out of pocket, I setup a cash pay appointment. They also charged me the Medicare rate but don't believe it was any different than the insurance approved rate I was billed in the past.

 

[teej1985]

I just had a skin check on my employer's insurance plan (GEHA HDHP) and the negotiated rate was $115.94.

 

[Sarah S]

He kindly gave you a break because you did not know in advance. I do not think you can count on it a second time as you would be there knowing in advance that it isn’t covered. If he is in a group this sort of thing done too often gets the provider spoken to.

 

[sengsational]

You're fortunate to have a dermatologist like that. I had the same confusion about accepting BCBS and they charged me the full rate. I ran it through insurance and got about $150 out of $600 towards my deductible. I asked for a reasonable rate, but they said they didn't do that. They called to get me back, and I said it depends on the rate. They wouldn't deal, so I went to the mega practice instead. Then they proceeded to find every billing code under the sun to assign

 

[Aerides]

I would call the office and find out before you go back. A regular visit, even retail rate, would probably not be much worse than your old insured rate.

But next year say you have a thing or two to snip and biospy...they might not be so willing to adjust.

 

[MRG]

I would call the office and find out before you go back. A regular visit, even retail rate, would probably not be much worse than your old insured rate.

But next year say you have a thing or two to snip and biospy...they might not be so willing to adjust.

+1
Exams are generally reasonable needing something done, even minor, can be a different story.

OP my ENT doesn't take ACA(not sure they take any private insurance) and gave me their insurance adjusted rate for an exam. I knew I needed more done and waited for Medicare. My first Medicare insured appointment they suggested corrections to my septum were needed and I certainly didn't want to pay that out of pocket..