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My referring doctor's scheduler scheduled me to have an EGD 40 miles from my house. (There are probably five hospitals within 15 miles of my house.) This meant my wife had to drive 160 miles for two round trips to drop me off and pick me up. At the time we were scheduling, I asked him if that was the closest hospital. He told my that's where my insurance requires me to go. (I have UHC PPO.) When I was paying for the procedure that hospital requested a $600 deductible - I was expecting $200. The hospital told me they were out of network, coverage is only 70% not 90%, and deductible is $600 not $200. Huge Red Flag. We called the referring doctor and he told me the scheduler was out until Monday.
My suspicion is the scheduler accidentally sent me to the UHC HMO hospital for this procedure. This is costing us (I'm guessing) probably $500 or so.
Assuming the scheduler did indeed screw up, should I expect the referring doctor to reimburse me for the $500? (I have future, big expensive, appointments with this doctor in the next month.)
In addition, it appears UHC would ONLY cover 70% of the customary fees. So, if the bills was $10K and customary was $5K, UHC would pay $3500 and according to UHC the hospital could bill us for the remaining $1500 PLUS the additional $5K they charged. Does this sound right?
Of course the scheduler is out until Monday so I thought I'd ask the City-Data brain trust for any comments.
I would cancel the appt. It an always be done later. I think you won't get reimbursement b/c it was not an emergency and you were told up front about the charges. You chose to stay and do it anyway.
I would cancel the appt. It an always be done later. I think you won't get reimbursement b/c it was not an emergency and you were told up front about the charges. You chose to stay and do it anyway.
I already had the procedure. I can't cancel the appointment.
I wasn't told up front about the charges. I was told by the referring doctor's scheduler that this the only hospital I can use.
wow that is unacceptable; I'd talk to the scheduler and get her to get the hospital to back down the charges. If that isn't possible then I'd get the doctor involved. His office screwed up; they should fix it! It's too bad hospitals never go over the expected charges before procedures take place.
...............................When I was paying for the procedure that hospital requested a $600 deductible - I was expecting $200. The hospital told me they were out of network, coverage is only 70% not 90%, and deductible is $600 not $200. Huge Red Flag. .....................
This sounds like before the procedure. Are you saying they wanted money after it, after you had been awakened from sedation? That would be pretty unusual. The usual procedure is pay when you check in. That is why I said you were warned and still chose to have it done.
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