Help me understand--insurance isn't covering my yearly preventive office visit

[AguaDulce]

Originally Posted by suzy_q2010

Can you post pictures of the bill and the EOB? Do not include your name or identifying info.

I will as soon as I get to work tomorrow (where there’s a scanner). Thanks.

[suzy_q2010]

Originally Posted by AguaDulce

I will as soon as I get to work tomorrow (where there’s a scanner). Thanks.

[bigdogmom13]

I just had my yearly physical as well, including thyroid testing. I just looked at my EOB. Complete lab work cost was $162 (comprehensive panel plus cholesterol panel); plan discount was $128; plan paid the remaining $34 and I owe nothing.

[arwenmark]

I think your best bet is calling and asking your doctor's office what the actual cost of that test is and why it is so high?

[jaminhealth]

OP: I'm guessing your employer does not offer health insurance benefits. Reading your story and thinking about my own life and how it's been with benefits from employers, it's hard to swallow where it is today. More and more greed on the part of the insurance companies. Personally, I didn't go to doctors unless I really needed to and that started after 50 when I went thru menopause and everything changes.. I worked for years on getting thyroid supported..due to those G.D. lab numbers. It's all money driven and numbers driven, forget about symptoms and how patients feel....I've ranted as I had to get things off my chest I suppose.

Your bill sounds terribly fishy to me. If you are left with monies they say you owe, make minimum payments -- they can't get blood from a turnip and you sound like you live pretty simply anyway and on a limited income. My 2cents for my almost 80 yrs on this earth.

So so much has changed and I must have had 15 employers in my 40 yrs of working, and they all offered a health insurance in their benefit package. We in many ways are a crazy money driven country.

I do my best to stay away from doctors but stuff happens...I do a LOT of my own healing and that's where a good sum of my money goes.

[bigbear99]

Originally Posted by RbccL

That does sound too high for one test. Definitely call your insurance company's customer service tomorrow, for all you know this could be in error in coding --that happens all of the time. Seriously, all of the time, and it isn't caught until the member calls and asks for an explanation of why that amount is so high. Good luck!

This is excellent advice. Also call the hospital billing office after talking to the insurer. One obvious question for the hospital is whether they received a denial from the insurance company.

Also, are there any footnotes on your EOB?

[xray731]

Originally Posted by AguaDulce

I have a high-deductible bronze plan that I signed up for at healthcare.gov. It allegedly covers preventive routine visits and screenings.

I went for my yearly preventive office visit a couple of weeks ago and today I received a bill from my doctor's office for $519.96 for the charges that my insurance company didn't cover.

Since I had my yearly thyroid test during the visit (among other tests that were not diagnostic) to determine whether my current Levothyroxin dose was still good (diagnostic), I did expect a bill, but $519.96?

The EOB from my insurance company shows the names of two doctors that I never saw, and includes a code notation as follows:

"45 - Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement."

Anyone experienced this?

You need to call your insurer directly as no one here knows you're policy and what's covered and what isn't. There are thousands of policies now a days and what is covered by some isn't by others so asking advice here is futile until you can provide more facts and figures. Best to you as I'm in a similar situation with
surgical bills - next time - I'll tell them to just watch it and if there is a change - then we will proceed with surgery.