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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:
Step one - call the provider to get a detailed bill and find out who the two docs are.
Step two - call the insurer and ask for clarification.
Step three - report back to here.
Step one - call the provider to get a detailed bill and find out who the two docs are.
Step two - call the insurer and ask for clarification.
Step three - report back to here.
Too many unknowns now to even venture a guess.
Thanks for your reply.
I have the detailed bill from my doctor's office and the EOB from the insurance company (which includes the two other doctors). Any questions?
Your doctor's office has a contractual obligation to charge the rates agreed to with your insurance company. Choosing a provider who has agreed to be in this contractual obligation is called "choosing a provider in your network". If they are charging above the contracted fee, too bad, neither you nor your insurance provider are obligated to pay that additional amount, they'll just have to write it off as a loss.
If the provider (either clinic or Dr) are not in your network, they will charge as they like, insurance will pay some or none, and you are left owing the balance.
In addition, you had services that aren't considered part of a 'routine yearly exam' even if the services are routine for you, they may not be routine for the average patient or visit. This may be counting towards your high deductible.
Your doctor's office has a contractual obligation to charge the rates agreed to with your insurance company. Choosing a provider who has agreed to be in this contractual obligations is called "choosing a provider in your network". If they are charging above the contracted fee, too bad, neither you nor your insurance provider are obligated to pay that additional amount, they'll just have to write it off as a loss.
If the provider (either clinic or Dr) are not in your network, they will charge as they like, insurance will pay some or Mone, and you are left owing the balance.
In addition, you had services that aren't considered part of a 'routine yearly exam' even if the services are routine for you, they may not be routine for the average patient or visit.
Thanks for your reply.
The doctor is in-network. I selected her from the in-network list on my insurance company's website.
The only service that was not routine/preventive was the thyroid test.
I don't have an issue with the high deductible. I just don't understand the $519 bill.
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?
In reference to the bold, the average person is not on Levothyroxin so testing isnt routine in a routine yearly physical. Any testing that comes up during the routine visit is subject to cause the event to leave the definition of "routine yearly exam".
My doctor asked if we should check my potassium levels, I advised only if my insurance covers that. Drs do know insurance, they like to get paid,
so it's ok to ask these questions.
*BTW, this is just IMO, I wasn't there and can't see the EOB.
In reference to the bold, the average person is not on Levothyroxin so testing isnt routine in a routine yearly physical. Any testing that comes up during the routine visit is subject to cause the event to leave the definition if "routine yearly exam".
My doctor asked if we should check my potassium levels, I advised only if my insurance covers that. Drs do know insurance, they like to get paid,
so it's ok to ask these questions.
*BTW, this is just IMO, I wasn't there and can't see the EOB.
Thanks for your reply.
I'm sorry if I wasn't clear.
I know that the thyroid testing was not routine. As I stated above, it was a diagnostic test, which means NOT routine. Which is why I did expect to receive a bill.
However, there was nothing else during the visit that was not part of a routine preventive yearly visit.
My insurance plan allegedly covers routine preventive visits 100%. I was expecting to be charged for the thyroid test, but that's all. And $519 seems like a lot of money for a thyroid test.
My take-home pay is about $1,500. I work full-time and I walk to work every day. I don't have a car, a cellphone, or cable. I don't smoke cigarettes. I have a roommate.
This $500 bill is tough. But I guess I'm lucky, because I hardly ever actually get sick. And I should count my blessings, because it could be worse.
My take-home pay is about $1,500. I work full-time and I walk to work every day. I don't have a car, a cellphone, or cable. I don't smoke cigarettes. I have a roommate.
This $500 bill is tough. But I guess I'm lucky, because I hardly ever actually get sick. And I should count my blessings, because it could be worse.
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!
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