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Old 05-01-2012, 09:59 PM
 
2 posts, read 2,950 times
Reputation: 10

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i went to an allergy dr but before hand i called and asked how much it cost for a cash patient they said 4-500 depending on the tests. i said ok i had new insurance with a 6 month pre-existing policy however i had never been to an allergy dr before so i figured i was clear. i go get tested and at the end they say it will be 450 for my deductible so i figure ok it's going towards my deductible which is 750 so i figure im almost clear of that whatever...the problem is they still bill my insurance for $445 so im like how can they charge double their rate they said and not have me pay it on my deductible? then my insurance says they have to review for pre-existing condition but during this time i'm getting the bill for this bunk 445 that should never be charged i called the insurance company and they said that it's normal for the dr office to do that but it doesn't sound very normal to me. very frustrating dealing with these thieves on both sides...i am going to slam the dr's office everywhere i can and i'm going to drop my health insurance and possibly take them to court if they deny me. anyone with experience chime in please.

Last edited by SouthernBelleInUtah; 05-01-2012 at 11:12 PM.. Reason: rude language
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Old 05-02-2012, 06:32 AM
 
Location: In a house
13,258 posts, read 34,793,730 times
Reputation: 20198
You asked them what the price was for a cash customer. They gave you the answer.

You then went in and submitted insurance information. That means, you weren't a cash customer. As such, they weren't obligated to charge you the cash price. They charged the -standard fee- which is higher than the -cash customer- fee.

In other words, they USUALLY charge more, because they USUALLY have to deal with insurance companies. The price they quote you was giving you a break on the price, because they wouldn't have to go through the HOURS and WEEKS of red tape involved in getting paid by an insurance company.

There's no bull involved. They offered you a discount. You chose not to accept it. Pay up and deal with it.
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Old 05-02-2012, 01:24 PM
 
Location: Dallas TX
14,374 posts, read 20,669,412 times
Reputation: 20386
I am confused by your question. Are you saying you gave them your insurance information unsure if you would have to pay, paid the bill in full and the allergist sent the claim to the insurance company?

If this is the case, the insurance company should reimburse you not the doctor. If they sent the check to the doctor, call up the doctor and have them cut you a check. They can't double dip.
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Old 05-02-2012, 01:39 PM
 
Location: Dallas TX
14,374 posts, read 20,669,412 times
Reputation: 20386
You also shouldn't slam the doctor's office. It is your error not theirs. If they refuse to pay you back that is one thing, but it sounds to me as if you created the problem.
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Old 05-02-2012, 02:04 PM
 
Location: Georgia, USA
21,618 posts, read 26,307,193 times
Reputation: 26715
Quote:
Originally Posted by cracker49 View Post
i went to an allergy dr but before hand i called and asked how much it cost for a cash patient they said 4-500 depending on the tests. i said ok i had new insurance with a 6 month pre-existing policy however i had never been to an allergy dr before so i figured i was clear. i go get tested and at the end they say it will be 450 for my deductible so i figure ok it's going towards my deductible which is 750 so i figure im almost clear of that whatever...the problem is they still bill my insurance for $445 so im like how can they charge double their rate they said and not have me pay it on my deductible? then my insurance says they have to review for pre-existing condition but during this time i'm getting the bill for this bunk 445 that should never be charged i called the insurance company and they said that it's normal for the dr office to do that but it doesn't sound very normal to me. very frustrating dealing with these thieves on both sides...i am going to slam the dr's office everywhere i can and i'm going to drop my health insurance and possibly take them to court if they deny me. anyone with experience chime in please.
You really need to understand how health insurance works before you start slamming the doctor and the insurance company and talking about suing,

You should get an explanation of benefits (EOB) from your insurance company. Do you have it? Did you read it? You may be able to look at it online at your insurance company's web site.

In order for you to receive credit toward paying your deductible, the claim must be filed with the insurance company. Otherwise, the insurance company has no way to know you paid it.

As someone else pointed out, you asked the wrong question when you made the appointment. You can forget the cash price, because it does not apply to you.

Because you have a new policy, the company will automatically ask for previous records to see if you have been treated for the condition before. If they determine that you have a pre-existing condition, you may be liable for the entire fee. If you ever even discussed allergies with another doctor, it will be considered a pre-existing condition. Seeing an allergist would not be required.

When you have insurance, the company usually negotiates a fee that is less than the cash patient fee. In this case, you were told that the cash fee was an estimate and could vary depending on the testing done.

What you need is a copy of the bill, sometimes referred to as a "Superbill". It will break down the charges for the visit: how much for the exam fee and how much for the testing.

That is how much will be sent on the claim to the insurance company. The company will only pay their discounted amount, not the entire amount.

Did you pay anything at the time of visit? That amount will be credited to your account.

Since you have not met your deductible, the insurance company will not pay the doctor anything. You have to meet your deductible before it starts paying.

The doctor then bills you an amount that is calculated by taking the insurance company's allowed amount and subtracting anything you paid at the time of visit and billing you the remainder. That is what you owe under the terms of the contract you have with the insurance company.

For example: Total fee for office visit: $445.00
Say your insurance allows: 300.00
You owe 300.00 which is applied to your deductible.

If you paid $450 on the first visit, you would be due a refund of $150.

You are getting the bill for $445 because the insurance company has not finished processing the claim. You do not need to do anything until the final determination is made on the pre-existing condition.

If it is determined that the claim is not covered, you will owe the entire $445, because for that visit you are uninsured. You can see if the doctor will accept the amount that the insurance company would have paid, but that is up to the doc. Any amount you pay will not go toward your deductible if the visit is not covered by the insurance company.

So, please look at the bill and the statement from the insurance company. Understand how it works before you go off half cocked and make yourself look silly.

The wisest thing to do when you have new insurance is to wait for the pre-existing condition time limit to expire before getting any non-urgent care.
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Old 05-02-2012, 08:24 PM
 
Location: home state of Myrtle Beach!
6,238 posts, read 18,208,505 times
Reputation: 3430
This must be the first time you are dealing with an insurance claim. How is the insurance company going to apply this $450 to your deductible if the doctor doesn't submit a claim? I agree with the others...before you go off on anyone make sure you know what you are talking about; cause it doesn't sound like you do.
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Old 05-03-2012, 05:31 PM
 
2 posts, read 2,950 times
Reputation: 10
you guys are just making things more confusing thanks for nothing...i told them i wanted to pay cash they said if i had insurance then i had to use it! i have never even mentioned allergies to any dr before which is why im mad at the insurance company and they have been sitting on their butts for 6 months asking me the same questions and for the same records that they have already received twice so i can be mad at whoever the hell i want when they are unprofessional and skating around doing their job. i did pay cash when i paid the portion that they said my insurance said would be the deductible. I know how deductibles and copays and how it's supposed to work and this is not it! i've read the bill and the eob. it's still pending but 6 months is ridiculous for an insurance claim this small to take. if none of you have anything to actually add besides unfounded criticism then don't bother. i'll just file a complaint with the insurance commission board and slam the company for being crap...and to add to this they told me i didn't have any allergies went to another dr for second opinion and i'm now being treated and getting better from allergies. what a waste.
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Old 05-03-2012, 06:16 PM
 
Location: Alexandria, VA
10,764 posts, read 19,165,026 times
Reputation: 14745
Alrighty then... you don't understand so first impulse is complain, sue, etc.
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Old 05-03-2012, 07:15 PM
 
Location: home state of Myrtle Beach!
6,238 posts, read 18,208,505 times
Reputation: 3430
If you didn't intend to use your insurance you should never have mentioned that you had any nor provided the doctor with your insurance card. The only way this happened is because you created the problem; plain and simple. Sure you can file a claim with the insurance commissioner, but being a state agency you will probably find they will take their time too.
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Old 05-03-2012, 07:30 PM
 
Location: Ohio
3,441 posts, read 5,006,630 times
Reputation: 2656
Quote:
Originally Posted by cracker49 View Post
you guys are just making things more confusing thanks for nothing..
It is clear from your description you do not understand how 'deductibles' work, you must pay whatever your deducible amount is BEFORE the insurance company pays a penny, they only credit what THEY would have paid the doctor/hospital to that deducible, but then that is all you have to pay too.
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