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I had to undergo 12 physical therapy hours for a broken ankle this spring. I went in to a physical ttherapy office near my home and asked if my insurance would cover my twelve prescribed visits.
They checked my two insurances and told me that my insurance would cover 100% of all twelve visits and that I would have no co-payments at all. I said, "Are you sure?" The answer was "Yes."
So I went through all 12 hours, and then I later received a bill from the physical therapy office for $99.00 BALANCE DUE.
I looked at the statement and saw that they actually charge by EACH thing they do during the hour, not a fixed hourly rate as they led me to believe!
I do not want to pay this bill because it was my understanding and agreement - based on what they told me - that I would have no out-of-pocket payment due.
I think that it was on them to inform me when our understanding and agreement changed. At the point that they knew I was over my insurance limit I think they were obligated to inform me, and that I was now going to be out-of-pocket.
I am a medical biller. Unfortunately there's not much you can do. Your contract with your insurance company puts you ultimately responsible for determining what is covered and what is not. I can't tell you how many times I've called an insurance company to verify coverage and/or copay amounts, and been given the wrong information.
You could always try calling the PT department, and tell them you were told you wouldn't owe anything. Maybe they'll cut you a deal and shave some of the bill off. Good luck either way.
This is a small private pt office. The owner said she has been in business for 15 years, so surely she would know what she charges and surely she would know what Medicare's limit is.
She never mentioned the possibility of me having to pay out of pocket.
I am a medical biller. Unfortunately there's not much you can do. Your contract with your insurance company puts you ultimately responsible for determining what is covered and what is not. I can't tell you how many times I've called an insurance company to verify coverage and/or copay amounts, and been given the wrong information.
You could always try calling the PT department, and tell them you were told you wouldn't owe anything. Maybe they'll cut you a deal and shave some of the bill off. Good luck either way.
You are correct, I was at the office of a doctor, and he did say look into
getting the shot for Shingles. I really dislike a shot, but said OK, then, requested, the nurse, and she checked with the desk about the cost factor.
350.00 if insurance does not pay, wow! I went home and did ask 3 or 4 times
then got the shot, it was covered in full! Noway, would I have got that
shot if not, but had chicken pox when young! Front desk also did say insurance does say yes for the bill, and then does not pay!
I had to undergo 12 physical therapy hours for a broken ankle this spring. I went in to a physical ttherapy office near my home and asked if my insurance would cover my twelve prescribed visits.
They checked my two insurances and told me that my insurance would cover 100% of all twelve visits and that I would have no co-payments at all. I said, "Are you sure?" The answer was "Yes."
So I went through all 12 hours, and then I later received a bill from the physical therapy office for $99.00 BALANCE DUE.
I looked at the statement and saw that they actually charge by EACH thing they do during the hour, not a fixed hourly rate as they led me to believe!
I do not want to pay this bill because it was my understanding and agreement - based on what they told me - that I would have no out-of-pocket payment due.
I think that it was on them to inform me when our understanding and agreement changed. At the point that they knew I was over my insurance limit I think they were obligated to inform me, and that I was now going to be out-of-pocket.
How shall I handle this? What do you think?
I'm guessing your 12 sessions of PT ran about several thousands of dollars, so consider paying only $99 a deal.
You are on the hook for paying at least SOME of any medical care you receive (even if its a copayment), so I'm not sure why you expected PT to be 100% covered.
Here is the thing: Would you not have had PT if you knew it would cost you $99? Of course not...so just pay it and move on. Its feeling better right? I'm sure that is worth $99...
The patient is always responsible for knowing or finding out if a medical procedure or service is covered. Medical providers who "check your insurance" do it as a courtesy and sometimes get it wrong. So, to the OP, you need to contact your insurance company and find out for sure what your coverage is / should have been. Also, as an FYI, all medical services are billed as SERVICES, not as HOURS. There is a procedure code for everything This is normal and reasonable, in my opinion. Sorry you had to learn this the hard way.
Here is the thing: Would you not have had PT if you knew it would cost you $99? Of course not...so just pay it and move on. Its feeling better right? I'm sure that is worth $99...
What I would have done is go for eleven sessions. And if they had disclosed how they bill me, for example, every time they put an icebag on my foot for 5 minutes they charged me $26. I would have skipped the final icebag and done it myself at home.
They led me to believe there was a fixed price for each visit.
I'm guessing your 12 sessions of PT ran about several thousands of dollars, so consider paying only $99 a deal.
You are on the hook for paying at least SOME of any medical care you receive (even if its a copayment), so I'm not sure why you expected PT to be 100% covered.
..
I expected to be 100% covered because the pt office checked my insurance and TOLD me I was 100% covered. The pt office TOLD ME I would have no co-pay.
And I asked. I asked, "What do you charge for an hour of physical therapy - about $150?" She said, "Yes, that's about right." She led me to believe each session was a fixed price.
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