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I'm asking for a close friend who is freaking out over a medical bill. He recently joined a new employer, with a new health plan, so this is the first time he's seen this doctor.
He went in for a few routine tests of a type many people get at least once a year, plus a prescription. The appointment seems to have gone smoothly, he said his test results are fine.
Only afterwards does he realize he's being billed $2500 for the tests in addition to $170 for the visit. With his deductible, he's going to be responsible for about $1200 of this.
These tests are really nothing fancy - according to some quick research, the usual out-of-pocket cost for people WITHOUT health insurance is supposed to be $50-200. In many places you can get the same tests for free from a public health service.
He's really angry the doctor didn't mention how much this was going to cost. I'm shocked as well - the times I've seen a doctor for comparable services, it has never cost me more than $60 all told (copay, prescription - once it was even free, because my doctor said he would count it as a physical).
Does anyone have advice for a situation like this? How can you prevent a doctor from gouging you when they are almost never upfront about cost?
First, if this is really just a "routine" yearly exam and not a visit for a specific condition or complaint, the insurance company is required to pay in full for the visit and for any acceptable tests that are done during the visit, with no deductible being applied. It's part of Obamacare that has already gone into effect. If he had things done that are not part of the "acceptable" list, then those would be billed separately. Also, if I interpret this correctly, if any tests are done at a facility other than through the doc's office, then there could be charges for those.
Secondly, where did he get the "billed" numbers from? It is a known fact that what the doc's office bills the insurance company and how much the insurance company actually pays is totally different. Most of the time they bill at least twice, if not more, than what they actually get paid. So if the $2500 is what was billed, that isn't necessarily what the insurance company rates are. And in conjunction with that, his co-pay is based on what the insurance company pays, NOT what the doc bills. For example, if the co-pay is 20%, he would pay the 20% (+ deductible) of what the insurance company says is acceptable payment for the tests, not what the doc bills.
Of course, this is all based on the assumption that the doctor is "participating" with the insurance company. If not, then all the above is out the window. I would tell him to not be too concerned until he actually gets a bill, IF he gets one. He may not even get one.
First, make sure there wasn't a typo when those charges were submitted. If not, call the insurance company and see how they are supposed to be covered under the policy he has. I agree, what are the tests?
It was a couple of STD tests plus an HIV blood test. He's gay and sexually active, so it's important to get this done every six months or so for safety's sake.
I agree there must have been some kind of mixup, maybe between the doctor's office and the insurance provider. It turns out that in the same hospital that did the testing, there's a drop-in clinic where you can get all the tests he had and more for $160. So, I'm hopeful it will turn out to have been a mistake.
Get a detailed explanation of benefits which shows the breakdown in costs. This might be available online if his insurance carrier sets up online accounts. I know BCBS does this.
Go from there, but these tests shouldn't cost more than $200.00
The insurance company should have a "negotiated" rate. The first step would be to find out what that rate is. Hospitals have "retail" charges that have gone beyond usury and very few states have stepped up to the plate and stopped them. In a worst case scenario, you have to show up in person at the billing department and beg, cajole, or threaten. The key is to walk out with a bill that says "paid in full" on it.
Most insurance claims are by coded treatment. He shuld wait for the insruance compnay to sen him a explinatio of benfits as tot eh treatemnt.of course he being new to plan will likely see higher cost ebcasuse of dedcutable not being covered. Most employers have a certain amount ehy apy if one uses their netwrok provide for a specific coded treatmrnt and what is pasid as well has his responsibilty will be fully covered on the explaintion of benefits sent.
I'm asking for a close friend who is freaking out over a medical bill. He recently joined a new employer, with a new health plan, so this is the first time he's seen this doctor.
He went in for a few routine tests of a type many people get at least once a year, plus a prescription. The appointment seems to have gone smoothly, he said his test results are fine.
Only afterwards does he realize he's being billed $2500 for the tests in addition to $170 for the visit. With his deductible, he's going to be responsible for about $1200 of this.
These tests are really nothing fancy - according to some quick research, the usual out-of-pocket cost for people WITHOUT health insurance is supposed to be $50-200. In many places you can get the same tests for free from a public health service.
He's really angry the doctor didn't mention how much this was going to cost. I'm shocked as well - the times I've seen a doctor for comparable services, it has never cost me more than $60 all told (copay, prescription - once it was even free, because my doctor said he would count it as a physical).
Does anyone have advice for a situation like this? How can you prevent a doctor from gouging you when they are almost never upfront about cost?
Tell him to look up the "Medicare Reimbursement rates for CPT code _____".xCPT codes are the number codes next to the description of the service on the invoice. The rates will be a fraction of what he was charged. Then use those to negotiate down the rates he ends up paying.
Read the "Bitter Pill" article in Time magazine.
One thing that I've tried and used effectively for myself and seen work for other people is to threaten to write a "Letter to the Editor" of the local paper to tell the whole community how a provider is attempting to take advantage. The bad publicity quickly gets the provider to change his tune to be willing to negotiate.
For me though, just a letter stating you have every intention of doing that along with a check for what you think is reasonable marked "invoice XYZ paid in full" or something to that effect works great. mention that the outrageous charges are X times more than Medicare Reimbursement rates blah blah blah. Do a little research to find out what "low cost labs" charge etc if that helps and mention that in the letter. State in the letter that if the check is deposited you will take that to mean that the bill has been paid in full, otherwise you have every intention of contacting the local paper to tell the readers how you are being gouged. You get the idea.
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