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Old 09-04-2010, 04:49 PM
 
Location: Ayrsley
4,714 posts, read 8,660,894 times
Reputation: 3815

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[quote=Sky1;15758625]Great, now here it the EOB for my visit. After my co-pay I am now responsible for another $325.

So AFTER insurance (That I pay $800 per month) It cost me $800 for a physical?

THis is crazy!!
So what did the doctor's office say? Did they re-submit the tests with different insurance codes (your fears about being denied coverage down the road because of how you had your tests coded is sheer paranoia).

Have you spoken to your insurance agency?

If your initial recourse is to go hire a lawyer well....you're not looking for a "good attorney", you're looking for an ambulance chaser.
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Old 09-04-2010, 10:40 PM
 
5,300 posts, read 11,487,118 times
Reputation: 13007
Quote:
Originally Posted by Sky1 View Post
Great, now here it the EOB for my visit. After my co-pay I am now responsible for another $325.

So AFTER insurance (That I pay $800 per month) It cost me $800 for a physical?

THis is crazy!!
Anyone know a good attorney in the Raleigh area?

What exactly do you expect a lawyer to do for you??

Were you injured in some way?? Was there a delay in diagnosis, missed diagnosis or other gross error of judgement made??

If you are so up in arms about the money, keep in mind the $800 you are griping about should buy you about 2 hours of a lawyers time....
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Old 09-05-2010, 03:01 AM
 
43,012 posts, read 94,975,217 times
Reputation: 30461
Quote:
Originally Posted by buddy5 View Post
i) Yes you are responsible if he makes an error.
Not true.

Quote:
Originally Posted by AnonChick View Post
If you actually had the tests performed, then yes you are responsible for paying them.

Yes, it's the doctor's responsibility to test you appropriately. But it's also your responsibility to be aware of what the doctor is ordering for you. If he says "go take this piece of paper and bring it to the lab and they'll take care of everything," it's up to you to ask "what does this piece of paper MEAN?"

And if he doesn't explain it in a way that you understand, you ask him to explain it differently. Or ask for the physician's assistant to explain it (they tend to speak Human-Ese rather than Doctor-Ese when talking to patients - they're bi-lingual like that ).
Some doctor's offices draw blood in the office. The doctor could say one test is being performed, but another test is done instead.

Quote:
Originally Posted by pinetreelover View Post
If they never discussed the labs with you, you should not have to pay for them. You could give them a reasonable chance to try to get the labs paid for by the insurance, but only if they are able to explain to you how these labs were necessary for your care.

When doctor's offices have in-house labs, pharmacies... they do tend to be more aggressive about using those services. Though they don't need your consent for every lab test (I'm sure you signed some sort of a global consent), it is the standard of care to explain to a patient what tests are to be done and why they are being done. If they don't have documentation in their notes of that conversation, then the conversation did not happen and they should reverse the charges.

Remember: calm, pleasant, polite and firm.
Definitely listen to pinetreelover. You can fight this, but not with an attitude. You call the Business Manager for the practice AND your insurance company. If the doctor's office doesn't reverse the charges (give them some time), write an official letter to the doctor's office and send it certified mail. Keep a copy of the letter you wrote and the receipts for the certified mail in a file or safe place. These will serve as your proof that you were billed in error. Usually a letter will inspire them to correct the error.

It annoys me that people let errors be paid by insurance companies. Nobody should pay for doctor errors. Patients shouldn't pay. Insurance companies shouldn't pay either.

Quote:
Originally Posted by bluedevilz View Post
What exactly do you expect a lawyer to do for you??

Were you injured in some way?? Was there a delay in diagnosis, missed diagnosis or other gross error of judgement made??

If you are so up in arms about the money, keep in mind the $800 you are griping about should buy you about 2 hours of a lawyers time....
Agreed. A lawyer isn't going to help an OP whatsoever. Not only will it cost her more money, but no lawyer would take the case. There are no damages.
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Old 09-05-2010, 03:12 AM
 
Location: Ohio
15,678 posts, read 14,151,481 times
Reputation: 21847
Quote:
Originally Posted by Sky1 View Post
Great, now here it the EOB for my visit. After my co-pay I am now responsible for another $325.

So AFTER insurance (That I pay $800 per month) It cost me $800 for a physical?

THis is crazy!!
Anyone know a good attorney in the Raleigh area?
This is why preventative medicine is not going to work.

Most people that have to pay high premiums for insurance are not going to seek out preventative care if they are going to be stuck with yet another hefty charge. People just can't afford it.
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Old 09-05-2010, 07:10 AM
 
Location: NJ
12,545 posts, read 22,525,108 times
Reputation: 11477
Quote:
Originally Posted by Sky1 View Post
Great, now here it the EOB for my visit. After my co-pay I am now responsible for another $325.

So AFTER insurance (That I pay $800 per month) It cost me $800 for a physical?

THis is crazy!!
Anyone know a good attorney in the Raleigh area?
I've been following this since you posted.
My opinion was that most doctors now; especially if you are a new patient, are ordering lots of blood work to get starting levels - I actually have 2 blood orders that I never used.

Since you've posted; I've gotten a bill in the mail from a Dr I saw in early 2009. This Dr was supposed to be in network; which means I would have a $15 copay. I was surprised to get a bill for $36.

Office visit - $197. - insurance paid $102.40 of this
Physician visit - $64 - insurance paid nothing
total - $261

I tried calling to get this cleared up & did not - thankfully I still have the EOB. I wish I could find the print out from the insurance page where the Dr was listed in network.

Have you called your insurance? That's what I'm doing next.
I wonder if their blood facility is not in network.
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Old 09-05-2010, 10:34 AM
 
43,012 posts, read 94,975,217 times
Reputation: 30461
Quote:
Originally Posted by Roselvr View Post
My opinion was that most doctors now; especially if you are a new patient, are ordering lots of blood work to get starting levels
I think we can avoid that by forwarding medical records to new doctors. Regardless, the OP says she has been going to this same doctor for a long time.

I hope you get your issue resolved, Roselvr. Definitely call your insurance company!
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Old 09-05-2010, 01:01 PM
 
Location: NJ
12,545 posts, read 22,525,108 times
Reputation: 11477
Quote:
Originally Posted by Hopes View Post
I think we can avoid that by forwarding medical records to new doctors. Regardless, the OP says she has been going to this same doctor for a long time.
Yeah, and some doctors decide that at a certain age; other tests should be done.

Either way, the doctor will probably say the blood work was needed for what ever reason.

Quote:
Originally Posted by Hopes View Post
I hope you get your issue resolved, Roselvr. Definitely call your insurance company!
I will or I'll pay it.
I didn't care for the Dr due to the amount of tests they wanted.
I'd gone there for Chantix
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Old 09-06-2010, 10:26 AM
 
Location: Georgia, USA
25,158 posts, read 30,047,716 times
Reputation: 31288
Quote:
Originally Posted by Roselvr View Post
I've been following this since you posted.
My opinion was that most doctors now; especially if you are a new patient, are ordering lots of blood work to get starting levels - I actually have 2 blood orders that I never used.

Since you've posted; I've gotten a bill in the mail from a Dr I saw in early 2009. This Dr was supposed to be in network; which means I would have a $15 copay. I was surprised to get a bill for $36.

Office visit - $197. - insurance paid $102.40 of this
Physician visit - $64 - insurance paid nothing
total - $261

I tried calling to get this cleared up & did not - thankfully I still have the EOB. I wish I could find the print out from the insurance page where the Dr was listed in network.

Have you called your insurance? That's what I'm doing next.
I wonder if their blood facility is not in network.
Was any of the amount charged to a deductible? Deductibles and copayments are not the same thing.

Did you make sure the doctor was in network by confirming it with the doctor's office before the visit? Insurance websites are notoriously sloppy in keeping physician status up to date.
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Old 09-06-2010, 10:45 AM
 
Location: Georgia, USA
25,158 posts, read 30,047,716 times
Reputation: 31288
Quote:
Originally Posted by Sky1 View Post
Great, now here it the EOB for my visit. After my co-pay I am now responsible for another $325.

So AFTER insurance (That I pay $800 per month) It cost me $800 for a physical?

THis is crazy!!
Anyone know a good attorney in the Raleigh area?

What is your deductible?
How does the EOB account for the amount that it says is your responsibility?
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Old 09-06-2010, 06:02 PM
 
Location: NJ
12,545 posts, read 22,525,108 times
Reputation: 11477
Quote:
Originally Posted by suzy_q2010 View Post
Was any of the amount charged to a deductible? Deductibles and copayments are not the same thing.

Did you make sure the doctor was in network by confirming it with the doctor's office before the visit? Insurance websites are notoriously sloppy in keeping physician status up to date.
Hard to say so long after but it's something I do normally because I know better.

There should not have been a deductible if they were in network. I never had a deductible with that insurance.
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