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Recently I went to a specialist to get something checked. Nothing was wrong, thankfully, except the bill when I got it.
I have an HSA plan (actually switching to a POS plan in 2012 for just this reason), so I'm sensitive about costs. I asked the receptionist what the visit would cost. She seemed unsure, but said a basic visit would be a bit over $100. I confirmed with her it would be under $200, and she said that a basic visit would be, but couldn't give an exact number depending on additional tests and follow-ups.
Well, I had the appointment. All 10 minutes of it. No tests, nothing special. In and out. Got the bill. $325.
Do I have any chance of getting this down?
I figured the best first step would be to contact the insurance company. I contacted them via email, and they gave me a completely irrelevant, canned response about it not being covered because I have an HSA. Well, that wasn't the point, the point was shouldn't an insurance company defend my basic rights as a consumer? Guess not.
Excuse my ignorance on the subject as I rarely go to the doctor, let alone a specialist.
I do billing for a doctor. #1 Did you see your primary care doctor or a specialty doctor? IF this was a specialist, was this your first visit? #2 A receptionist can only give you an estimated range. You cannot bill a visit only by the time spent with a patient, there's different factors that go into picking the code for the visit. #3 Does your physician participate with your insurance company?
1. An HSA isn't insurance. It's a Health Savings Account. It's just a savings account, a bank account, earmarked specifically for medical expenses. The company holding your money has no obligation to you, or any other consumer, other than to hold your money and release it back per whatever agreement you made (whether it's reimbursing you, or paying the doctor directly).
2. Generally, the cost of the doctor's visit isn't determined until after the visit is over. They have no idea what they're going to do, when they see you, until they see you. And the billing code doesn't get added to your patient file until after you leave the office. It's possible that the billing code is incorrect, but you won't know that til you call their billing office.
3. If the receptionist really and truly gave you a verbal statement that you would not be responsible for a bill higher than 200 dollars, then you need to speak with the office manager and lodge a complaint against the receptionist.
Tarragon's point about the physician participating with your insurance plan is important.
The claim should still be filed with your insurance company, and if your doctor participates, the company has probably negotiated a discounted fee.
You should then receive an "Explanation of Benefits" from the insurance company telling you what that negotiated fee is.
With an HSA, you have a high deductible. If you have not met your deductible, then you may owe the entire (discounted) fee.
When the receptionist seemed unsure, you should have asked to speak to the person who does the insurance claims. It appears she misled you. The fee for the first visit is usually a bit higher because of the administrative chores that are involved with a new patient. The $325 for a first visit to a specialist does not sound out of line, but it is possible the complexity of the visit was not coded properly. Again, the insurance specialist for the practice should be able to help you with that.
Keep in mind that you are paying for your doctor's expertise, not his time (unless he is a psychiatrist --- they bill strictly by length of visit). For example, your family practitioner sees a skin dohickey that he's never seen before. He can either remove it (with a fee for doing that and a fee for a pathologist to look at the specimen.) Or, he can send you to a dermatologist who has seen dozens of similar dohickies and knows they do not need to be removed. The dermatologist spends a few minutes with you and you are done. But if you have never seen this dermatologist before you will be billed a new patient code.
By the way, if you ever do see a dermatologist, ask for an all over skin exam when you make the appointment. The dohickey your family doctor saw may not need to be removed. The one hidden in your hair that he did not see may need to come off.
Everyone has given great input- I agree that you should talk to someone in their office to make sure it was coded right but my guess is that the price is correct because most have told me that 1st appoints can in fact go over what you paid. It may not be the time the Dr spent but also the staff with setting the file up & taking information. I'm slapping my head as I say all of this because I hate Drs who can't just quote a price for a 1st visit. I normally move on to someone that can.
Recently I went to a specialist to get something checked. Nothing was wrong, thankfully, except the bill when I got it.
I have an HSA plan (actually switching to a POS plan in 2012 for just this reason), so I'm sensitive about costs. I asked the receptionist what the visit would cost. She seemed unsure, but said a basic visit would be a bit over $100. I confirmed with her it would be under $200, and she said that a basic visit would be, but couldn't give an exact number depending on additional tests and follow-ups.
Well, I had the appointment. All 10 minutes of it. No tests, nothing special. In and out. Got the bill. $325.
Do I have any chance of getting this down?
I figured the best first step would be to contact the insurance company. I contacted them via email, and they gave me a completely irrelevant, canned response about it not being covered because I have an HSA. Well, that wasn't the point, the point was shouldn't an insurance company defend my basic rights as a consumer? Guess not.
Excuse my ignorance on the subject as I rarely go to the doctor, let alone a specialist.
Appreciate any advice.
Wow!! That's alot of money for a Doctors visit. I have never heard of this type of plan you have. We have oxford and a visit to a specialist is $50.00 and our regular MD is $30.00. Good Luck Disputing the bill.
Recently I went to a specialist to get something checked. Nothing was wrong, thankfully, except the bill when I got it.
I have an HSA plan (actually switching to a POS plan in 2012 for just this reason), so I'm sensitive about costs. I asked the receptionist what the visit would cost. She seemed unsure, but said a basic visit would be a bit over $100. I confirmed with her it would be under $200, and she said that a basic visit would be, but couldn't give an exact number depending on additional tests and follow-ups.
Well, I had the appointment. All 10 minutes of it. No tests, nothing special. In and out. Got the bill. $325.
Do I have any chance of getting this down?
I figured the best first step would be to contact the insurance company. I contacted them via email, and they gave me a completely irrelevant, canned response about it not being covered because I have an HSA. Well, that wasn't the point, the point was shouldn't an insurance company defend my basic rights as a consumer? Guess not.
Excuse my ignorance on the subject as I rarely go to the doctor, let alone a specialist.
Appreciate any advice.
I have the same kind of plan and a comparable experience.
I was concerned I had strep and called the Dr to get an estimate of the charges to come in for a test. I was told $95. At that price I felt getting the test and a jump on treatment (if I had it) were worth it. When I went to pay the bill was $195. As I was paying I made sure to tell them that I was very unhappy as I'd called in advance to get an estimate of the charges and was told $95. Evidently that was for the visit and didn't included the test. Well the entire reason I went there was for the test! IF they'd told me approx. $200 I'd have waited. (I ended up NOT having strep.) It was an office visit and a test; the services were provided so there really was nothing to dispute.
I had a similar experience a while back trying to "shop" for the best price on a very expensive prescription. I called the insurance carrier, the RX processing company, and 4 pharmacies and got little to no information.
I consider myself an informed healthcare consumer as I used to work for a health insurance company and my employer promotes self-care, personal accountability and making good personal and financial choices when it comes to healthcare decisions. With a high deductible plan and an HSA this is exactly how it is supposed to work. When it's your money, you tend to care more about how it's spent. The problem is that the system isn't set up for this. I can't think of any other product or service I buy that I have no idea what it's going to cost until afterwards.
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