We didn't call our provider, but the dermatologist said it was pre-authorized. We have high deductible HSA's but never had seen a bill come back this much before. And what did who tell me when I received the bill? My insurance company?
> We have high deductible HSA's
Did you reach your deductible for the year before the procedure? If not, then the entire cost of the procedure may have been out of pocket.
No we’re not at our deductible. At some point, the receptionist told us the ~$400 would be because it is around 20% of the procedure. Afterwords and during this hot mess, they told us that’s what it would have been IF we were already at our deductible…? So was that assumed? Because that’s terrible and it’s January for crying out loud. Our deductible just reset.
Was hearing that it would be around 20% of the procedure a red flag for you? If you knew that you hadn’t met your deductible yet, wouldn’t you be expecting to pay the full cost?
Yeah, $300-$400 per leg being 20% of the cost of the procedure puts you right at the price point that they’re charging.
It’s clear that the communication was at least a bit muddled, but it seems like they did actually provide information on what the full cost of the procedure would be. They just couched it in terms of an unrealistically optimistic expectation about how much insurance was likely to cover out of that amount.
That plus the reaction afterward doesn’t give the greatest impression as far as their overall professionalism, but it also seems like they didn’t technically lie about the cost.
We actually don't know what was said...this is just a one sided argument. This dude didn't even hit his deductible and probably doesn't even know how his insurance really works.
if anything this is just a problem with the us heatlhcare system and op's lack of understanding about his policy and why High Deductible HSAs are the closest thing to a junk policy since they got rid of junk policies with the ACA.
Why do you think HDHSAs are junk? When I did the math for all my plans (I have a shitton of options through the federal government), the HSA made the most sense even if I hit the deductible (because we also get a contribution to our HSA). Was there something I missed?
The main reason being that the HSA plan was less than half the cost of the low deductible plans per pay period. Plus I can move some money from my paychecks into the HSA and then invest that. If I use that money on medical expenses in retirement, neither the principle nor the earnings are taxed.
HDHSA plans suck unless you aren't using them and just see it as an investment because in practice you pay for everything out of pocket, then if you have some serious medical problem and hit the deductible... Well then i hope its not really bad or you will hit your payout cap and be back to paying put of pocket again... In my 7 years of working in the medical field patients who got the angriest over costs were ones those plans, often those frustrations were taken out on us because you. The person who looked at health insurance plans and chose the cheapest one with an option to have tax free account, now realizes its worthless and that tax was basically eaten up by premiums
Eh, high deductible HSA compatible plans are useful for some. As a 26 year old male, I haven't had any medical costs for the past 4 years (prior to that didn't really either until you go back to my childhood years, but was under different insurance with my parents). I just get my annual check up, flu shot, now covid shot, which all costs $0, max out my HSA, and move on to the next year. The plan is free at my job whereas a lower deductible plan would cost money, I have money set aside to cover my deductible should something happen, and I'm stuffing money away in my HSA.
If I was older and more likely to need care, or had a family with kids, maybe a different plan would make sense, but for now the high deductible plan is great.
That's all fine and dandy until something serious happens and then everything is out of pocket, depending on cost you may end up hitting the payout cap most of these plans have and be back to paying put of pocket and hitting your deductible
I remember thinking that I must have misunderstood something when this type of policy got offered by my employer.
Ok so I pay a monthly premium for insurance...but I pay 100% of all costs as well? That can't possibly be correct. I actually thought the monthly premium went into the savings account and I could use that money to pay for stuff lol.
Nope, you pay hundreds of dollars a month into thin air, then ALSO pay for whatever healthcare you need. If you then happen to spend whatever the out of pocket maximum is, THEN your premium dollars go to work and they are gracious enough to cover most costs after that. ok great, thanks. Worst thing ever.
Not quite. It's not when your out of pocket maximum is reached. It's when your deductible is reached that your insurance kicks in.
A high deductible plan is best for young people who are generally healthy and don't expect to have any procedures.
Before HDHP/HSA, I used to pay $400/mo in premiums. When I switched to HDHP/HSA, I now pay $200/mo in premiums and deposit $200/mo into my HSA. I get to take that HSA with me when I switch providers or employers.
But the monthly premium is a lot less right? And how much is the deductible? Wouldn't you reach the deductible well before they $5k procedure?
I have the high deductible plan and every way I ran the numbers, only something catastrophic with multiple surgeries and hospital stays would make the higher premium plans worth it.
I remember looking at the HDHP option my employer offered thinking "This might actually make sense if you don't need medical services much", and then I remembered that in the U.S. even needing a single medical service can cost more than $5000 and I noped the hell out of there.
Yep. I just started with a new company and had the HSA is waaay better rammed at me for like a week. There was another guy who started with me who took the hsa previously and was left with all this debt cause of a medical problem that came to light before they had time to put anything into it.
You really need to take time to read your benefit book and understand things. It’s complicated, frustrating, and unclear. Insurance companies are a NIGHTMARE to deal with.
But it is absolutely necessary otherwise you really can end up in a bad spot. Like I know, ahead of time, which Emergency rooms I can go to and which hospitals are covered. It would save a ton of hassle going to the in-network ER and then being admitted to that in-network hospital versus being admitted to an out-of-network hospital or arranging for private transportation once stabilized.
I also had to spend nine months, countless phone calls, letters, and I don’t even know how many hours fighting with the insurance company over an ambulance bill, but eventually I succeeded in my claim, and they had to change the way the policy was written for the entire state.
(Long story short, they had advertised a $150 copay for “in-network” emergency ambulance services, and an 80% copay for “out-of-network” emergency ambulance services. After I was slammed with a $6,000+ bill from the city, I found out that in my state, since emergency ambulance services were all operated by the city or county instead of any healthcare facilities, there was literally no such thing as an “in network” emergency ambulance service. So I complained that had I known that, I never would have chosen the policy, as it was deceptive and fraudulent advertising. I had to get the state board of insurance involved….that’s pretty much the key to getting a valid claim actually addressed. Insurance companies do not like it when you get the state board involved, because it usually means massive fines for them…even threatening to report it will likely get your dispute more quickly resolved, or at least you will have their attention.
However, in your case, your policy probably is pretty clear about the fact that you have either total or majority responsibility of copay until your deductible is met. That’s pretty standard.
Hate to say it, but you’re probably going to have to pay the bill. If you haven’t met your deductible, it is what it is. For what it’s worth I have never had anyone ask me if I’m at my deductible. System sucks. For the future, definitely have your guard up when going to anywhere that does cosmetic procedures. They are for profit businesses first and foremost. Or any time you are doing something outside of normal every day doctors appointments. The costs can go up insanely fast and you need to read every document they hand you, even if you are really sick in an ER because it can also include what they are allowed to do during the surgery, contingencies, etc. Again, it sucks.
If possible I would take down the reviews, call back, kiss some butt, and see if it gets you anywhere.
To be honest, they did not mislead you. Very possible they told you this last year after you hit your deductible and then the procedure got moved years. They even explained the 20% to you. Insurance sucks and it’s sad we collectively have to understand how it works, but we do need to understand that and you really do owe them that money. Their conduct was unprofessional. With that said if you hit your deductible go buck wild on medical things for the rest of the year.
to be fair, our insurance and healthcare in general in this country is so needlessly obtuse its almost like situations like this are the point of it. I worked front office at a medical clinic for 7 years (in addition to being an ma and rad tech) and ive even seen medical workers who understand insurance get sideswiped by coverage issues
20% after you hit the deductible most likely. High deductible plans (or really those with any deductible) are not paying out until you hit that deductible apart for routine doctors visits and similar.
Pre-authorization only means that your provider has deemed the procedure medically necessary, not that they’ve deemed it to be cheap or free.
Hopefully this will work out for you, but in the future, the best course of action is to call your insurance company to best understand the costs involved in any non-emergent procedure, as the office can’t be expected to know the costs and coverages associated with each individual patient’s insurance situation.
Am I the only one who can never get a straight answer from health insurance companies on how much something will cost me? I’ve even had specific codes and still got nowhere.
Insurance doesnt charge. The provider charges. Ask the provider.
Edit: In this context the provider is the oloffice/doctor.
Just because something is supposed to be a certain way/price doesn't mean it is. I got screwed on a 10k dollsr bill because the ER said they didn't have a contract with Cigna, Cigna said they did. Health insurance must go through federal courts. Most lawyers will not take the cases because they cannot seek payment from the insurance or provider. Its all out of pocket which is rarely worth the cost.
The provider can bill any amount they want. What matters is what their agreed in network rate is for specific procedure codes with the insurance company. Though good luck getting insurance to divulge that information to you prior to an EOB.
Having been a call agent for an insurance company... the call agents don't even have access to the fee schedules for providers. It's not that they don't want to help... they aren't even given the tools to.
Idk why you’re getting downvoted, this is the right answer. Insurance literally will only say yes or no, and what % they cover. The provider charges for the procedure. Call insurance, get yes/no, then call provider and ask the cost of procedure.
Did you at least talk with your insurance after you got the bill to make sure everything was processed and coded appropriately? I feel like you’ve only been dealing with the derm office when they have minimal control over what your insurance covers/what your responsible for.
Also there are laws about sending bills to collections. I most states as long as you are paying something they can't just send u to collections any time they want. I'd look into that.
EDIT: only to say - the only advice here was to say check the laws in your state on rules around collections especially during Covid. Not any direct advice on paying or not paying. This is after years of dealing with providers and being involved with others' medical debt. Also, it is not bad advice.
This is not true. Please don’t listen to this person. Perhaps what they meant is if you were ON AN AGREED TO PAYMENT PLAN ALREADY then they could not send you.
Statute of limitations on medical bills is 7 years I believe.
Research yourself, and the type of procedure may have something to do with it, but I believe as long as you pay something they can't send you to collections. Then after 7 years, even if it's not paid in full, they can't collect anymore so you can just stop paying and it can't affect your credit or be collected.
To add to the notes above, you can retroactively have procedures or medications pre-authorized and approved. Typically, you need a Dr to communicate with your insurance to provide the diagnosis (tests that gave them that diagnosis would be included if they’ve been done) which argues that it’s medically necessary. You can also appeal (this happens from time to time) the decision and provide additional details which sometimes is expected to happen. If you pay upfront (I’ve done this many times to get something quickly) then retroactively go through the process prepare for it to be lengthy and a bit of your leverage is gone since you’ve paid so you’d need to follow up prudently, take notes on the conversations and provide the appropriate documentation (diagnosis, tests, reasons it’s medically necessary).
[It is, though. ](https://en.m.wikipedia.org/wiki/Prior_authorization)It simply means insurance says “Yes, we’ll cover this” at whatever rate it should be covered, which is sometimes near-zero if the provider is out of network or if a deductible hasn’t been met.
That link is correct. What you said, was not. "Pre-authorization *only* means that your provider has deemed the procedure medically necessary." (Emphasis mine)
Prior auth denials happen all the time on procedures providers deem necessary. A prior auth is your provider checking with the insurance company to make sure services are covered and many times will generate a prospective out of pocket dollar figure for the patient. Sometimes your provider can appeal (things like peer to peer) and get a service covered by showing necessity (time/condition/circumstances) or that prior therapies have been covered and this is the next step.
In this situation, the pre-auth *only* means that OP’s insurance deemed the procedure necessary, so they’d cover it - not that it would be cheap or free. No need to discuss denials as it wasn’t denied - the rest of your comment is good info, but irrelevant to OP’s situation and/or why he owes more than he expected.
Fine, what you said was still wrong and adds confusion to the situation about things being covered. First your statement didn't include the insurance company, which is wrong. Don't say a prior auth is ONLY saying a PROVIDER said the procedure is necessary. That's a wrong statement no matter how you try and correct it later.
I’m pretty sure that everyone else, including OP, knew exactly what my comment meant. If this is what you need to do with your morning then have at it. Hope you have a lovely day!
If OP didn't know how their deductible applied and thought they were being bait and switched there is a good chance they didn't understand what a prior auth was, thus their predicament. Don't say stuff that is wrong and now quadruple down when called on it. Be better.
Even if it was covered with an HSA you're still going to pay for that up front....
It might be a covered medical procedure but that just means it's going to count towards your deductible. Which is good, it's the beginning of the year, do as you get closer to max on one person anything covered will eventually cap.
And even before that step you have to get fucked by the:
"oh yes, we take that insurance!"
then after the bill comes and insurance didn't cover anything:
"oh yes, by "take" we just mean we submit it to your insurance, but since we aren't actually in their network they wouldn't cover anything"
I want to burn their fucking buildings to the ground every time with this shit. You should be able to trust people in medicine.
This is so frustrating. I’ve taken to getting providers on record as to whether or not they’re in network, rather than whether or not they ‘take’ my insurance. I also generally follow up with my insurance to verify. But, it’s ridiculous that we need to do that especially when these providers and insurance companies work so hard to obfuscate the true costs to the end user.
Yes just had a really frustrating experience with a new insurance plan. I thought I picked something similar to what I’ve always picked where preventative stuff is covered except a copay. I went to a dermatologist recently to check in since they wouldn’t refill a prescription without seeing me in person and then was charged for the whole office visit. When I called my insurance they said nothing is covered until I meet my deductible (which is just odd to me because visits like this have always been covered for me in the past, but maybe I just didn’t read the new plan carefully enough 🤷🏼♀️)
That's why you always confirm with your insurance company what the expected costs will be or if a provider/facility is in-network. I don't understand why people don't do this one step. Yes, the system should not be this complicated. But it is for now.
It is shitty but I don't understand why people have so much faith in health care providers' quotes. Insurance is the one paying the bill, of course they should be the main point of contact on if something is covered or not
I don't ask Marriott if I can expense room service for my work. My work is the one paying so I ask them
I think people are under the notion that you can go anywhere, flash your health care card, and get good coverage. Which would be great, but in reality it's no different than shopping for a good deal online. Gotta work with insurance to find what's covered and where it's most affordable
Pre-authorized doesn't mean your insurance will cover the whole cost. Was the procedure done in 2022? If you have a high deductible plan, it's likely going to deductible. You should call your insurance and ask for details regarding your plan and what portion of the bill they covered versus what you are responsible for.
100% this. As a provider, I have in writing in multiple places and ALWAYS verbally tell people directly that they need to talk to their insurance company about their coverage for my services. There are too many different plans, and information I don't have (like deductible status), for me to be able to give any guarantees about out of pocket costs unless they're paying fully out of pocket (annnd, cue a conversation about the many benefits of cash pay).
The receptionist telling you the $300-$400 was 20% of the cost is an important detail! They were exactly correct, 20% of $3700 is $740, or $370 per leg. As many others have explained, somehow the receptionist assumed you’d met your deductible (was this in 2021?), and insurance would cover 80%. But they can’t know that, and it’s your responsibility to know your insurance coverage and deductibles. You do seem to understand it resets in January so I can’t really understand why you’d expect your insurance to cover 80% if you have a high deductible plan. I think this is a hard lesson learned and not really their fault. Look at it this way: now you’ve met a bunch of your deductible for the year already, and you’re closer to your coverage kicking in on other health services.
This is the only answer. You have an HSA. It’s high deductible. You will pay high costs until you reach the deductible. If you’re already getting surgery’s at 27. You might want to switch out of an HSA
>you’re already getting surgery’s at 27. You might want to switch out of an HSA
In many situations it is *still* cheaper to be in an HDHP, the difference in annual premiums can often exceed the out-of-pocket max.
I am 44. I have had various insurance plans on my own for over 20 years. They get weirder and harder to understand each time I have changed jobs.
I read the summaries before signing up. I go through the more detailed versions once I have picked a plan and I still get surprise bills and fees. Lately more in a pay for seeing the doctor but itemize every other aspect of a bill and the doctor’s office can’t give a price and insurance can’t say how much (last time it was a letter that said “you may save up to $290* ** ***”, but when I called they said there was no way to know how much I could save (or pay) until everything was done.
It was not always like this. It used to be a copay and you were done and didn’t have to worry or think about it after that.
I agree with everyone who says insurance is complicated and didn’t mean to be harsh!! Just to realistically answer the question. I know I’d be surprised and upset by bills sometimes too, which is why I only ever select the HMO. I’m sorry for people who don’t have an HMO option!
I have an HMO, and still ended up with a surprise bill that I'm still not sure if its legit.
I have plaque psoriasis and had a spot come up on my inner thigh that looked like guttate psoriasis. Went to the dermatologist and they wanted to do a skin biopsy. All done in office. I get to the desk to pay my copay($35) and she rings up over $100. I've never had something done in office that wasn't completely covered before, but I've never had a skin biopsy before. I wasn't expecting to pay more than my copay that day, I didn't really have the money, but what could I do? I paid it and then pinched pennies for the rest of the month.
Then I get my EOB for that visit and it says the amount I should have owed was $0. I called the insurance company and asked them about it, they said that I should call the dermatologist office for a refund. So I called the office and told them and they issued a refund.
6 months later I get a notification that a new EOB is available to view. I login to view it and there are actually 2 EOBs issued on the same day. One is an exact duplicate of the one I received 6 months ago and the other is dated the same but says I owed the amount that I had paid and then been refunded. Called my insurance and they said "oops, yeah something was coded wrong and actually we didn't cover it and you owe the office the money".
Another month went by and I did receive a bill(last month actually) from the dermatologist office. I haven't paid it yet, because again its a completely unexpected bill and the whole thing feels shady af. No one has told me what was coded wrong, how it was "wrong", why the new code is something they don't cover, etc. Do I need to talk to insurance, the office? Somehow manage to get both on the call at the same time(probably impossible because the dermatologists office is nigh impossible to contact via phone, they have a texting service they prefer you use instead).
I would look at your benefit summary document (or maybe even somewhere on the front or back of your card). In my HMO co-pay for an office visit is one amount and copay for a specialist office visit is higher. Is $35 what you pay at your primary care doc, and $100 for specialist visit? If $35 is the specialist copay, then yes I would ask the ins co what the other $65 is for. It’s clearly related to the office visit if it was the biopsy then that would have been a lab charge and not charged by the dermatologist at the office. I think you owe something because there are always co-pays in my experience except for basic preventive services (annual physical, etc.). Those are always co-pay-free thanks to the ACA. (Also, unrelated to your specific question so not advice just informational: to the benefits of an HMO, you don’t seem to be being charged for the lab/biopsy, that seems to be fully covered. It would not be in a PPO, you’d have to pay if you hadn’t met your deductible and if you had you’d still pay 20% if you hadn’t reached your max out of pocket. Which is why I stick with the HMO.)
$20 is my PCP amount, $35 is the copay for specialist visits and what I've paid every other time I've visited that dermatologist. The actual total was like $168, so my $35 copay + $133 for whatever it was that wasn't covered. From what I can tell on the EOB the lab stuff was covered, its just the "procedure" of them taking the skin that was covered and then later decided they didn't cover it.
This case is pretty straightforward, but it's frustrating how obtuse and overly complicated the system really is. Talk to your PCP about mental health? Surprise bill. Facility uses an out of network specialist? Surprise bill. There's only so much diligence you can do when the entire system is set up to maximize profit.
To be fair, insurance is not necessarily easy for everyone to understand. It’s definitely not like they teach it in school. Many people can figure it out with a little effort but often people don’t truly understand it until something sucky like what happened to OP.
It is beyond obtuse. Even when fully informed, you run into issues like the doctor not knowing the cost of procedures. Even weirder, dental insurance plans (in the US, at least) usually have an annual maximum coverage (typically 1,000-2,000 USD), meaning any cost over that cap is your responsibility. This is exactly the opposite of how health insurance works, where hitting the annual "max out of pocket" means they pay the rest. It is so counter-intuitive, that my dentist alerts patients. When I told my parents, they decided to cancel their personal policy (mine is provided by work), as the maximum coverage was 2000 (which they never hit) and the annual cost was 1800.
It’s not an easy thing to understand. I mean, actuarial science is a whole ass field with multiple degrees, so it’s generally accepted as an unnecessarily complicated subject.
That aside, knowing your deductible and getting the flyer that explains what the plan covers in and out of network will go a long way in situations like this.
Completely agreed.
To add to that
1. Don't expect the health care provider to understand your insurance coverage
2. All questions, concerns, difficulties with navigating insurance, should be directed to the *insurance company*
If the office cares about their patient they would have done a insurance benefits check before the procedure and talked about where the patient is with their deductible and what the total out of pocket should be. It’s a short call to the insurance company. Yes, the burden is on the patient to understand their benefits but to avoid all of this the office should help with explaining as well.
Patient should also talk to the doctor to let them know about their office staff and how they’ve been treated. The front desk and admin as gatekeepers and treating the patients poorly is a huge problem with the private practice experience and delivery of healthcare. Most put up with it but there’s no reason to… patients have options to choose to go elsewhere.
We can just as easily say the patient can take these steps. It sounds to me like the office already did make this call since they knew the percentage due after deductible. I'm betting that said "it'll be $x after deductible" and OP just ignored the "after deductible" part.
Always, always, always call your insurance and don't talk to the office about insurance. They have absolutely no idea if you are covered or not. The office can only give their best guess.
I also have a high HSA, and pre approval, means it will be convered and count towards the deductible.
But thay doesnt mean, if the deductible wasn't met it will be 20% or whatever.
Pay the bill and move on.
While they were rude, and a neg review is warrented for that. It doesnt sound like its their fault your deductible wssnt hit already
Unfortunately I think this is the answer. I'm also on a high deductible plan and this is how they work.
The rudeness is unacceptable but the bill honestly seems completely reasonable. You cannot take a receptionists opinion on how your insurance will work. They aren't going to know.
And to make it worse. Its was in january.
If the appointment was made in nov/dec, when they called to get pre-approved for the patient. The insurance company might have said 'and their amount will be 20%"
But since the deductible is now un fulfilled, its 100%, how would a office manager know this?
This is true. No one in that office knew how much your procedure was going to cost. Your doctor does the needful, a coder reads his surgical note and assigns a procedure code. Your insurance applied a negotiated discount and passed it onto your deductible. There was no way the receptionist knew what the doctor was going to do, what the billing code was, or what the specific contracted discount with your particular insurance plan was.
Lesson: Read your insurance plans carefully. Don’t use a HDHP unless you really don’t plan to see a doctor that year aside from a free annual checkup. HDHPs prevent you from being bankrupted by a car accident, not to cover your wife’s varicose veins.
At my company it’s a choice between a $30 copay and high deductible plan. Once you do the math it actually ends up the HDHP plan is cheaper in 90% of situations, you just pay for the healthcare you use as opposed to in premiums. I know multiple companies who structure it this way.
The "once you do the math" is situational. It is cheaper for you, it will certainly not be cheaper for others. Everyone needs to think about their own hypothetical healthcare expenses for the year and pick the plan that will be best for them. I'm sure you know this, I'm just saying this for others reading it that high deductible plans may not be right for them.
It is not situational. We worked out a graph for different spend levels and there is only a small 10% portion where you win having the $30 copay plan. This is actual math, you just have to figure out if you think you fall in the 10%.
You have chosen arbitrary spend levels and then determined that only 10% of those arbitrary inputs result in the normal deductible plan being better. That's fine for you but certainly doesn't represent the range of medical expense levels anyone could experience. There's no upper limit on how much a family could conceivably incur in medical expenses in a year. The set of potential spend levels for any given family is, as I said, situational.
>HDHP plan is cheaper in 90% of situations
I'd argue that it's closer to 70-75% of the time, especially if you have a family with young kid. Under 30 with no known health issues HDHP is going to be the correct choice. For the rest of people, eh not so much.
My 90% was based off my company's benefit structure. Still true with a pregnant wife and 3 year old, with a lot of other medical costs. Sorry if I wasn't clear.
A HDHP also provides access to an HSA, which is a great savings vehicle. That should be part of the consideration when you're picking an insurance plan.
You’re correct we’ll need to call insurance tomorrow.
And also correct. We had a verbal agreement before signing a financial policy. Again, just feeling like we were told something, signed the agreement off of that and we’re billed entirely different…
..7. Patient is billed if insurance estimate was low and not enough was collected in step 5 or Patient has a credit balance if total owed after insurance processing is less than initial estimate that was collected in step 5.
..8. Read your EOB and reconcile it against what you paid in step 5 and expect a bill for the delta or call the office and get them to issue you the refund for the overpayment.
Thats how these medical billing offices work. The admin and staff do their best to lie, mislead, and otherwise cheat you. You should never trust what any of them say. At best they are just stupid and will tell you the wrong thing by ignorance, and at worse they will maliciously lie to you.
The most important lesson here is that in *most* cases, a verbal agreement isn't worth the paper it's written on (and the exceptions are few and far between). In other words, verbal agreements are usually unenforceable and don't mean anything when all is said and done. Always get something in writing before you can depend on it (and read it carefully before you sign!). I'm dealing with some asshattery with my bank right now, and while they said all the right things when they called me, I always requested (and thankfully got - it seems like someone understands that they screwed up and need to fix it rather than blame me) an email confirmation of what they said before I believed it was actually true...
> verbal agreements are usually unenforceable and don't mean anything when all is said and done. Always get something in writing before you can depend on it
Or a recorded call, in compliance with state wiretap laws (i.e. giving notice in states that require it).
The reason "verbal agreement" is hard to defend in court isn't that they're not legally binding, it's that one side often remembers what was said differently than it actually was. It's much more likely that somewhere in this conversation they said "great it's going to be $x after deductible" and you just aren't remembering the deductable part being discussed. Regardless the agreement to pay that they have you sign is there to remind you that ultimately it's your responsibility to know how your insurance works and whatever the office staff have told you is more of a courtesy. Take it as a lesson learned that next time you'll want to ask what three procedure will be billed to insurance for, then call your insurance to tell them exactly when you plan to have the procedure and what they'll be billing for it. That call with insurance will be recorded and whatever \*they\* tell you will actually be something you can rely on later if insurance covers less than they say. But again it depends on exactly when the procedure occurs too because if you were quoted some price if the procedure happened in December after a year or other deductible payments and then you defer the procedure to January it all resets so the quote will be wrong until you call the insurance again. (I'm not unsympathetic, I just had the pleasure of my own $800 co pay for a procedure yesterday bc of the Jan reset, it's just how it works.)
> As for the payment plan, they aren’t required to offer one.
But revoking one agreed upon due to a bad review smells illegal. Wouldn't it be exortion, along with breach of contract?
>we had a verbal agreement that the cost would be around $800 at the most.
Unless you recorded it on video, "verbal agreements" don't mean shit. It's he-said-she-said and will (almost) never hold up. Let this be a lesson to you, always get it **IN WRITING**.
What likely happened if the receptionist thought you had, or would, hit your deductible with the procedure, and then you'd pay a 20% co-insurance. Which would be about $400 per leg.
An unfortunate lesson, and an expensive one. But this is why it is important when going for any large or costly expense to hammer all the details out **IN WRITING** before committing.
You're 100% correct with one addition - It is in writing already and he signed it.
So he's hoping that the verbal "contract" will somehow override the signed document which I assume covers all the things you're mentioning here.
I feel like you got the price quote while you were in 2021 and are suprised it's not the same in 2022 now that you have a deductible to reach again 🤷♀️
Doctors office people can never know how much insurance would decide your fair share upfront. This is definitely a plan by plan thing. The question is, are they in-network? The second question is, what’s your EOB saying you should pay? Whenever you choose a high deductible plan, always assume paying the deductible fully. I personally plan that i will pay the maximum out of pocket every year and go on with my life. Life is too short to waste fighting stupid people over a stupid bill. I don’t do “payment plans” either even if it’s zero interest rate. Be careful too with those negative reviews, you can get hit with a defamation lawsuit (unless you have an umbrella insurance)
A few things:
First, depending on the state you’re in, if you did not tell them you’re recording them what you did was illegal. If you try to use that recording you’re going to be in trouble. Check the consent laws for your state.
Second, always get pre approval for procedures. Sounds like your insurance did not cover the procedure or you’ve not hit your deductible. These sorts of things are your responsibility.
Third, they should not have told you an incorrect cost. That makes them dishonest though, not illegal. I would not go back to them but you’re gonna be on the hook unless you can convince them to wave the cost, which seems unlikely.
You have a signed financial statement, and you are claiming a bait and switch? They likely told you an estimate after insurance but Insurance sucks and likely will try to fight it. You need to call your insurance company and try to get them to cover it. What does your EOB say? Was it preauthorized?
That sucks. I work for a doctor’s office so maybe I can help!
1. You need a prior authorization/pre-authorization for certain procedures to be covered by insurance. Because the bridge is burned with the derm office it might be a little awkward to ask them about if that was done or not. But I would call the number on the back of the insurance card to ask.
2. A lot of times procedures especially at the dermatologist are not viewed as essential and are just charged like a cosmetic procedure would be, unless the doctor had submitted rationale to your insurance.
3. Never listen to what a receptionist says in terms of cost for a procedure in the future, reach out to the number on the back of your insurance card
Call your insurance company before you pay out. Ask if they can send you an EOB so you can see how much you are supposed to pay. It might be that they put the wrong code on the claim. Update the review with the information that you have her on voice recording treating you like dirt because of the bad review. Next time contact your insurance before hand
Make sure they even billed your insurance. Submit the bill to your insurance independently. Always call your insurance before any procedure and get the preapproval letter or a letter/email that says the procedure doesn't need a preapproval. This has saved my hiney on several occasions.
Reading through everything I think the problem is our healthcare and insurance is soooo confusing that the everyday person doesn’t understand. It’s easy to misinterpret things or for a healthcare facility to even slip random charges in or an insurance company not to pay something. Why can’t it just be cut and dry? 😟
I feel for you OP. I understand where the misunderstanding happened with the receptionist but I feel like she should have been more clear and to have you check with your insurance company for the actual cost. I also feel that they were very unprofessional about you giving them a bad review. They should have just talked to you calmly and helped you understand what happened.
So you will want to get an itemized bill for each charge and then call your insurance provider and go over the bill with them to see if they will cover any of it or if anything seems incorrect. After that if they still won't pay ask the office if they have a reduced cash price.
2 things, prior authorization checks and the derms end will just give them a bool of whether you're covered for the procedure or not, it doesn't return any information on the payment amount on your end. Those contracts are typically worked out way above the head of whoever you talked to.
2nd, did they give you a physical quote for the procedure or only verbally? If physical, the quote should have preliminary information/codes on what you will be charged for. Compare the quote to the billing statement to see if the codes line up. If they don't line up you'll have to talk to the derm office to see if it was a mistake and if they refute/you still belive it's a mistake you'll have to dispute the chatges with the insurance company who will then open an investigation iirc.
Jesus, how do you guys deal with all of this healthcare paperwork / rules?
It boggles my mind that anyone likes/wants this system. Best of luck OP I hope it works out for you guys.
I work at a health plan processing claims. First check with your insurance to see if they billed. If they did, ask how the claim was processed and what is your out of pocket cost. If the doctor is contracted the rates would be much lower than that. 2nd if they haven’t billed they cannot bill you upfront for those costs. 3rd they cannot send you to collections if you are making payments (this is for California check with your state) even if it’s $5 make a payment. Since there is no payment agreement (she revoked it) the you can pay as much as you want without being sent to collections. 4th make a letter stating your issue as stated above send it to your insurance, your state’s medical board, the doctor that saw your wife (if you search in the medical board website it will list their mailing address) and most importantly the office of inspection general. Make sure you indicate in your letter that this could possibly be fraudulent billing since raised their pricing without letting you know. Also they cannot bill you unless you signed an advanced beneficiary notice that indicates the procedure code and the total cost of the procedure.
Wow this is a lot to unpack! I echo everything everyone else is saying, quoted prices do not hold much ground. Unfortunately your HDHP is part of the issue here. The receptionist was most likely quoting the co-insurance after the deductible was met, if your deductible reset then you’re on the hook for it. You should call the office and apologize profusely, and explain that you did not understand how your insurance worked, and were surprised by the bill and were frustrated by the ordeal. See if they’ll put you on a payment plan.
In the future, call the billing office ahead of time where you get a procedure, and get the CPT codes for the procedure, as well as the diagnosis codes. Then call your insurance and ask them how much it costs, supplying that information, you’ll get a much better idea of the cost.
I had a similar issue with a CT scan I had a few months ago. I was quoted a certain price by the billing people at the imaging center. Verified it against my plan, and was surprised I got a bill for 3 times that amount.
I called them back immediately and talked with my initial contact who was as surprised and frustrated as me. Turns out that imagine center is treated as a hospital, despite being free standing, but only for my particular plans contract. Neither the imaging center or I were aware of that, as it has always been free standing otherwise.
We discussed it and they agreed to take only 20% of the remaining balance and called it even, and I was emailed and mailed proof of this. Be careful and viligant for the future!
I am no legal expert by any means but I am in the healthcare tech industry
2022 No surprise medical bills
https://www.cms.gov/newsroom/fact-sheets/no-surprises-understand-your-rights-against-surprise-medical-bills
Wow this seems huge, hopefully it's as good in practice as it is on paper.
Will be nice not to have to worry about which emergency rooms are in network
It’s about time patients get more leverage and transparency. Even though this mandate is already in effect, patients are left in that dark on their resources. & don’t forget to Always ask for an itemized receipt from any ER/Urgent care visit as well.
This isn't a surprise bill though and won't meet the criteria. The receptionist simply made the assumption you had hit your deductible and would only pay 20% of the bill. It's on you to actually verify that though. Since you carry a high deductible plan, the cost comes out of your pocket. This isn't surprise billing.
You can cc your correspondence to the BBB to the credit bureaus AND the office stating they revoked the offer of a payment plan based on your review. Ultimately knowing the cost of procedures is patient responsibility, however, the one time I really got into it with an urgent care, calling them on their shit to the state licensing board and credit bureaus (I was 100% in the right and it was a small charge for clarity), and cc'ing the company running a background check on me for employment at the time, got them to pull the collections at least. However, in my situation, the office was at fault for being wildly incompetent and losing my check.
If they’re members of the BBB, then it matters to them. They’ve agreed to certain terms and conditions, and will have their rating drastically reduced or their membership revoked if they do t follow through. If they’re not BBB members, then it’s not worth a damn.
This may be something to try. We realize that because the form was signed we dont have much lee-way. I think the fact that this seems to have happened to other people and potential discrimination because of the review my wife left (ironically enough after they emailed and asked for it).
This isn't "discrimination" - they weren't treating you differently because of a protected class or an unchangeable part of who you are.
This was a response to what was likely a rude interaction - if you are willing to blast them on the internet because you have a high deductible plan and don't understand it, they don't want to enter into an interest-free unsecured loan with you. If you have a high deductible plan, you should be using your HSA to set aside your deductible so you're ready at the start of the year.
This is your expensive life lesson not to sign documents binding you to be financially responsible for indeterminate sums. Next time get everything is writing and confirm the things that you're told with the actual controlling party (insurance).
>admitting to revoking the payment plan because of the review (is that legal?)
Yes.
Your mistake was going to a dermatologist (skin doctor) for a vein problem (vascular surgeon). I worked at a vein practice and did this procedure often. Dermatologists have no business doing this type of procedure. This is as bad as dentists doing Botox and lip fillers.
You need the right tool for the job.
You aren't getting scammed. Or at least not by the dr. office. You are just participating in an absolutely byzantine medical billing system. Did they mention the 20% bit before or just after? If before it's on you to know the high level details of your insurance plan. High deductible means you pay the full cost of care until you reach it. So they weren't wrong. It's just 'your insurance' for the first $Xk a year - that's you. 20% paid by you. 80% also paid by you since you haven't reached deductible. If the 20% bit was never mentioned before and just your expected cost is $400/leg that's crappy but they aren't bound to that estimate verbal or written, it's an estimate. Dr's offices are never bound to fixed prices before billing. It's sort of wierd thing. It's not a market, you can't effectively shop around.
If you have other procedures in planning do your best to schedule them in this same deductible period.
Probably time to mea culpa with the office manager and if you are sincere and pull the negative reviews I think it's likely they will offer the payment plan again. Maybe even a cash payment discount. You get more flies with honey.
Do you have a payment plan already agreed to and set up? If you do, just follow that and pay the minimum, drag it as long as possible. They can't unilaterally revoke your payment plan because they don't like you. Doctor offices are sucker for cash flow.
I would call the doc and and tell them exactly how their receptionist is acting, and that your next calls will be to the state medical board and the insurance company. It is also illegal to threaten someone when attempting to collect a debt, and you could get them into some [serious hot water](https://www.consumer.ftc.gov/blog/2014/07/stop-debt-collectors-empty-threats) for her behavior.
What threat? OP said the office said (to his wife, so now we're 3or 4 deep in the telephone game) that they were going to revoke the payment plan option and "take their ass to collections". A payment plan is a courtesy and if I'm being yelled at about a fictional "verbal agreement" and deceitful "bait and switch" activities I'm probably going to revoke that courtesy also. And if OP's wife said they're not going to pay then of course it's reasonable to tell her that they'll be sending the bill to collections. So now all we have is whether the office person was out of line for saying "ass" to them, if that's what was even said, and while I definitely agree that's unprofessional, it certainly doesn't rise to illegal or worthy of any type of investigation.
Let's stop telling people to report any inconvenient situation to the ftc, state medical boards, BBB, and everywhere else. There's a place for those but this sounds very far from one.
No they are not. Federally, and in 43 states (including Op's), they are one-party consent laws. Since op is a "party" and he consents, it is perfectly legal to record his own conversations. There are 7 states that require "two-party consent" so it's always good to know your local laws but it is not correct to imply this is the norm across the country.
Let them send you to collections!!! It is way worse for them. Normally healthcare gets around 30% back for what they bill. That balance is going to sit in their AR buckets for 4 months before collections can happen. When they sell the debt they normally get way less than the afore mentioned 30%.
Of note...I bet the actual Physician has no idea this is happening. Talk to him/her. Things might very well change. Also...if you have a government backed insurance plan did they ask you to sign an ABN? If not...doom on them. If commercial the amount billed will depend upon your deductible. On the positive side...if you hit your out of pocket max this early in the year blow up your healthcare. Get your colonoscopy. Get your joints fixed. 😊
Getting something sent to collections destroys your credit score and makes your life much more difficult for you than the doctor's office. I had a doctor's office send a bill to collections and my credit score dropped nearly 200 points. I was lucky that the office admitted their mistake to me that they did not send a physical bill and they only tried to call once. The person who called said the number was not in service, so the assumption is they typed it in wrong and just didn't try again.
They helped me get the debt removed by writing a letter to the collection agency, but even that process took months. I was buying a house and months later, only two scores were updated so my credit scores went something like 800, 800, 600. Luckily I had the letter explaining the situation and they only use the middle score, but a bill going to collections was almost disastrous for me.
What you do next is simple. Pay what you owe. Take down the reviews, and apologize to the manager and hope you can get the payment plan deal.
But you 100% owe it all, based on what you said. Someone messed up, you, or them, but its your responsibility to know if you've met your deductible or not, and you haven't.
Then go enjoy your wife's $4000 legs.
Let them send you to collections!!! It is way worse for them. Normally healthcare gets around 30% back for what they bill. That balance is going to sit in their AR buckets for 4 months before collections can happen. When they sell the debt they normally get way less than the afore mentioned 30%.
Of note...I bet the actual Physician has no idea this is happening. Talk to him/her. Things might very well change. Also...if you have a government backed insurance plan did they ask you to sign an ABN? If not...doom on them. If commercial the amount billed will depend upon your deductible. On the positive side...if you hit your out of pocket max this early in the year blow up your healthcare. Get your colonoscopy. Get your joints fixed. 😊
This is probably not the best advice, but I had something VERY similar happen to me. Basically they assured me a procedure would be fully covered by my insurance and instead they sent me a bill for $25,000.
I basically said, too bad, you screwed up, I won't be paying this, deal with my insurance if you want it.
I stopped taking their calls and all mail went straight to the recycle. 5 years later and nothing bad has happened. Credit seems fine. Can't say this will be your experience though.
Ohio's wiretapping law is a "one-party consent" law. Ohio law makes it a crime to intercept or record any "wire, oral, or electronic communication" unless one party to the conversation consents. ... See Ohio Rev. Code § 2933.51.
That sounds crazy expensive. I know everyone's insurance is different, but I had to do 5 vein treatments on my greater saphenous vein (2 laser, 2 rf, and one with foam) in order to finally seal it, the whole thing from ankle to groin. The valves in the vein became incompentent, so the whole vein failed to function properly. I used two different doctor offices but I only had to pay for the $40 specialist visit. They were both vascular surgeons.
Excuse me as I go knock on some wood. I have a follow up this month and I hope its still closed.
Doctors offices are notorious liars. If it's not in writing, it didn't happen. The office manager is definitely being ratchet about it. I'd start sending in partial payments certified mail noting it is a payment plan and what you can afford; once they accept the first one that IS a payment plan.
Your post has been removed [because it is primarily a legal question or discussion (rule 5)](https://www.reddit.com/r/personalfinance/about/rules) which is off-topic for /r/personalfinance. /r/legaladvice can help you determine if you need to contact a lawyer and you may get some basic advice.
**While /r/legaladvice can sometimes offer basic advice, talking to a local attorney is the best way to answer any legal questions.**
*If you have questions about this removal, please [message the moderators](http://www.reddit.com/message/compose?to=%2Fr%2Fpersonalfinance&subject=Removal%20help%20request&message=Hello%20moderators,%20.%20%0a%0a%0aMy%20submission:%20https://www.reddit.com/r/personalfinance/comments/sig5c1/currently_getting_bait_and_switchd_by_a/%0a).*
Did you call your insurance company to ensure this was covered? What did they tell you when you received the bill or the EOB?
We didn't call our provider, but the dermatologist said it was pre-authorized. We have high deductible HSA's but never had seen a bill come back this much before. And what did who tell me when I received the bill? My insurance company?
> We have high deductible HSA's Did you reach your deductible for the year before the procedure? If not, then the entire cost of the procedure may have been out of pocket.
No we’re not at our deductible. At some point, the receptionist told us the ~$400 would be because it is around 20% of the procedure. Afterwords and during this hot mess, they told us that’s what it would have been IF we were already at our deductible…? So was that assumed? Because that’s terrible and it’s January for crying out loud. Our deductible just reset.
Was hearing that it would be around 20% of the procedure a red flag for you? If you knew that you hadn’t met your deductible yet, wouldn’t you be expecting to pay the full cost?
Yeah, $300-$400 per leg being 20% of the cost of the procedure puts you right at the price point that they’re charging. It’s clear that the communication was at least a bit muddled, but it seems like they did actually provide information on what the full cost of the procedure would be. They just couched it in terms of an unrealistically optimistic expectation about how much insurance was likely to cover out of that amount. That plus the reaction afterward doesn’t give the greatest impression as far as their overall professionalism, but it also seems like they didn’t technically lie about the cost.
We actually don't know what was said...this is just a one sided argument. This dude didn't even hit his deductible and probably doesn't even know how his insurance really works.
if anything this is just a problem with the us heatlhcare system and op's lack of understanding about his policy and why High Deductible HSAs are the closest thing to a junk policy since they got rid of junk policies with the ACA.
Why do you think HDHSAs are junk? When I did the math for all my plans (I have a shitton of options through the federal government), the HSA made the most sense even if I hit the deductible (because we also get a contribution to our HSA). Was there something I missed? The main reason being that the HSA plan was less than half the cost of the low deductible plans per pay period. Plus I can move some money from my paychecks into the HSA and then invest that. If I use that money on medical expenses in retirement, neither the principle nor the earnings are taxed.
HDHSA plans suck unless you aren't using them and just see it as an investment because in practice you pay for everything out of pocket, then if you have some serious medical problem and hit the deductible... Well then i hope its not really bad or you will hit your payout cap and be back to paying put of pocket again... In my 7 years of working in the medical field patients who got the angriest over costs were ones those plans, often those frustrations were taken out on us because you. The person who looked at health insurance plans and chose the cheapest one with an option to have tax free account, now realizes its worthless and that tax was basically eaten up by premiums
Eh, high deductible HSA compatible plans are useful for some. As a 26 year old male, I haven't had any medical costs for the past 4 years (prior to that didn't really either until you go back to my childhood years, but was under different insurance with my parents). I just get my annual check up, flu shot, now covid shot, which all costs $0, max out my HSA, and move on to the next year. The plan is free at my job whereas a lower deductible plan would cost money, I have money set aside to cover my deductible should something happen, and I'm stuffing money away in my HSA. If I was older and more likely to need care, or had a family with kids, maybe a different plan would make sense, but for now the high deductible plan is great.
That's all fine and dandy until something serious happens and then everything is out of pocket, depending on cost you may end up hitting the payout cap most of these plans have and be back to paying put of pocket and hitting your deductible
I remember thinking that I must have misunderstood something when this type of policy got offered by my employer. Ok so I pay a monthly premium for insurance...but I pay 100% of all costs as well? That can't possibly be correct. I actually thought the monthly premium went into the savings account and I could use that money to pay for stuff lol. Nope, you pay hundreds of dollars a month into thin air, then ALSO pay for whatever healthcare you need. If you then happen to spend whatever the out of pocket maximum is, THEN your premium dollars go to work and they are gracious enough to cover most costs after that. ok great, thanks. Worst thing ever.
Not quite. It's not when your out of pocket maximum is reached. It's when your deductible is reached that your insurance kicks in. A high deductible plan is best for young people who are generally healthy and don't expect to have any procedures.
Before HDHP/HSA, I used to pay $400/mo in premiums. When I switched to HDHP/HSA, I now pay $200/mo in premiums and deposit $200/mo into my HSA. I get to take that HSA with me when I switch providers or employers.
But the monthly premium is a lot less right? And how much is the deductible? Wouldn't you reach the deductible well before they $5k procedure? I have the high deductible plan and every way I ran the numbers, only something catastrophic with multiple surgeries and hospital stays would make the higher premium plans worth it.
I remember looking at the HDHP option my employer offered thinking "This might actually make sense if you don't need medical services much", and then I remembered that in the U.S. even needing a single medical service can cost more than $5000 and I noped the hell out of there.
Yep. I just started with a new company and had the HSA is waaay better rammed at me for like a week. There was another guy who started with me who took the hsa previously and was left with all this debt cause of a medical problem that came to light before they had time to put anything into it.
You really need to take time to read your benefit book and understand things. It’s complicated, frustrating, and unclear. Insurance companies are a NIGHTMARE to deal with. But it is absolutely necessary otherwise you really can end up in a bad spot. Like I know, ahead of time, which Emergency rooms I can go to and which hospitals are covered. It would save a ton of hassle going to the in-network ER and then being admitted to that in-network hospital versus being admitted to an out-of-network hospital or arranging for private transportation once stabilized. I also had to spend nine months, countless phone calls, letters, and I don’t even know how many hours fighting with the insurance company over an ambulance bill, but eventually I succeeded in my claim, and they had to change the way the policy was written for the entire state. (Long story short, they had advertised a $150 copay for “in-network” emergency ambulance services, and an 80% copay for “out-of-network” emergency ambulance services. After I was slammed with a $6,000+ bill from the city, I found out that in my state, since emergency ambulance services were all operated by the city or county instead of any healthcare facilities, there was literally no such thing as an “in network” emergency ambulance service. So I complained that had I known that, I never would have chosen the policy, as it was deceptive and fraudulent advertising. I had to get the state board of insurance involved….that’s pretty much the key to getting a valid claim actually addressed. Insurance companies do not like it when you get the state board involved, because it usually means massive fines for them…even threatening to report it will likely get your dispute more quickly resolved, or at least you will have their attention. However, in your case, your policy probably is pretty clear about the fact that you have either total or majority responsibility of copay until your deductible is met. That’s pretty standard.
Hate to say it, but you’re probably going to have to pay the bill. If you haven’t met your deductible, it is what it is. For what it’s worth I have never had anyone ask me if I’m at my deductible. System sucks. For the future, definitely have your guard up when going to anywhere that does cosmetic procedures. They are for profit businesses first and foremost. Or any time you are doing something outside of normal every day doctors appointments. The costs can go up insanely fast and you need to read every document they hand you, even if you are really sick in an ER because it can also include what they are allowed to do during the surgery, contingencies, etc. Again, it sucks. If possible I would take down the reviews, call back, kiss some butt, and see if it gets you anywhere.
To be honest, they did not mislead you. Very possible they told you this last year after you hit your deductible and then the procedure got moved years. They even explained the 20% to you. Insurance sucks and it’s sad we collectively have to understand how it works, but we do need to understand that and you really do owe them that money. Their conduct was unprofessional. With that said if you hit your deductible go buck wild on medical things for the rest of the year.
At what point? Did the receptionist tell you this in December? Before the procedure date was set, anything like that?
[удалено]
to be fair, our insurance and healthcare in general in this country is so needlessly obtuse its almost like situations like this are the point of it. I worked front office at a medical clinic for 7 years (in addition to being an ma and rad tech) and ive even seen medical workers who understand insurance get sideswiped by coverage issues
You haven't hit your deductible so you pay 100% instead of 20%.
20% after you hit the deductible most likely. High deductible plans (or really those with any deductible) are not paying out until you hit that deductible apart for routine doctors visits and similar.
Pre-authorization only means that your provider has deemed the procedure medically necessary, not that they’ve deemed it to be cheap or free. Hopefully this will work out for you, but in the future, the best course of action is to call your insurance company to best understand the costs involved in any non-emergent procedure, as the office can’t be expected to know the costs and coverages associated with each individual patient’s insurance situation.
Am I the only one who can never get a straight answer from health insurance companies on how much something will cost me? I’ve even had specific codes and still got nowhere.
Insurance doesnt charge. The provider charges. Ask the provider. Edit: In this context the provider is the oloffice/doctor. Just because something is supposed to be a certain way/price doesn't mean it is. I got screwed on a 10k dollsr bill because the ER said they didn't have a contract with Cigna, Cigna said they did. Health insurance must go through federal courts. Most lawyers will not take the cases because they cannot seek payment from the insurance or provider. Its all out of pocket which is rarely worth the cost.
in this scenario is the provider the the dermatologist?
The provider can bill any amount they want. What matters is what their agreed in network rate is for specific procedure codes with the insurance company. Though good luck getting insurance to divulge that information to you prior to an EOB.
Having been a call agent for an insurance company... the call agents don't even have access to the fee schedules for providers. It's not that they don't want to help... they aren't even given the tools to.
But then what if they lie and lowball you? And do you mean doctor? It's confusing because people are saying insurance provider
Idk why you’re getting downvoted, this is the right answer. Insurance literally will only say yes or no, and what % they cover. The provider charges for the procedure. Call insurance, get yes/no, then call provider and ask the cost of procedure.
Insurance essentially sets the fee schedule for in-network providers.
He didn't hit his deductible, see his other post. The guy doesn't know how a high deductible health plan works.
Thanks. Definitely lived and am learning. I guess we're the suckers for taking them at their word and not checking with our insurance provider first.
Did you at least talk with your insurance after you got the bill to make sure everything was processed and coded appropriately? I feel like you’ve only been dealing with the derm office when they have minimal control over what your insurance covers/what your responsible for.
Have not yet. Will get on that tomorrow.
Also there are laws about sending bills to collections. I most states as long as you are paying something they can't just send u to collections any time they want. I'd look into that. EDIT: only to say - the only advice here was to say check the laws in your state on rules around collections especially during Covid. Not any direct advice on paying or not paying. This is after years of dealing with providers and being involved with others' medical debt. Also, it is not bad advice.
This is not true. Please don’t listen to this person. Perhaps what they meant is if you were ON AN AGREED TO PAYMENT PLAN ALREADY then they could not send you.
Will do. Thank you.
[удалено]
"Here's one penny every month for the rest of my life" Worth it.
Statute of limitations on medical bills is 7 years I believe. Research yourself, and the type of procedure may have something to do with it, but I believe as long as you pay something they can't send you to collections. Then after 7 years, even if it's not paid in full, they can't collect anymore so you can just stop paying and it can't affect your credit or be collected.
To add to the notes above, you can retroactively have procedures or medications pre-authorized and approved. Typically, you need a Dr to communicate with your insurance to provide the diagnosis (tests that gave them that diagnosis would be included if they’ve been done) which argues that it’s medically necessary. You can also appeal (this happens from time to time) the decision and provide additional details which sometimes is expected to happen. If you pay upfront (I’ve done this many times to get something quickly) then retroactively go through the process prepare for it to be lengthy and a bit of your leverage is gone since you’ve paid so you’d need to follow up prudently, take notes on the conversations and provide the appropriate documentation (diagnosis, tests, reasons it’s medically necessary).
That is not what a pre-authorization is.
[It is, though. ](https://en.m.wikipedia.org/wiki/Prior_authorization)It simply means insurance says “Yes, we’ll cover this” at whatever rate it should be covered, which is sometimes near-zero if the provider is out of network or if a deductible hasn’t been met.
That link is correct. What you said, was not. "Pre-authorization *only* means that your provider has deemed the procedure medically necessary." (Emphasis mine) Prior auth denials happen all the time on procedures providers deem necessary. A prior auth is your provider checking with the insurance company to make sure services are covered and many times will generate a prospective out of pocket dollar figure for the patient. Sometimes your provider can appeal (things like peer to peer) and get a service covered by showing necessity (time/condition/circumstances) or that prior therapies have been covered and this is the next step.
In this situation, the pre-auth *only* means that OP’s insurance deemed the procedure necessary, so they’d cover it - not that it would be cheap or free. No need to discuss denials as it wasn’t denied - the rest of your comment is good info, but irrelevant to OP’s situation and/or why he owes more than he expected.
Fine, what you said was still wrong and adds confusion to the situation about things being covered. First your statement didn't include the insurance company, which is wrong. Don't say a prior auth is ONLY saying a PROVIDER said the procedure is necessary. That's a wrong statement no matter how you try and correct it later.
I’m pretty sure that everyone else, including OP, knew exactly what my comment meant. If this is what you need to do with your morning then have at it. Hope you have a lovely day!
If OP didn't know how their deductible applied and thought they were being bait and switched there is a good chance they didn't understand what a prior auth was, thus their predicament. Don't say stuff that is wrong and now quadruple down when called on it. Be better.
The pre authorization will tell you what the insurance will pay though
Even if it was covered with an HSA you're still going to pay for that up front.... It might be a covered medical procedure but that just means it's going to count towards your deductible. Which is good, it's the beginning of the year, do as you get closer to max on one person anything covered will eventually cap.
[удалено]
And even before that step you have to get fucked by the: "oh yes, we take that insurance!" then after the bill comes and insurance didn't cover anything: "oh yes, by "take" we just mean we submit it to your insurance, but since we aren't actually in their network they wouldn't cover anything" I want to burn their fucking buildings to the ground every time with this shit. You should be able to trust people in medicine.
This is so frustrating. I’ve taken to getting providers on record as to whether or not they’re in network, rather than whether or not they ‘take’ my insurance. I also generally follow up with my insurance to verify. But, it’s ridiculous that we need to do that especially when these providers and insurance companies work so hard to obfuscate the true costs to the end user.
Yes just had a really frustrating experience with a new insurance plan. I thought I picked something similar to what I’ve always picked where preventative stuff is covered except a copay. I went to a dermatologist recently to check in since they wouldn’t refill a prescription without seeing me in person and then was charged for the whole office visit. When I called my insurance they said nothing is covered until I meet my deductible (which is just odd to me because visits like this have always been covered for me in the past, but maybe I just didn’t read the new plan carefully enough 🤷🏼♀️)
That's why you always confirm with your insurance company what the expected costs will be or if a provider/facility is in-network. I don't understand why people don't do this one step. Yes, the system should not be this complicated. But it is for now.
It is shitty but I don't understand why people have so much faith in health care providers' quotes. Insurance is the one paying the bill, of course they should be the main point of contact on if something is covered or not I don't ask Marriott if I can expense room service for my work. My work is the one paying so I ask them I think people are under the notion that you can go anywhere, flash your health care card, and get good coverage. Which would be great, but in reality it's no different than shopping for a good deal online. Gotta work with insurance to find what's covered and where it's most affordable
[удалено]
That last part was so sad it made me laugh at their absurdity. Sorry you had to go through that
Pre-authorized doesn't mean your insurance will cover the whole cost. Was the procedure done in 2022? If you have a high deductible plan, it's likely going to deductible. You should call your insurance and ask for details regarding your plan and what portion of the bill they covered versus what you are responsible for.
100% this. As a provider, I have in writing in multiple places and ALWAYS verbally tell people directly that they need to talk to their insurance company about their coverage for my services. There are too many different plans, and information I don't have (like deductible status), for me to be able to give any guarantees about out of pocket costs unless they're paying fully out of pocket (annnd, cue a conversation about the many benefits of cash pay).
The receptionist telling you the $300-$400 was 20% of the cost is an important detail! They were exactly correct, 20% of $3700 is $740, or $370 per leg. As many others have explained, somehow the receptionist assumed you’d met your deductible (was this in 2021?), and insurance would cover 80%. But they can’t know that, and it’s your responsibility to know your insurance coverage and deductibles. You do seem to understand it resets in January so I can’t really understand why you’d expect your insurance to cover 80% if you have a high deductible plan. I think this is a hard lesson learned and not really their fault. Look at it this way: now you’ve met a bunch of your deductible for the year already, and you’re closer to your coverage kicking in on other health services.
This is the only answer. You have an HSA. It’s high deductible. You will pay high costs until you reach the deductible. If you’re already getting surgery’s at 27. You might want to switch out of an HSA
>you’re already getting surgery’s at 27. You might want to switch out of an HSA In many situations it is *still* cheaper to be in an HDHP, the difference in annual premiums can often exceed the out-of-pocket max.
Agreed. It's so sad how many people don't understand their insurance.
I am 44. I have had various insurance plans on my own for over 20 years. They get weirder and harder to understand each time I have changed jobs. I read the summaries before signing up. I go through the more detailed versions once I have picked a plan and I still get surprise bills and fees. Lately more in a pay for seeing the doctor but itemize every other aspect of a bill and the doctor’s office can’t give a price and insurance can’t say how much (last time it was a letter that said “you may save up to $290* ** ***”, but when I called they said there was no way to know how much I could save (or pay) until everything was done. It was not always like this. It used to be a copay and you were done and didn’t have to worry or think about it after that.
I agree with everyone who says insurance is complicated and didn’t mean to be harsh!! Just to realistically answer the question. I know I’d be surprised and upset by bills sometimes too, which is why I only ever select the HMO. I’m sorry for people who don’t have an HMO option!
I have an HMO, and still ended up with a surprise bill that I'm still not sure if its legit. I have plaque psoriasis and had a spot come up on my inner thigh that looked like guttate psoriasis. Went to the dermatologist and they wanted to do a skin biopsy. All done in office. I get to the desk to pay my copay($35) and she rings up over $100. I've never had something done in office that wasn't completely covered before, but I've never had a skin biopsy before. I wasn't expecting to pay more than my copay that day, I didn't really have the money, but what could I do? I paid it and then pinched pennies for the rest of the month. Then I get my EOB for that visit and it says the amount I should have owed was $0. I called the insurance company and asked them about it, they said that I should call the dermatologist office for a refund. So I called the office and told them and they issued a refund. 6 months later I get a notification that a new EOB is available to view. I login to view it and there are actually 2 EOBs issued on the same day. One is an exact duplicate of the one I received 6 months ago and the other is dated the same but says I owed the amount that I had paid and then been refunded. Called my insurance and they said "oops, yeah something was coded wrong and actually we didn't cover it and you owe the office the money". Another month went by and I did receive a bill(last month actually) from the dermatologist office. I haven't paid it yet, because again its a completely unexpected bill and the whole thing feels shady af. No one has told me what was coded wrong, how it was "wrong", why the new code is something they don't cover, etc. Do I need to talk to insurance, the office? Somehow manage to get both on the call at the same time(probably impossible because the dermatologists office is nigh impossible to contact via phone, they have a texting service they prefer you use instead).
I would look at your benefit summary document (or maybe even somewhere on the front or back of your card). In my HMO co-pay for an office visit is one amount and copay for a specialist office visit is higher. Is $35 what you pay at your primary care doc, and $100 for specialist visit? If $35 is the specialist copay, then yes I would ask the ins co what the other $65 is for. It’s clearly related to the office visit if it was the biopsy then that would have been a lab charge and not charged by the dermatologist at the office. I think you owe something because there are always co-pays in my experience except for basic preventive services (annual physical, etc.). Those are always co-pay-free thanks to the ACA. (Also, unrelated to your specific question so not advice just informational: to the benefits of an HMO, you don’t seem to be being charged for the lab/biopsy, that seems to be fully covered. It would not be in a PPO, you’d have to pay if you hadn’t met your deductible and if you had you’d still pay 20% if you hadn’t reached your max out of pocket. Which is why I stick with the HMO.)
$20 is my PCP amount, $35 is the copay for specialist visits and what I've paid every other time I've visited that dermatologist. The actual total was like $168, so my $35 copay + $133 for whatever it was that wasn't covered. From what I can tell on the EOB the lab stuff was covered, its just the "procedure" of them taking the skin that was covered and then later decided they didn't cover it.
This case is pretty straightforward, but it's frustrating how obtuse and overly complicated the system really is. Talk to your PCP about mental health? Surprise bill. Facility uses an out of network specialist? Surprise bill. There's only so much diligence you can do when the entire system is set up to maximize profit.
I only understand that I pay monthly for insurance I can't really afford to use
To be fair, insurance is not necessarily easy for everyone to understand. It’s definitely not like they teach it in school. Many people can figure it out with a little effort but often people don’t truly understand it until something sucky like what happened to OP.
It is beyond obtuse. Even when fully informed, you run into issues like the doctor not knowing the cost of procedures. Even weirder, dental insurance plans (in the US, at least) usually have an annual maximum coverage (typically 1,000-2,000 USD), meaning any cost over that cap is your responsibility. This is exactly the opposite of how health insurance works, where hitting the annual "max out of pocket" means they pay the rest. It is so counter-intuitive, that my dentist alerts patients. When I told my parents, they decided to cancel their personal policy (mine is provided by work), as the maximum coverage was 2000 (which they never hit) and the annual cost was 1800.
It’s not an easy thing to understand. I mean, actuarial science is a whole ass field with multiple degrees, so it’s generally accepted as an unnecessarily complicated subject. That aside, knowing your deductible and getting the flyer that explains what the plan covers in and out of network will go a long way in situations like this.
Completely agreed. To add to that 1. Don't expect the health care provider to understand your insurance coverage 2. All questions, concerns, difficulties with navigating insurance, should be directed to the *insurance company*
I think Insurance is complicated on purpose so people are too afraid to go to the doctor Incase of surprise bills.
If the office cares about their patient they would have done a insurance benefits check before the procedure and talked about where the patient is with their deductible and what the total out of pocket should be. It’s a short call to the insurance company. Yes, the burden is on the patient to understand their benefits but to avoid all of this the office should help with explaining as well. Patient should also talk to the doctor to let them know about their office staff and how they’ve been treated. The front desk and admin as gatekeepers and treating the patients poorly is a huge problem with the private practice experience and delivery of healthcare. Most put up with it but there’s no reason to… patients have options to choose to go elsewhere.
We can just as easily say the patient can take these steps. It sounds to me like the office already did make this call since they knew the percentage due after deductible. I'm betting that said "it'll be $x after deductible" and OP just ignored the "after deductible" part.
Possible.
Always, always, always call your insurance and don't talk to the office about insurance. They have absolutely no idea if you are covered or not. The office can only give their best guess.
I also have a high HSA, and pre approval, means it will be convered and count towards the deductible. But thay doesnt mean, if the deductible wasn't met it will be 20% or whatever. Pay the bill and move on. While they were rude, and a neg review is warrented for that. It doesnt sound like its their fault your deductible wssnt hit already
Unfortunately I think this is the answer. I'm also on a high deductible plan and this is how they work. The rudeness is unacceptable but the bill honestly seems completely reasonable. You cannot take a receptionists opinion on how your insurance will work. They aren't going to know.
And to make it worse. Its was in january. If the appointment was made in nov/dec, when they called to get pre-approved for the patient. The insurance company might have said 'and their amount will be 20%" But since the deductible is now un fulfilled, its 100%, how would a office manager know this?
This is true. No one in that office knew how much your procedure was going to cost. Your doctor does the needful, a coder reads his surgical note and assigns a procedure code. Your insurance applied a negotiated discount and passed it onto your deductible. There was no way the receptionist knew what the doctor was going to do, what the billing code was, or what the specific contracted discount with your particular insurance plan was. Lesson: Read your insurance plans carefully. Don’t use a HDHP unless you really don’t plan to see a doctor that year aside from a free annual checkup. HDHPs prevent you from being bankrupted by a car accident, not to cover your wife’s varicose veins.
At my company it’s a choice between a $30 copay and high deductible plan. Once you do the math it actually ends up the HDHP plan is cheaper in 90% of situations, you just pay for the healthcare you use as opposed to in premiums. I know multiple companies who structure it this way.
The "once you do the math" is situational. It is cheaper for you, it will certainly not be cheaper for others. Everyone needs to think about their own hypothetical healthcare expenses for the year and pick the plan that will be best for them. I'm sure you know this, I'm just saying this for others reading it that high deductible plans may not be right for them.
It is not situational. We worked out a graph for different spend levels and there is only a small 10% portion where you win having the $30 copay plan. This is actual math, you just have to figure out if you think you fall in the 10%.
You have chosen arbitrary spend levels and then determined that only 10% of those arbitrary inputs result in the normal deductible plan being better. That's fine for you but certainly doesn't represent the range of medical expense levels anyone could experience. There's no upper limit on how much a family could conceivably incur in medical expenses in a year. The set of potential spend levels for any given family is, as I said, situational.
>HDHP plan is cheaper in 90% of situations I'd argue that it's closer to 70-75% of the time, especially if you have a family with young kid. Under 30 with no known health issues HDHP is going to be the correct choice. For the rest of people, eh not so much.
My 90% was based off my company's benefit structure. Still true with a pregnant wife and 3 year old, with a lot of other medical costs. Sorry if I wasn't clear.
A HDHP also provides access to an HSA, which is a great savings vehicle. That should be part of the consideration when you're picking an insurance plan.
You mean to tell me the cheapest insurance plan has poor coverage???
[удалено]
You’re correct we’ll need to call insurance tomorrow. And also correct. We had a verbal agreement before signing a financial policy. Again, just feeling like we were told something, signed the agreement off of that and we’re billed entirely different…
[удалено]
..7. Patient is billed if insurance estimate was low and not enough was collected in step 5 or Patient has a credit balance if total owed after insurance processing is less than initial estimate that was collected in step 5. ..8. Read your EOB and reconcile it against what you paid in step 5 and expect a bill for the delta or call the office and get them to issue you the refund for the overpayment.
Thanks for finishing it. They really should teach this shit in school. Would save a lot of people a lot of headaches.
It doesn't sound like you had a verbal agreement though.
Yeah he had a very loose quote. The full meaning of the quote was written on the document he was given and signed.
Thats how these medical billing offices work. The admin and staff do their best to lie, mislead, and otherwise cheat you. You should never trust what any of them say. At best they are just stupid and will tell you the wrong thing by ignorance, and at worse they will maliciously lie to you.
The most important lesson here is that in *most* cases, a verbal agreement isn't worth the paper it's written on (and the exceptions are few and far between). In other words, verbal agreements are usually unenforceable and don't mean anything when all is said and done. Always get something in writing before you can depend on it (and read it carefully before you sign!). I'm dealing with some asshattery with my bank right now, and while they said all the right things when they called me, I always requested (and thankfully got - it seems like someone understands that they screwed up and need to fix it rather than blame me) an email confirmation of what they said before I believed it was actually true...
> verbal agreements are usually unenforceable and don't mean anything when all is said and done. Always get something in writing before you can depend on it Or a recorded call, in compliance with state wiretap laws (i.e. giving notice in states that require it).
The reason "verbal agreement" is hard to defend in court isn't that they're not legally binding, it's that one side often remembers what was said differently than it actually was. It's much more likely that somewhere in this conversation they said "great it's going to be $x after deductible" and you just aren't remembering the deductable part being discussed. Regardless the agreement to pay that they have you sign is there to remind you that ultimately it's your responsibility to know how your insurance works and whatever the office staff have told you is more of a courtesy. Take it as a lesson learned that next time you'll want to ask what three procedure will be billed to insurance for, then call your insurance to tell them exactly when you plan to have the procedure and what they'll be billing for it. That call with insurance will be recorded and whatever \*they\* tell you will actually be something you can rely on later if insurance covers less than they say. But again it depends on exactly when the procedure occurs too because if you were quoted some price if the procedure happened in December after a year or other deductible payments and then you defer the procedure to January it all resets so the quote will be wrong until you call the insurance again. (I'm not unsympathetic, I just had the pleasure of my own $800 co pay for a procedure yesterday bc of the Jan reset, it's just how it works.)
> As for the payment plan, they aren’t required to offer one. But revoking one agreed upon due to a bad review smells illegal. Wouldn't it be exortion, along with breach of contract?
>we had a verbal agreement that the cost would be around $800 at the most. Unless you recorded it on video, "verbal agreements" don't mean shit. It's he-said-she-said and will (almost) never hold up. Let this be a lesson to you, always get it **IN WRITING**. What likely happened if the receptionist thought you had, or would, hit your deductible with the procedure, and then you'd pay a 20% co-insurance. Which would be about $400 per leg. An unfortunate lesson, and an expensive one. But this is why it is important when going for any large or costly expense to hammer all the details out **IN WRITING** before committing.
You're 100% correct with one addition - It is in writing already and he signed it. So he's hoping that the verbal "contract" will somehow override the signed document which I assume covers all the things you're mentioning here.
I feel like you got the price quote while you were in 2021 and are suprised it's not the same in 2022 now that you have a deductible to reach again 🤷♀️
Doctors office people can never know how much insurance would decide your fair share upfront. This is definitely a plan by plan thing. The question is, are they in-network? The second question is, what’s your EOB saying you should pay? Whenever you choose a high deductible plan, always assume paying the deductible fully. I personally plan that i will pay the maximum out of pocket every year and go on with my life. Life is too short to waste fighting stupid people over a stupid bill. I don’t do “payment plans” either even if it’s zero interest rate. Be careful too with those negative reviews, you can get hit with a defamation lawsuit (unless you have an umbrella insurance)
A few things: First, depending on the state you’re in, if you did not tell them you’re recording them what you did was illegal. If you try to use that recording you’re going to be in trouble. Check the consent laws for your state. Second, always get pre approval for procedures. Sounds like your insurance did not cover the procedure or you’ve not hit your deductible. These sorts of things are your responsibility. Third, they should not have told you an incorrect cost. That makes them dishonest though, not illegal. I would not go back to them but you’re gonna be on the hook unless you can convince them to wave the cost, which seems unlikely.
Leave another Google review with the info about being cussed at and revoking the payment plan.
You have a signed financial statement, and you are claiming a bait and switch? They likely told you an estimate after insurance but Insurance sucks and likely will try to fight it. You need to call your insurance company and try to get them to cover it. What does your EOB say? Was it preauthorized?
That sucks. I work for a doctor’s office so maybe I can help! 1. You need a prior authorization/pre-authorization for certain procedures to be covered by insurance. Because the bridge is burned with the derm office it might be a little awkward to ask them about if that was done or not. But I would call the number on the back of the insurance card to ask. 2. A lot of times procedures especially at the dermatologist are not viewed as essential and are just charged like a cosmetic procedure would be, unless the doctor had submitted rationale to your insurance. 3. Never listen to what a receptionist says in terms of cost for a procedure in the future, reach out to the number on the back of your insurance card
Call your insurance company before you pay out. Ask if they can send you an EOB so you can see how much you are supposed to pay. It might be that they put the wrong code on the claim. Update the review with the information that you have her on voice recording treating you like dirt because of the bad review. Next time contact your insurance before hand
Make sure they even billed your insurance. Submit the bill to your insurance independently. Always call your insurance before any procedure and get the preapproval letter or a letter/email that says the procedure doesn't need a preapproval. This has saved my hiney on several occasions.
Reading through everything I think the problem is our healthcare and insurance is soooo confusing that the everyday person doesn’t understand. It’s easy to misinterpret things or for a healthcare facility to even slip random charges in or an insurance company not to pay something. Why can’t it just be cut and dry? 😟 I feel for you OP. I understand where the misunderstanding happened with the receptionist but I feel like she should have been more clear and to have you check with your insurance company for the actual cost. I also feel that they were very unprofessional about you giving them a bad review. They should have just talked to you calmly and helped you understand what happened.
So you will want to get an itemized bill for each charge and then call your insurance provider and go over the bill with them to see if they will cover any of it or if anything seems incorrect. After that if they still won't pay ask the office if they have a reduced cash price.
2 things, prior authorization checks and the derms end will just give them a bool of whether you're covered for the procedure or not, it doesn't return any information on the payment amount on your end. Those contracts are typically worked out way above the head of whoever you talked to. 2nd, did they give you a physical quote for the procedure or only verbally? If physical, the quote should have preliminary information/codes on what you will be charged for. Compare the quote to the billing statement to see if the codes line up. If they don't line up you'll have to talk to the derm office to see if it was a mistake and if they refute/you still belive it's a mistake you'll have to dispute the chatges with the insurance company who will then open an investigation iirc.
Jesus, how do you guys deal with all of this healthcare paperwork / rules? It boggles my mind that anyone likes/wants this system. Best of luck OP I hope it works out for you guys.
Ridiculous. Thank you
This is awful, I’m so sorry you have to deal with this kind of treatment from the owners.
Thank you…
I work at a health plan processing claims. First check with your insurance to see if they billed. If they did, ask how the claim was processed and what is your out of pocket cost. If the doctor is contracted the rates would be much lower than that. 2nd if they haven’t billed they cannot bill you upfront for those costs. 3rd they cannot send you to collections if you are making payments (this is for California check with your state) even if it’s $5 make a payment. Since there is no payment agreement (she revoked it) the you can pay as much as you want without being sent to collections. 4th make a letter stating your issue as stated above send it to your insurance, your state’s medical board, the doctor that saw your wife (if you search in the medical board website it will list their mailing address) and most importantly the office of inspection general. Make sure you indicate in your letter that this could possibly be fraudulent billing since raised their pricing without letting you know. Also they cannot bill you unless you signed an advanced beneficiary notice that indicates the procedure code and the total cost of the procedure.
Wow this is a lot to unpack! I echo everything everyone else is saying, quoted prices do not hold much ground. Unfortunately your HDHP is part of the issue here. The receptionist was most likely quoting the co-insurance after the deductible was met, if your deductible reset then you’re on the hook for it. You should call the office and apologize profusely, and explain that you did not understand how your insurance worked, and were surprised by the bill and were frustrated by the ordeal. See if they’ll put you on a payment plan. In the future, call the billing office ahead of time where you get a procedure, and get the CPT codes for the procedure, as well as the diagnosis codes. Then call your insurance and ask them how much it costs, supplying that information, you’ll get a much better idea of the cost. I had a similar issue with a CT scan I had a few months ago. I was quoted a certain price by the billing people at the imaging center. Verified it against my plan, and was surprised I got a bill for 3 times that amount. I called them back immediately and talked with my initial contact who was as surprised and frustrated as me. Turns out that imagine center is treated as a hospital, despite being free standing, but only for my particular plans contract. Neither the imaging center or I were aware of that, as it has always been free standing otherwise. We discussed it and they agreed to take only 20% of the remaining balance and called it even, and I was emailed and mailed proof of this. Be careful and viligant for the future!
I am no legal expert by any means but I am in the healthcare tech industry 2022 No surprise medical bills https://www.cms.gov/newsroom/fact-sheets/no-surprises-understand-your-rights-against-surprise-medical-bills
Wow this seems huge, hopefully it's as good in practice as it is on paper. Will be nice not to have to worry about which emergency rooms are in network
It’s about time patients get more leverage and transparency. Even though this mandate is already in effect, patients are left in that dark on their resources. & don’t forget to Always ask for an itemized receipt from any ER/Urgent care visit as well.
I'll give this a read thank you
This isn't a surprise bill though and won't meet the criteria. The receptionist simply made the assumption you had hit your deductible and would only pay 20% of the bill. It's on you to actually verify that though. Since you carry a high deductible plan, the cost comes out of your pocket. This isn't surprise billing.
I hope this works out for you
Thanks. We're not going down with at least a good bit of fight for the next 60 days.
You can cc your correspondence to the BBB to the credit bureaus AND the office stating they revoked the offer of a payment plan based on your review. Ultimately knowing the cost of procedures is patient responsibility, however, the one time I really got into it with an urgent care, calling them on their shit to the state licensing board and credit bureaus (I was 100% in the right and it was a small charge for clarity), and cc'ing the company running a background check on me for employment at the time, got them to pull the collections at least. However, in my situation, the office was at fault for being wildly incompetent and losing my check.
The BBB (Better Business Bureau) is Yelp for old people. They have no power or authority.
If they’re members of the BBB, then it matters to them. They’ve agreed to certain terms and conditions, and will have their rating drastically reduced or their membership revoked if they do t follow through. If they’re not BBB members, then it’s not worth a damn.
This may be something to try. We realize that because the form was signed we dont have much lee-way. I think the fact that this seems to have happened to other people and potential discrimination because of the review my wife left (ironically enough after they emailed and asked for it).
This isn't "discrimination" - they weren't treating you differently because of a protected class or an unchangeable part of who you are. This was a response to what was likely a rude interaction - if you are willing to blast them on the internet because you have a high deductible plan and don't understand it, they don't want to enter into an interest-free unsecured loan with you. If you have a high deductible plan, you should be using your HSA to set aside your deductible so you're ready at the start of the year.
I would add all this BS to the review as well. Since you have it on recording, make a tik-tok and blast them on there (no, not really, but maybe)...
Healthcare shouldn't be a for-profit endeavor
This is your expensive life lesson not to sign documents binding you to be financially responsible for indeterminate sums. Next time get everything is writing and confirm the things that you're told with the actual controlling party (insurance). >admitting to revoking the payment plan because of the review (is that legal?) Yes.
Your mistake was going to a dermatologist (skin doctor) for a vein problem (vascular surgeon). I worked at a vein practice and did this procedure often. Dermatologists have no business doing this type of procedure. This is as bad as dentists doing Botox and lip fillers. You need the right tool for the job.
Report to state medical board as well.
You aren't getting scammed. Or at least not by the dr. office. You are just participating in an absolutely byzantine medical billing system. Did they mention the 20% bit before or just after? If before it's on you to know the high level details of your insurance plan. High deductible means you pay the full cost of care until you reach it. So they weren't wrong. It's just 'your insurance' for the first $Xk a year - that's you. 20% paid by you. 80% also paid by you since you haven't reached deductible. If the 20% bit was never mentioned before and just your expected cost is $400/leg that's crappy but they aren't bound to that estimate verbal or written, it's an estimate. Dr's offices are never bound to fixed prices before billing. It's sort of wierd thing. It's not a market, you can't effectively shop around. If you have other procedures in planning do your best to schedule them in this same deductible period. Probably time to mea culpa with the office manager and if you are sincere and pull the negative reviews I think it's likely they will offer the payment plan again. Maybe even a cash payment discount. You get more flies with honey.
Do you have a payment plan already agreed to and set up? If you do, just follow that and pay the minimum, drag it as long as possible. They can't unilaterally revoke your payment plan because they don't like you. Doctor offices are sucker for cash flow.
I had this procedure done. I paid $300 per leg. I never tried to get insurance to cover it. But the price just seems crazy high.
I would call the doc and and tell them exactly how their receptionist is acting, and that your next calls will be to the state medical board and the insurance company. It is also illegal to threaten someone when attempting to collect a debt, and you could get them into some [serious hot water](https://www.consumer.ftc.gov/blog/2014/07/stop-debt-collectors-empty-threats) for her behavior.
What threat? OP said the office said (to his wife, so now we're 3or 4 deep in the telephone game) that they were going to revoke the payment plan option and "take their ass to collections". A payment plan is a courtesy and if I'm being yelled at about a fictional "verbal agreement" and deceitful "bait and switch" activities I'm probably going to revoke that courtesy also. And if OP's wife said they're not going to pay then of course it's reasonable to tell her that they'll be sending the bill to collections. So now all we have is whether the office person was out of line for saying "ass" to them, if that's what was even said, and while I definitely agree that's unprofessional, it certainly doesn't rise to illegal or worthy of any type of investigation. Let's stop telling people to report any inconvenient situation to the ftc, state medical boards, BBB, and everywhere else. There's a place for those but this sounds very far from one.
Might want to double-check you arent in a state with a wiretap law. Surreptitious recordings like that are illegal in many states.
No they are not. Federally, and in 43 states (including Op's), they are one-party consent laws. Since op is a "party" and he consents, it is perfectly legal to record his own conversations. There are 7 states that require "two-party consent" so it's always good to know your local laws but it is not correct to imply this is the norm across the country.
Name and Shame
Let them send you to collections!!! It is way worse for them. Normally healthcare gets around 30% back for what they bill. That balance is going to sit in their AR buckets for 4 months before collections can happen. When they sell the debt they normally get way less than the afore mentioned 30%. Of note...I bet the actual Physician has no idea this is happening. Talk to him/her. Things might very well change. Also...if you have a government backed insurance plan did they ask you to sign an ABN? If not...doom on them. If commercial the amount billed will depend upon your deductible. On the positive side...if you hit your out of pocket max this early in the year blow up your healthcare. Get your colonoscopy. Get your joints fixed. 😊
Getting something sent to collections destroys your credit score and makes your life much more difficult for you than the doctor's office. I had a doctor's office send a bill to collections and my credit score dropped nearly 200 points. I was lucky that the office admitted their mistake to me that they did not send a physical bill and they only tried to call once. The person who called said the number was not in service, so the assumption is they typed it in wrong and just didn't try again. They helped me get the debt removed by writing a letter to the collection agency, but even that process took months. I was buying a house and months later, only two scores were updated so my credit scores went something like 800, 800, 600. Luckily I had the letter explaining the situation and they only use the middle score, but a bill going to collections was almost disastrous for me.
What you do next is simple. Pay what you owe. Take down the reviews, and apologize to the manager and hope you can get the payment plan deal. But you 100% owe it all, based on what you said. Someone messed up, you, or them, but its your responsibility to know if you've met your deductible or not, and you haven't. Then go enjoy your wife's $4000 legs.
Let them send you to collections!!! It is way worse for them. Normally healthcare gets around 30% back for what they bill. That balance is going to sit in their AR buckets for 4 months before collections can happen. When they sell the debt they normally get way less than the afore mentioned 30%. Of note...I bet the actual Physician has no idea this is happening. Talk to him/her. Things might very well change. Also...if you have a government backed insurance plan did they ask you to sign an ABN? If not...doom on them. If commercial the amount billed will depend upon your deductible. On the positive side...if you hit your out of pocket max this early in the year blow up your healthcare. Get your colonoscopy. Get your joints fixed. 😊
This is probably not the best advice, but I had something VERY similar happen to me. Basically they assured me a procedure would be fully covered by my insurance and instead they sent me a bill for $25,000. I basically said, too bad, you screwed up, I won't be paying this, deal with my insurance if you want it. I stopped taking their calls and all mail went straight to the recycle. 5 years later and nothing bad has happened. Credit seems fine. Can't say this will be your experience though.
[удалено]
[удалено]
[удалено]
Personal attacks are not okay here. Please do not do this again.
Ohio's wiretapping law is a "one-party consent" law. Ohio law makes it a crime to intercept or record any "wire, oral, or electronic communication" unless one party to the conversation consents. ... See Ohio Rev. Code § 2933.51.
He, the recording party, consents
That sounds crazy expensive. I know everyone's insurance is different, but I had to do 5 vein treatments on my greater saphenous vein (2 laser, 2 rf, and one with foam) in order to finally seal it, the whole thing from ankle to groin. The valves in the vein became incompentent, so the whole vein failed to function properly. I used two different doctor offices but I only had to pay for the $40 specialist visit. They were both vascular surgeons. Excuse me as I go knock on some wood. I have a follow up this month and I hope its still closed.
Doctors offices are notorious liars. If it's not in writing, it didn't happen. The office manager is definitely being ratchet about it. I'd start sending in partial payments certified mail noting it is a payment plan and what you can afford; once they accept the first one that IS a payment plan.
Post this to r/legaladvice record every conversation and Sue
Your post has been removed [because it is primarily a legal question or discussion (rule 5)](https://www.reddit.com/r/personalfinance/about/rules) which is off-topic for /r/personalfinance. /r/legaladvice can help you determine if you need to contact a lawyer and you may get some basic advice. **While /r/legaladvice can sometimes offer basic advice, talking to a local attorney is the best way to answer any legal questions.** *If you have questions about this removal, please [message the moderators](http://www.reddit.com/message/compose?to=%2Fr%2Fpersonalfinance&subject=Removal%20help%20request&message=Hello%20moderators,%20.%20%0a%0a%0aMy%20submission:%20https://www.reddit.com/r/personalfinance/comments/sig5c1/currently_getting_bait_and_switchd_by_a/%0a).*