Insurance is Irritating

[PLFXpert 0]

I just got off the phone with insurance provider. I have full coverage through my employer.

I went for a routine annual exam and then got a "Benefits Summary" aka "How We Screwed You Summary" and I owe $60 which will be billed to me, likely, by the provider soon.

Of course, the "summary" was in greek---I mean it used English words, but the message was definitely greek. I understood that the provider charged more than my insurance carrier allowed. But, what I did NOT understand was this was a provider I picked from my carrier's own website.

I won't even get into the conversation with the idiot I spoke to. He had the nerve to say, "Do you usually shop for the cheapest doctor?"

I had nothing extra, nothing special, just the routine annual goodies performed by a provider that my carrier referred me to. IMO, the carrier should cover whatever they charge, then. I paid my co-pay like a good girl.

Why should I now pay another $60???

Insurance sucks (pardon my french).

Paint me in a corner, but my color comes back.

[simplyputsi 0]

You may not actually owe $60. Your insurance carrier may bargain with them to get them to reduce the fee and then you will owe nothing. I used to get bills all the time when I was doing physical therapy that said I owed money. I never paid a thing and the insurance company had everything adjusted. My mom worked in a benefits department and told me that is how it works. The doctor sends you the bill and the insurance the bill at the same time. Things can get pretty messed up from there.
I feel your pain. I hate, hate, hate insurance these days.

Skymama's #2 stalker -

[d_squared431 0]

There are negotiation fees from a doctors office to the insurance company. For example the set fee an insurance company will pay for routine exam may be $85 but the doctors fee may be $135 for the visit. so if the insurance company says "hey that is only worth $65 dollars" then the doctor writes off the difference between $65 and $85 and the rest is the patients responsibility. Unless there is a deductible that hasn't been met, then you pay the full amount. Maybe the $60.00 falls under your deductible and that is why you have to pay that amount.

TPM Sister#130ONTIG#1
I love vodka.I love vodka cause it rhymes with Tuaca~LisaH
You having a clean thought is like billyvance having a clean post.iluvtofly

[PLFXpert 0]

No deductible.

And simplyputsi I think you're right. While I don't pretend to be an expert by any means on insurance, I do recall getting a "summary" once before through another carrier but the bill from the provider never came.

After three months I called the provider (Yes, I'm royally anal if you haven't picked up on that yet.) to make sure there wasn't a mistake as I always pay my bills, in full, right away and I didn't want anything on my credit if they'd sent it to the wrong address or if it was lost in the mail, or whatever.

They explained the whole adjustment thing to me and said there was no bill b/c I did not owe anything.


I've take the $60 out of my shoe fund for now and will wait for the bill. If I get a bill, however, you can bet I'll begin the appeals process with my carrier.

The way I budget, anything unexpected comes out of my shoe budget. Rarely do I get anything unexpected b/c I'm the kind of person who is meticulous and knows when to expect everything. But, when I do they don't get a cent of my shoe budget without a fight. And I usually win the fight, thus I have a closet full of glorious shoes.

Paint me in a corner, but my color comes back.

[tigra 0]

I would think that you would only owe the additional $60.00 if you went (by choice) to a doctor that was not part of your insurance company's network. When I was being treated for my broken ankle a few years back, I got those notices fairly often. Usually, a phone call wasn't even required. It was a matter of the provider "forgetting" that they were only allowed to bill a certain amount, and sometimes the insurance company had to "remind" them!

[PLFXpert 0]

I called the # for the provider straight from my carrier's network list on their website. I think it doesn't matter who I go to anyways, but they still have a list of providers on their website and I picked the nearest one to me.

We'll see if I get a bill. But, I dont like seeing a box telling me "You owe." We'll see if "I owe."

I normally wear this hat: but mess with my shoe fund and I put on this hat:

Paint me in a corner, but my color comes back.

[NWFlyer 2]

Make your provider and your insurance company duke it out. This money doesn't sound like it's your responsibility. Keep notes on all your conversations, of course, and follow up.

"There is only one basic human right, the right to do as you damn well please. And with it comes the only basic human duty, the duty to take the consequences." -P.J. O'Rourke

[PLFXpert 0]

Mos def'.


I already wrote down the conversation reference code for my first call.

I'm with you--let them duke it out.

Paint me in a corner, but my color comes back.

[JENNR8R 0]

I believe the doctor's offices are just as irritating as the insurance companies.

I had a doctor insist that I pay $1,000 that I didn't owe. When the insurance paid him too, he conveniently "forgot" to give me a refund. It took me six months, and many phone calls, to get it back.

A doctor put a $2,000 lien on my mother's estate based on the amount he was owed on the day of her death. When the lien was initiated the bill was actually $150 because Medicare had already paid most of it, and the secondary insurance carrier had not even been billed yet. To top it all off, they wouldn't answer my phone calls for three weeks! When I finally talked with someone, they said it was to protect me as a North Carolina taxpayer. None of Mom's heirs live in North Carolina!!!

What do you call a beautiful, sunny day that comes after two cloudy, rainy
ones? -- Monday.

[PLFXpert 0]

That's terrible. I shall fight the good fight in your honor, too.

Yes, the doctor's office was just as irritating, but for different reasons. I was there 3 hours!!! I had an appointment, of course. Supposedly they're the best and everyone in the waiting room just raved about them. I was repeatedly apologized to for the delay and thanked for my patience.

What they don't know is I have no patience--except for animals, elderly & children in that order. My sweetness was a phasade---Afterall you don't want to upset the person who is about to stick something in you.

Paint me in a corner, but my color comes back.

[livendive 8]

Quote

My sweetness was a phasade...

________________________________________
I always edit for spelling/grammar. It just bothers me.

I have nothing to add, I just wanted to quote you before the inevitable edit.

Blues,
Dave

"I AM A PROFESSIONAL EXTREME ATHLETE!"
(drink Mountain Dew)

[d_squared431 0]

Quote

I believe the doctor's offices are just as irritating as the insurance companies.

Many doctors offices are real asses.There are a few that really work with patients. Our office just wrote off over 900.00 for a lady because Blue Cross of California doesn't see our office as a signed provider even though we are. (because we didn't sign specifically with California) What most people forget is that when they sign a registration form you are signing that you are responsible regardless if your insurance pays. We have several patients who can't afford to pay anything except there copays and if they take the time to write letter or call the office we usually write off most the bill. I know we can't be the only doctors office that does this.I think that is why I have stayed with the same employer for so long. I know it isn't the pay

TPM Sister#130ONTIG#1
I love vodka.I love vodka cause it rhymes with Tuaca~LisaH
You having a clean thought is like billyvance having a clean post.iluvtofly

[flyinghonu 0]

If your doc office is contracted with your insurance carrier, which sounds like the case since your insurance carrier referred you to this doc office, then look over your EOB carefully. There should be a section that says something like amount owed by patient (if you co-pay is $10, it will say $10). Most likely, the doc office billed your insurance company at the regular rate (not the contracted rate they have established with your insurance company). Apparantly, doc offices do this in hopes of an oversight by the insurance company, hoping to get paid the regular rate not the contracted rate for the service. If your EOB says you only owe $10, then most likely the doc office will write-off (will read "adjustment" on your EOB or bill) the $60.

If your insurance carrier is not contracted with this doc office and/or the doc office is not a "preferred provider" than you will probably be paying the $60.

"Excuse me while I kiss the sky..." - Jimi Hendrix