Feel like I'm being soaked on a medical bill

[robr]

So the story is this, when I was unemployed, I had insurance through the state which offers it for the unemployed at a subsidized rate. When I found a job, my health insurance didn't kick in for a month. During my unemployment, my son had been going thru some medical problems and had been referred to an allergist. The appointment was after I had started working again. The allergist's office called the insurance company to confirm we had insurance coverage and went ahead and gave him a prick test. Basically a nurse came in, pricked his skin with something coated with different allergens, came back 20 minutes later to observe the results and jot down the results, then the doctor came in and talked to us for 5 minutes.

A month later I get a bill for $900+. As it turns out, my insurance was later retroactively cancelled by the state as they apparently terminate insurance 7 days after you receive your last unemployment check. I'm sure this was probably mentioned somewhere on some stack paperwork I received a year prior and I take responsibility for not being aware of this. I was expecting to be notified when my insurance was terminated. As I had been being billed and paying for it, it never occurred to me that it was possible to retroactively cancel insurance.

I called the allergist's office and explained the situation and asked that they be willing to work with me on billing and I'd be happy to pay them whatever the insurance company would normally pay for the visit so they wouldn't be out anything. They tell me no, they want the whole payment and the only thing they are willing to do is put me on a payment plan.

From what I can find online, the retail price of the allergen testing kit that was used is $340. I'm sure they probably pay quite a bit less. Judging from other payments I've seen the insurance company make, my guess (and that's all it is), is they probably wouldn't get more than $500-600 from the insurance company.

What would Brian Boitano do?

 

[Vega$ NSX]

What would Brian Boitano do?

A triple lutz and spin his way out of medical bills and to victory!

 

[NsXMas]

Yes it seems you are being soaked. Why they wouldn't accept the insurance contracted rate seems greedy to me.

 

[Hrant]

Ah the world of "judging" what is fair for individuals with no insurance - cash pay, vs. those who negotiate discounted rates because they offer volume.

Since the doctor's office has the upper hand in here in terms of ruining your credit history should you pay less than what they "want" and in the timeline that they "want" .... your only realistic leverage is to see if your local TV news station is willing to take your cause. A call from the TV is most likely enough to settle this at a compromise for both parties as I am sure the doctor's office wouldn't want to explain why a prick and a visit by a nurse (check if it was an RN or LVN - latter are paid half of RN wages) would cost $900.

 

[bee_are_bee]

I'm not going to judge the motivation of cost of the procedure. You can look at the cost of an allergy kit, implements used etc, but most of us can't know what fully goes into the cost of a medical procedure. Not only are you paying for the cost of materials used for the test but you're also paying for the doctors time, the time of the lab, doctor's medical school, medical malpractice insurance, rent on his office, etc. There's a reason something like this costs what it does. Often times it's too complex for us to fully understand. Generally, what the consumer pays is reflective of the total cost to bring that service to the consumer. It's easy for us to say "the doc is hosing us" without knowing the monthly nut the doctor and his practice has to crack. I'm not saying the doctor isn't fleecing but I'm not going to judge for sure that he is. With that being said it would have been nice if the cost of the procedure was disclosed up front but since you thought your insurance was converting the procedure you couldn't have known to ask that. Sounds like the doctor/clinic isn't willing to be flexible on a payment plan and that sucks.

 

[Hagasan]

So if the allergist called they insurance company and the insurance company confirmed to the allergist that the patient has insurance..... why should the patient have to pay when it's a result of the other two parties? Shouldn't the allergist be chasing the insurance company instead of the easy target patient?

Pick on the little guy huh...it's easier

 

[jond]

I don't know, but congrats on finding a new job.

 

[kookoo4nsx]

I don't like the fact that every other business in the world posts prices BEFORE you take a service.

Medical offices should clearly have prices posted for services.

 

[SilverStone05]

I don't like the fact that every other business in the world posts prices BEFORE you take a service.

Medical offices should clearly have prices posted for services.

Bingo.

And that is a problem with healthcare in this country.

Because when someone is "covered" by insurance...they don't bother asking how much that allergy test costs because they aren't paying for it. And people will opt for unnecessary procedures, and utilize the emergency room for non life threatening symptoms driving up costs more and more.

Only when you have to pay out of pocket does price become a factor.

Furthermore - it isn't easy to find out how much a procedure costs. Try asking the Dr. a price on a procedure and 9 times out of 10 he/she isn't going to know.

:frown:

Rob - in my experience...if you offer to pay the bill at one time they will offer you a 20% discount. Otherwise you are going to have to bite the bullet and take a lesson from this. Good luck and congrats on the new gig.

 

[robr]

I don't have an issue with them not posting prices as 99% of people that walk in their door probably don't care, also it's not an operation where they can easily say up front what things will cost, they probably have 400 different lab kits in the back somewhere just for diagnostics. Again, I don't want to stiff these guys, I just want to pay what they otherwise would have been paid had I been insured.

I was hoping to get some ideas of applying leverage, the only one I have come up with and I don't even know if it's viable, is to go after them with small claims court, not necessarily with the intent to win, but with the thought that if the doctor has to spend a few hours in court, he's going to lose more $$ from not being in the office that he would from adjusting my invoice.

In most doctors offices these days, I recall signing paperwork that says if an insurance company won't pay, I am responsible for the bill. I don't think my wife signed such paperwork here and don't know if that can be used as an out. I don't want an out though, that test kit they used was a couple hundred out of the doctor's pocket. I just want what to pay what I consider to be fair. I can't afford a $500 bill, never mind $900, even with a new job. The industry doesn't pay what it used to in my line of work, that's for sure.

As an entirely unrelated side note, the guy was a MAJOR jerk and during the two office visits (the 2nd one was covered) he was rude and condescending to my wife when she asked him questions. Every single question she had, he tried to make her feel stupid. I wasn't there, but my wife has no reason to make that up.

PS, thanks jond

 

[SilverStone05]

I'm going to be direct.

But what you describe is yet another problem with healthcare in this country.

People who believe that Doctors or others in the medical field should render their services for free or for what the patient believes amounts to a "fair" price.

You aren't entitled to decide what you think you should pay. The doctor performed the service....you didn't ask how much it would cost. This is your doing, not his...whether he was an Azzhat to your wife or not. Paying the bill would be the honorable thing. Dragging the guy into court because you don't agree wouldn't be.

 

[robr]

I'm going to be direct.

But what you describe is yet another problem with healthcare in this country.

People who believe that Doctors or others in the medical field should render their services for free or for what the patient believes amounts to a "fair" price.

You aren't entitled to decide what you think you should pay. The doctor performed the service....you didn't ask how much it would cost. This is your doing, not his...whether he was an Azzhat to your wife or not. Paying the bill would be the honorable thing. Dragging the guy into court because you don't agree wouldn't be.

There's where I have to disagree, he's losing NOTHING by charging me what the insurance company would pay him, not a penny. Anything beyond that is him being greedy and sticking it to the individual and if he's willing to choose that route, then I will fight that battle using whatever means I have at my disposal.

When is the last time ANYBODY reading this that has medical insurance has asked a doctor's office how much something is going to cost? There's nothing that can be done about it once you have the answer, not like you can haggle with the guy on behalf of the insurance company, so why ask?

 

[Russ]

When you tried to negotiate with the allergist you no doubt were dealing with the hard ass billing lady aka the gatekeeper. Try to talk with the doctor, he or she may be more agreeable to meeting you halfway. I know for a fact Dr's will knock down their bills by a third on a regular basis rather than go through collections which will cost them at least as much with no guarantee of success.

 

[SilverStone05]

There's where I have to disagree, he's losing NOTHING by charging me what the insurance company would pay him, not a penny. Anything beyond that is him being greedy and sticking it to the individual and if he's willing to choose that route, then I will fight that battle using whatever means I have at my disposal.

Another reason that medical procedures cost so much is because a lot of people don't pay or pay very little...driving up costs for everyone else. It's a vicious circle.

When is the last time ANYBODY reading this that has medical insurance has asked a doctor's office how much something is going to cost?

I do it every time I go. I have a catastrophic plan with a high deductible. I pay for 80% of my costs out of pocket up to a certain point. As a result I am very cognizant of my health and what my doctor charges.

There's nothing that can be done about it once you have the answer, not like you can haggle with the guy on behalf of the insurance company, so why ask?

That just isn't true. You can negotiate. You tell an office that you are self pay upfront and all of the sudden a new price list comes out. If your current Doctor doesn't do that, find another.

Good luck.

 

[robr]

You're comparing apples with oranges. If you self pay, of course you're going to ask and negotiate. If you just pay a flat rate for an office visit (as I thought I was doing), there isn't much point in asking.

If I had high catastrophe insurance or was paying out of pocket, I ABSOLUTELY would ask. I had one office visit myself when I knew I wasn't insured and spoke with my doctor and she gladly said she'd bill things at a lower rate and in a different manner.

Good point on the hard-ass billing lady gatekeeper. I will ask for a call back from the doctor. She told me it's not their policy so I figured that was what the doctor had her doing, but you're right, it can't hurt to ask to speak with him directly.

 

[peiserg]

There's where I have to disagree, he's losing NOTHING by charging me what the insurance company would pay him, not a penny. Anything beyond that is him being greedy and sticking it to the individual and if he's willing to choose that route, then I will fight that battle using whatever means I have at my disposal.

When is the last time ANYBODY reading this that has medical insurance has asked a doctor's office how much something is going to cost? There's nothing that can be done about it once you have the answer, not like you can haggle with the guy on behalf of the insurance company, so why ask?

you can only say this making big assumptions.. you are assuming what the insurer is paying is not only covering his expenses (malpractice, electricity, supplies, all office personnel, education, malpractice, time, etc), but also paying enough after 40% taxes on the 60% left after those costs to be worth doing.

just because $500 is.what the insurer pays, doesn't mean the dr. can clear expenses AND make enough to be "worth" it. it may just be what the insurer has muscled him down to...

as for small claims court, what is your claim? your insurer isnt paying. ultimately t you are unfortunately on the hook. the only absolute guaranteed outcome there is that doctor wil refuse to see you ever again, AND he/she will mention you for the next 6 months to all his other allergist buddies so they can watch out for you.


try speaking directly with the dr. I commonly give 20 to 40% off if patient requests if they agree to pay right away, and are polite. aholes get zero. hope that helps

 

[docjohn]

Rob,do you or your family have a sympathetic internist/regular doctor/pediatrician?

 

[queenlives]

When is the last time ANYBODY reading this that has medical insurance has asked a doctor's office how much something is going to cost?

since you asked, my wife and i do and we have for years. we began doing this when we fell into a situation similar to yours. we have excellent (cobra) insurance from her former employer but after being hammered like you are, we took it as a lesson-learned and lived by those rules going forward. like peiserg says, offer to pay whatever costs we can up-front to receive a lower bill.

my take is to contact the doc, explain your situation and ask for some consideration on the bill and to arrange payment terms. difficult, i know, but that's likely your best option @ this point.

 

[robr]

docjohn, I play cards with my pediatrician and do some of his home IT stuff, so we have a very sympathetic pediatrician.

peiserg, i really don't feel like im the ahole here (not sure if you're implying that or not), I haven't gone down the ahole road yet, but until the suggestion came up to talk directly to the doctor, I felt like I was being forced down that path unless i suck it up and pay the bill as is which I will not do without exhausting alternatives. i really don't care who he tells or talks to, he was alleged to be the best in the area and we are not happy with his services or his attitude with my wife or son. i have insurance now, i can just take my kid to lahey, we have no intention of ever returning to this guy. this has absolutely nothing to do with the billing.

 

[NetViper]

The crappy thing is if you just lost your job and told them you cannot pay the full amount they would work out a deal for you to pay a lower rate in one payment.

Since you just got a job, now they want you to pay the whole amount.

Very annoying.

FYI, I always ask what something is going to cost, and they rarely if ever know correctly and I always seem to get more bills a month later for things they forgot.

 

[steveny]

Yes it seems you are being soaked. Why they wouldn't accept the insurance contracted rate seems greedy to me.

well if they did that then everyone could negotiate their medical bills without having to participate in getting reamed up the ass, I mean paying astronomical rates for health insurance, I mean paying for everyone else who doesn't pay. I would LOVE the opportunity to pay what the insurance would pay without having to first pay 1600 bucks a month for the insurance.

Rob should be able to pay what insurance would pay but he can't because then they would have to allow everyone to do the same. Just think if a company like verizon could simply pay what the insurance paid and not have to pay for the insurance. With the savings on their 85K employees in less than a months time verizon could build their own medical facility and then buy a jet to fly their people in to see a doctor and it would still be CHEAPER than paying 1600 a month per person. 85000 x 1600 a month is 136 MILLION dollars in health care PER MONTH!!! I would guess a hospital could be built for that kind of money?

 

[NsXMas]

...try speaking directly with the dr. I commonly give 20 to 40% off if patient requests if they agree to pay right away, and are polite. aholes get zero. hope that helps

Ger, I thought you demand cash right before the surgeon starts cutting on the surgeon table, thus your 99.999% success rate in your collections? Otherwise the patient has to go through surgery without any pain medicine? :biggrin:

 

[steveny]

Often times it's too complex for us to fully understand.

Whenever something is too complex for you to understand you're getting ripped off 99.9% of the time. People make things complex for selfish reasons. Nothing needs to be so complex that it can't be understood unless there is something that someone doesn't want you to see.

 

[Hrant]

As peiserg said, you have no standing in small claims. I negotiate health care contracts, provider relations for a living. The gist of the issue is you find $900+ to be too much.

As others suggested, talk to the doctor in a polite tone and explain your assumption and how you were surprised that your insurance denied the claim. The gatekeeper may not let you pass her just to shield the doctor and this may be by design if the office has rudeness factor.

So bottom line, how much do you think you should pay and how much hassle are you willing to go through for say $200 savings. Try to ask around and see what others in your community charge (usual customary fees). If you still believe you were "hosed" then as I suggested see if you can rally the local TV's consumer advocate - seems to work for many here. Good luck and HTH.

 

[NsXMas]

Hrant has some excellent suggestions.

Also check to see if the allergist needs some IT work, perhaps some bartering would work well...