Forget Co-Pays, Your Bill Is Due Now
$10 copays are history in some doctor's offices these days, as some clinics are requiring the entire out-of -pocket cost up front. But what if you get overcharged?
Michael Gurion, an Atlanta attorney, says he didn't object when an optometrist collected around $70 from him during a visit a few years ago for an exam and contact lenses. But months later, when he looked at his insurer's explanation of benefits, he discovered he'd only owed about $25. He called the optometrist's office and was told the difference was being kept by the practice as a credit toward future visits.
If you do end up paying in full before leaving, watch for the insurer's explanation of benefits in the mail. If it's less than what you paid, ask for a refund.
Post a comment
Comments:
There are some states (ex: IL) and some providers (ex: Blue Cross Blue Shield) where the provider either A) Asks you to pay your copay $$ if that's your plan, or B) Has to send it in if it's just a co-insurance plan (and the insurance needs to determine what you owe.) On the type B plan described above, at least in Illinois, they cannot ask you for the money up front - they need to wait until they get Blue Cross' EOB before billing you.
Funny, I just noticed my ophthalmologist (coincidentally, in Atlanta) sent me a bill for $180 last week, the day before I received my EOB from the insurance company showing I only owe $134. Kicker is, the appointment was back on May 12.
Yeah - the system sucks - and you have to watch out for yourself. Personal responsibility! Try some!
@Skin Art Squared: So you think that it's acceptable to steal people's time, money, medical supplies, etc. because you're too selfish to pay for what you're using? I'd say it's selfish, self centered people like you that cause problems like this.
Don't blame "the system," find a doctor that you can work with and be an honest human being. You're disgusting.
My wife had a chiropractor that once did that. Was supposed to be a $35 first time visit. She ended up taking the $35 from us and billing my insurance company an additional $150 or so. She never told us she would do that and I didn't find out until I got the explanation of benefits. I went ballistic and told her I was reporting it to the insurance co. She said she was using the money as a credit towards future visits not even knowing if the wife was going to go back. I don't know what happened but her practice isn't around anymore.
@Skin Art Squared: It would be much cheaper (by hundreds or thousands of dollars) for you to go to "immediate medical care" or walk-in doctor offices, rather than the emergency room.
Many of them can handle everything from broken bones and sutures to a bad flu. They also handle simpler things.
Our city hospital has an off-site medical clinic for the uninsured, people pay what they can on a sliding scale. Call your hospital's community relations department or help line and see if they offer something like this.
Get your flu shot free or $10 through your city health department, and also ask them about free or low cost medical services for the uninsured.
I've gone to Care Now clinics a few times and they require payment up front. After the EOB comes through I've always gotten a check back for the difference.
More irritating is when you don't have to pay anything up front, the EOB comes through and then you get a bill for like $3 because insurance doesn't quite cover it all.
The whole system is based on the premise that someone else is paying for it . The rates they charge are based on the premise someone else is paying for it . This has been going on for so long now that most doctors/practice feel entitled to this pricing .
I heard this is why many doctors scheduled weeks if not months apart if you need repeat visits as to insure that your insurance has paid them . Throw in over booking and you have scheduling nightmares - I digress .
I've had practices make you sign waivers that you will pay any differences from what the insurance covers even though if you accept that insurance company's payment you are not to expect any more from the patient .
I've had clerks very sternly make me pay the co pay before seeing the doc even though my insurance was fully recognized and had they had social security for a credit check or tracking . I had another clerk tell the office manager who approved a payment plan for me I wasn't worthy and bill my insurance without my permission . I had payed over half the bill in CASH and had a half dozen prior visits where I was paid current frequently with CASH . Too many clerks are trying to justify their existence
@Necoras:
LOL, "find a doctor I can work with".... now there's a novel idea. Next time I'll try bartering down the outrageous bill and see how that goes over.
I have zero guilt over gaming a system that is clearly broken beyond repair. Between the ridiculous charges these hospitals put on a bill, to the insane way the insurance companies treat their policies (customers), health care is destined to collapse very soon. It's not just me.... there are currently MILLIONS of people in this country with absolutely no insurance whatsoever, because a.) they can't afford it, and b.) they can't get approved for it.
Yet we do NOTHING to fix it. Funny, the healthcare seems to be working in the UK, France, Canada, Cuba...... why? Do those people have more money than we do here in the US?
Get over your moral self. The healthcare system views you as a number. It's a business. And the same applies the other direction. It's a business decision. One that's saving me a ton of money I might add.
@Julia789: Those require payment up front. The ER does not.
And there's no way I'm ever getting another flu shot. Haven't had one since I left the military in '91.
Another related bit of advice confirmed by my insurance company recently: just don't pay ANYTHING out of pocket on the day. Wait for a bill.
I had to have foot surgery and had almost $900 remaining on the yearly deductible. So, in pre-registration for the hospital, I paid it to them. But even though the hospital billed insurance before my doctor, insurance processed the doctor's bill first, so the remaining deductible was applied there.
I called the insurance when the doctor billed me that almost $900 and said I'd paid it to the hospital. Insurance company says they can't transfer it or fix it; I had to chase down the hospital for over a month and eventually leave furious messages on the voicemail for a manager (threatening to go to American Express and request that they pull the charge since I now had documentation supporting that I shouldn't have had to pay the hospital) before they refunded the money so I could then pay the doctor with it.
Insurance rep confirmed that they advise never paying upfront, to always request to be billed later so such issues can't come up.
Or I could move home to Canada, grumble grumble...
I had to do this with my oral surgeon when I got my molars removed. It was a bit frustrating to suddenly find out you had to throw down nearly $1000, but I can understand why they do it. Insurance companies are so up in the air about what they will and won't pay, and with medical expenses being the number one debt, well, they have to make sure they're getting their money from someone.
@Necoras: I wish my insurance was so good. I always owe at least $30, more often around $55. I would write $3 check after $3 check gladly over the ones I have to write.
@Skin Art Squared: Wait, you're criticizing me for having morals? For not stealing whatever I feel like? Did you even listen to yourself think as you typed those things? Would you criticize someone for not robbing your business? For not breaking into your house and taking anything they want because they can't find a job and everything is broken, boohoo?
Yes, the system has problems. It's broken because people don't want to take responsbility for their actions and decisions. People want free healthcare. You don't expect free gas, or food, or a place to live, or, well until this past week free cars. Why should medical care be free? And insurance companies don't want to take responsibility and pay for medical care for their clients as they promise they will.
What kind of a person are you that you can say you have no guilt stealing from other people? What kind of a twisted mind do you have that you tell people to be less moral in their daily lives?
YOU are the problem with the healthcare system, YOU are the problem with the economy, and YOU are why it is collapsing.
Grow some balls man and take responsibility for yourself. Stop being a pathetic leach on society.
Some docs around here want me to pay $XXX+ upfront to get my junk snipped. Can't afford it, so the wife and I don't have the sex.
@Necoras:
Who said I wanted it to be "free"? I pay PLENTY in taxes every year to both state & federal entities, that should very easily cover the minute amount of healthcare I use. I go to the hospital when I NEED to, not when I have a runny nose. If it's broken, gushing blood, or falling off, then it's time to see a doctor. Not for all the petty aches & pains you people get every day as a normal part of life. In fact, the types that do that are the reason why insurance companies are so jacked up to begin with.
Nothing you say will convince me I need to fork over more money than I can ever make in a lifetime to these hospitals for their insanely over-inflated bills. It should not cost me $10k+ in 1993 to have a child born, when I HAVE insurance. I can only imagine what it costs now today, even when you have insurance.... probably something like, $50k+? Please.... for what? A vial of painkiller and a few hours of some nurses time? Are you kidding me?
I AM taking responsibility for myself. I've ceased being a slave to the health care system. They exist to serve ME. Not the other way around.
Another story in the series of "Proud Moments in Private Health Care/Commie Gubermint Soshulizm be Damned."
@Skin Art Squared: I'm curious. What are your feelings in regards to the vying health care reform proposals?
I don't understand why the doctor not returning money he's not entitled to for services rendered isn't criminal theft. Why isn't the patient filing a police report and a small claims suit (after trying to resolve it amicably, of course)?
@TinkishDelight: Wrong. Doctors' offices have a staff paid to wrestle with the insurance companies while consumers do not. And their time is valuable.
Pushing the cost of their collecting what's due to patients - err, victims - is wrong.
@Trai_Dep: If they're going to actually go through with it and give me an option to let the government pick up the tab, I'm all for it. Like I said, I pay enough in taxes to easily cover my healthcare needs, with plenty left over for whatever else they wanna burn it on.... war, political limos, I don't really care. The amount of taxes they bring in annually should easily cover every man, woman, & child in this country for healthcare. Assuming of course, that someone would step up and eliminate the enormous waste first. "Cash for clunkers"? Seriously? We continue to piss away tax dollars on the most ridiculous things, like bailing out AIG, instead of keeping people healthy.
I don't really know the specifics of the proposals yet, just the basic premise, because I'm not convinced it's going to ever get beyond proposal status, as usual. So I'm not going to get worked up over anything until it has more of a grip in reality. We've all seen these proposals get buried countless times before. I have no reason to believe this current round has any better of a chance. It's most likely just another political tool.
Do we get better health care because we pay outrageous sums of money for it? No. Not when most people can't get any healthcare at all because of the cost. No one can deny the system is doomed to fail. It's on its way down right now. There's no way to sustain our healthcare system at the prices they want. A week long stay in a hospital should not be paying for the doctor's entire college education. It's beyond stupid. But of course, there will always be those hardheaded people that live in fear of "socialism" and insist the only way to get your broken leg fixed is to fork out $20k for it. So the proposals, I think, meet that halfway. Want to stay with the current stupid system? Fine. Want the gov to cover it? Fine. Win / Win.
@Trai_Dep: That's exactly what I'm thinking. You overcharged me for a service, you owe me a refund. Don't want to pay? Fine, lets to talk in front of the JP.
But to the actual basis - I understand why doctors are asking for some payment upfront. Insurance Companies, Medicare, Medicade, BCBS all take, on average, from 4 to 6 months to pay insurance claims. On top of that, most practices just assume, day 1, that 50% of their charges will not be paid. Drop 20% off that for insurance negotiated rates/medicare rates, that's still 30% of their receivables that are just bad debt. Kind of makes sense, doesn't it?
@Necoras: So if you lose your job, your insurance, and can't afford COBRA, you'll just curl up in a corner and die? How noble of you.
@Tux the Penguin: And that's why doctors and hospitals overcharge- they assume they're only going to collect a fraction of that amount, so they've already built in the long term receivable and underpayment. But when the insurance company doesn't pay, they still give it to a collector. So you're getting overcharged because and sent to collections because the insurance company doesn't feel like paying what it owes.
But thank god we have a private system that is more efficient and costs less.
/snark
What I hate is that many practices try to bill for the difference that insurance doesn't cover for a procedure. They agreed to those amounts to be accepted by the program... Coming after me because they aren't getting what they feel they should is wrong as well...
@rellog321: Some plans forbid providers from going after patients for anything other than a copay and co-insurance percentage.
Some things like certain vision or dental plans allow that kind of thing unless they expressly ban it in the provider agreement. IE: dental plan forbids any "in network preferred dentist" from charging a patient the difference between the negotiated rate and what the dentist would charge someone who paid cash (no insurance).
@Trai_Dep: Sounds like insurance fraud to me. Contacting the state board of insurance, state AG's office and local law enforcement might be a good idea. One of the three should be enough to shame or prosecute this doctor.
@Julia789: And while you're there, your city health department can tell you how many of those programs have dried up due to budget cuts and increased costs.
@Necoras: That is really uncalled for.
If we had a functional health care system that existed to provide care rather than to make a few people rich this would not even be an issue. When everyone is in the risk pool and the funding pool together having a few people that are short on cash is not an issue.
Calling someone names because they are not forking over money to the insurance industry. That same industry that has massive profits, overpaid execs and spends more time denying people than anything else. The system that isn't working for Skin Art is the exact same system that will take everything you own even if you have insurance given the opportunity.
@Skin Art Squared: Funny... my kids needed a check up and booster shots for school. I called their pedi, and said, "Right now, we have no insurance." Guess what they did. They cut my bill. Because I was self paying. I went to the health department and got the days and times for the shot clinic. Walking into the ER because you are too lazy to pay for what you are using is a larger part of the reason why our health care system is in the shambles it is in.
Any clinic demanding anything beyond your copay up front should raise suspicions. They are either unethical and possibly running a scam or they are starved for cash. The starved for cash raises other concerns about how they run the business or why they don't have enough money to run said clinic.
I have gone to a few doctors that ran very bare bones clinics but were talented doctors. I never had one of them try to gouge me or scam me out of money.
Now the doctors (dentists and eye doctors also) with the swanky new clinics with all the bells and whistles. I have had more than a few of those try to scam my insurance, convince me to get services I didn't need or tried to overcharge me.
@Madaline_7: I hardly think so. The last time I went to the ER was to get stitches in my knee after it met with a chainsaw. I was there for about an hour, got my stitches, and nothing else. No painkillers, no pills of any kind. Why was the bill for $1900? At 5 stitches, that's $380 per stitch.
Are you really suggesting that the healthcare system is in shambles because I refuse to pay $1900 for 5 stitches when I need it? If so, you are defending a broken system that cannot survive. If I'd had insurance, how long would I have been paying monthly premiums for that insurance, that may or may not cover my expenses, and even if it did, would only increase then because it was used.
I'm not "too lazy" to pay for it. I'm not paying for it on purpose. It is the very opposite of lazy. I'm going out of my way to NOT pay for it.
Good luck trying to get this from me. My co-pays alone are $40 each visit for a specialist. I had knee surgery in March but I had to see a cardiologist for stress test ($40 bucks each visit), PT to see if the problem can be fixed w/o surgery ($40 bucks each visit x 20), seeing my orthopedic doctor ($40 each visit) and then PT after plus post op visits ($40 each visit). I was very grateful that my doctors and PT was able to bill me and allow me to pay off my co-pays, without it I would still be in a lot of pain and not have had knee surgery yet which meant I couldn't have worked which meant I would lose my job and my health insurance. You see what a slippery slope it would be? Now doctors want to charge me up front? I don't think so. You start doing that and only the wealthy will be able to afford to get health care outside of an emergency room.
hate to break it to you, but your cheating the system will do exactly jack squat for you when you develop a chronic illness--and guess what, if you're lucky enough to live a long time, you will, it's in the nature of things. When (not if) that happens, the ER will treat you all right--when you're acutely sick enough that what may have been easily treatable will now threaten your life.
You're part of the problem, but I rest easy knowing that if you stick with it, you'll be well f**ked
@treimel:
We're all gonna die you know. You, me, and the ones with the best insurance money can buy as well as the ones selling you that insurance.
My focus is on living. Not on "how the hell am I ever going to pay off this insurmountable debt to the hospital for the rest of my life".
You're going to die comfortable and content with the knowledge that you paid your premiums all your life like a good little citizen and had all your medical bills current.
I'm going to die not giving a shit about insurance companys or golf memberships for my doctors.
But we've all got it coming.... sooner or later.
Wait a sec--very often, they have NOT "agreed" to the cost of the procedure just becuase they're willing to accept the insurance. There's absolutely nothing illegal or unethical about charging X amount for a procedure, when the insurance company will only pay 1/2 x (or whatever percentage) so long as it's made clear up front. True, many plans' participation forbid the doctor from charging more--others do not.
@bohemian:
Wow--what on earth is suspicious or shady that I willingly go to a doctor even though I know I have to self-pay the difference between what he charges and what my insurance covers? I chose him because he's good--the fact that he's willing to allow me to pay the difference (and trust that I won't stiff him) is a problem how exactly?
@Skin Art Squared: It could be claimed that the reason hospitals charge $1900 for 5 stitches is in part because some people skip out on their bills, so the hospital piles those losses into what they charge.
However, if that is truly the case, those high prices are still just a symptom of a long broken system. If measures had been in place to ensure that everyone's bill could be paid, then the vicious cycle of people not paying their bill and the hospital jacking up prices would have never gotten started in the first place. As long as people can't afford care, the situation will just worse and worse.
@9900dude: I have had to bicker with my ob/gyn's office about this repeatedly. There are a couple of major employers in the city who use a particular plan that works one way; we're with a very small employer with a different plan where all the bills have to be sent to the insurer first, and THEN I pay. My ob/gyn's insurance person gets it, but their front office scheduling people totally can't cope when I don't pay at the time of service.
For all you "Pay for it you deadbeat" people.... healthcare isn't an option. It's not a luxury or something you can wave off with your hand and say "don't spend above your means"..... it's not a new car.
It is a basic service the government SHOULD be providing to every single person in this country. Taxes pay for police and fire departments for ALL people, why not basic healthcare? What would this country look like if we all had to individually BUY fire department insurance policies and make co-pay on it? Probably would be a LOT of houses burning down is my guess. Sounds ridiculous yes? Yet we allow millions to have zero healthcare whatsoever because, "they gots no money!" This is a freakin' travesty. Cuba has better health care than we do.
It sucks. And there is no other way to put it. Healthcare is ALREADY for the rich. Either fix it, or let's go ahead and make fire & police for the rich as well and stop pretending we give a shit about anyone but ourselves.
You get my copay and that's it, until a bill shows up in the mail. I need to visit my doctor monthly because the FDA decided the country would all turn into a bunch of drug addicts if I could get refills on my meds, and I don't need the additional hassle of babysitting a reimbursement I'm due.
@Trai_Dep: Around here, the medical folks deal directly with insurance while dental won't. I'm not sure whether that got established because of the difference between the plans or just because.
I know my dental practice bills for more than the procedure is worth so that they can up the average amount that the procedure costs, since the dental insurance only covers like 80% of the average. Once my mom overpaid the dental bill, we were double covered, and they billed both insurance companies equally or something. She had a credit, and she was like....keep it. It's a nice buffer for if you have a bad dental year (like I did) and can use the credit before the insurance is billed.
I used to work for a managed-care company, so I may be able to add a little insight here:
Depending on the contract that a provider (doctor, hospital, etc.) has with a managed-care plan, they may not be allowed to ask a patient for any more money up-front than just what is designated as a "co-pay." If you have insurance — especially a PPO or HMO plan — and are asked for more than the co-pay at the time of service, you may want to call your managed-care company and report it to their provider-relations department.
The person in the WSJ article may want to contact his insurance company and report this, as it may be a violation of contract.
The unfortunate thing for patients in these cases, is that they aren't privy to the contracts that are signed between providers and insurance companies. They do not necessarily know that this is disallowed ... but it often is. Compounding this is that physicians often enter these contracts in groups (known e.g. as IPAs), so individual physicians may not be clear on that. They should be, but often aren't.
It took me two years to get a refund ($194) for the overpayment on my daughter's birth from the hospital. They kept telling me it was their policy to keep all overpayments.
I don't know what finally made them give in and send a refund check (two days after I received the check, I got a call from someone in their billing office telling me, once again, that it was their policy to keep all overpayments).
Co-Pays? LOL
My new insurance plan: Emergency Room. Sorry, I don't have insurance and I don't have any money. Now fix the problem.
Sorry, but the health care system created the situation, not me.