Vintage Mustang Forums banner

1 - 11 of 11 Posts

·
Registered
Joined
·
8,714 Posts
Discussion Starter #1
Looking for some strategy of addressing this bill. In general, the insurance I have takes care of most of the amount on these bills. I'm fortunate for that.

The statement in question is coming directly from the doctor's billing office. Most of the amount (surgery) has already been handled by the insurance company.
The remainder of this bill has a CONSULTATION on the day of the surgery, which is a fair chunk of change. The dr's office statement is listing it as my responsibility.
Fair enough, I get it..... however, here's the rub- on my insurance company's explanation of benefits, that exact amount is denied, stating "when a consultation and
surgical care are received from the same provider during the same inpatient stay, your health care plan provides benefits only for the surgical services. No additional
payment can be made."

I didn't speak with the doctor at all on the day of the surgery to the tune of nearly half a grand. I'm thinking my approach is to talk to the provider's billing department
about "negotiating" this amount.

Anyone have any tips, tricks or hints?

Thanks in advance.
 

·
Registered
Joined
·
1,906 Posts
The doc didn’t come to the pre op and check on you? That’s considered the consultation along with reviewing your records and tests. I had three procedures last year and my wife had one. Except for when I was admitted from the ER for complications from one of the procedures we were charged similar fees though they were built into the upfront payment. The ER and OR at the hospital had their own maze of out of network providers. IIRC our consultations were only a couple/few hundred at the time.

You could try to contest it but may not have much luck. You could ask for the rate the insurance company would pay. We’ve had good luck with that on surprise bills and getting on interest free payment programs so we don’t go out of pocket all at once.
 

·
Registered
Joined
·
8,714 Posts
Discussion Starter #3
The doc didn’t come to the pre op and check on you? That’s considered the consultation along with reviewing your records and tests. I had three procedures last year and my wife had one. Except for when I was admitted from the ER for complications from one of the procedures we were charged similar fees though they were built into the upfront payment. The ER and OR at the hospital had their own maze of out of network providers. IIRC our consultations were only a couple/few hundred at the time.

You could try to contest it but may not have much luck. You could ask for the rate the insurance company would pay. We’ve had good luck with that on surprise bills and getting on interest free payment programs so we don’t go out of pocket all at once.
Thanks vegasloki.
No visit from the doc prior.
Those are good suggestions on the bill.
 

·
Premium Member
Joined
·
2,726 Posts
Some legislation was recently spoken of, if not passed, preventing "surprise" medical charges.
 

·
Registered
Joined
·
8,714 Posts
Discussion Starter #6
PM sent.
 

·
Registered
Joined
·
1,906 Posts
Some legislation was recently spoken of, if not passed, preventing "surprise" medical charges.
One is in committee in the House, the Senate has a proposal but nothing actively working its way through the system. There have been others as well. There is big pushback from the medical industry lobby, the administration and many Republicans in Congress. Disagreements include what is considered a surprise bill and any sort of arbitration process to address the bills to name a couple. Even if it passed the House it’s unlikely the Senate would hold a vote. This is a big revenue stream to get around the negotiated prices with insurance plans.

Here’s the text of what’s going on in the House.

Here is a comparison of the different bills proposed.
 

·
Registered
Joined
·
708 Posts
I would try to negotiate the removal of the charge. First, since the doctor did not come in before the surgery, make them "explain" what was done to justify the charge. If that alone does not work, state exactly what the insurance company said regarding consultation and surgical charges as part of the same procedure on the same day. Years ago when my son was born, the insurance I had through my employer was supposed to pay 80% of "fair and reasonable" charges. When we received the first round of reimbursements from insurance, the insurance was paying out at about 60%. When we inquired as to why, they said our doctor's charges were not fair and reasonable. However, we were permitted to obtain comparable charges from 3 other doctors to justify what was fair and reasonable. Indeed, all the doctors in the Pasadena area were charging at a similar rate. The comparable fees were submitted to insurance and they paid most of the 20% difference. It appeared the insurance had not brought their list of fair and reasonable charges to current levels, many years old. Check with other doctors in the area doing the same procedure to determine if they add consultation charges. The answer may give you ammunition to use with both the doctors billing and or insurance company. What we learned, the insurance companies will say no and low ball you on charges in an effort to pay less than they have to, it is up to you to resist.
 

·
Registered
Joined
·
8,714 Posts
Discussion Starter #9 (Edited)
I've got a plan of attack and will be on the phone today. We'll see what the end result is......
(Insurance provider agrees with it being an improper billing & told me to talk to the Dr's billing people. Billing is looking into it.)
 

·
Registered
Joined
·
1,906 Posts
I would try to negotiate the removal of the charge. First, since the doctor did not come in before the surgery, make them "explain" what was done to justify the charge. If that alone does not work, state exactly what the insurance company said regarding consultation and surgical charges as part of the same procedure on the same day.
I’d negotiate too. I’d be more concerned the surgeon didn’t stop by rather than the charge in and of itself. There is nothing in the law that prohibits the charge from the doctor. Regardless of what private insurance pays you’re still on the hook. Those on Medicare and Medicaid are pretty much insulated. It’s an issue of for profit health payment systems where many times profit is put above care and a lack of transparency in the pricing of services.
 

·
Registered
Joined
·
708 Posts
Good luck in your negotiations. I completely agree with the comment about it being about profit.
So far the worst aspect of retirement living in Prescott has been healthcare. The primary provider that BCBS of AZ set us up width would never fly in the republic of CA. Three offices, one doctor listed as the primary that no one sees, only PAs in the offices. Fortunately I have gone on Medicare and a insurance agency associated with Costco was able to help me improve my supplement coverage for less money and provided a referral that both my wife and I will soon provide access to "real" physicians. The downside is it takes 4 months to get to see the doctor for the first time, scheduled for late April. I fear that the Corona virus will shift those first visits out months.
Sorry about the rant, went to Costco this morning, not a pleasant experience to say the least.
 
1 - 11 of 11 Posts
Top