Community Chat

[Ms X]

@chrystaltree  Are you saying that if a patient overpays a deductible they would not refund it?

[LTT1]

@Stray
It seems to keep changing, the rules requirement to pay upfront. (For doctors office procedures)

[LTT1]

@Ms X
Wondering if you can pay these by credit card and then dispute the charges if they are wrong?

[Ms X]

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@LTT1 wrote:
@Ms X
Wondering if you can pay these by credit card and then dispute the charges if they are wrong?

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I misunderstood your post at first.  That's an ingenious idea!  That would work if they accept plastic!

[IamMrsG]

Several years ago I had an ordeal with a huge medical insurance company.  It began with a store clerk's careless error on a handwritten receipt -- somehow, she wrote the wrong year, and I didn't catch it at the time.

It took several months and many phone calls to get nowhere with the insurance company.  What they did not know, however, was that I was keeping detailed records of every date, name and conversation throughout the time.

After I lost patience and hope of resolution, I sent a 20 page printout of those records via certified mail to the President of the company.  The claim was settled within a few days of receipt, and I was also told later that "positions were lost" as a result of my notes.

It's unfortunate that such steps are necessary when dealing with 'customer service,' but that's the way it is.  To this day, I take notes during a business call.  I begin with the date, phone number/extension and name.  If I miss the person's name, I have no qualms about asking them to either repeat or spell it. Notes are made as the conversation progresses.  The habit has frequently been helpful later, but, luckily, not to the degree I described above.  

[chrystaltree]

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@Ms X wrote:

@chrystaltree  Are you saying that if a patient overpays a deductible they would not refund it?

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       No, of course not.  Deductibles are patient responsibilities.  If we did everything properly, with the information we had available to us at the time and if we were not overpaid, we don't refund the deductible.  We do not get into fights with the doctors over who got their claim in first.    We only refund the deductible if the patient paid it and the deductible had already been met at the time the patient paid it.  But that never happens today because its's 2016 and every hospital can verify deductible in 30 seconds by accessing the payor's website online.  And every hospital should do that.    And even in those rare occasions when there is lag, we seldom actually owe the patient any money because if we took the deductible when we shouldn't have; there is still the 20% co-pay that the patient owe us.  So we would apply the money to the co-pay.  Generally patients owe co-pays on more than one claim so the money would be applied to anything the patient owes.  Once there is a zero balance on all claims, if there is money left over, we would refund the patient.  That never happens.  The lesson to be learned from op's situation is that patients should always verify their deductible situation with their insurer before their surgery or medical visit.  The deductible (and co-pays) are out of pocket, meaning it's the money the patient is responsible for based on their insurance coverage.  It's it is the patient's responsibility to keep track of it.  

[Stray]

@LTT1- maybe so but, I have not encountered it. My husband was just hospitalized with subsequent rehab and home care.  We did a lot of outpatient follow up as well.  No one asked for money upfront and we were billed entirely.  I've had multiple orthopedic surgeries and no payment was requested upfront by the hospital.  I did select an out of network doctor for tendon transfers in my feet and did pay partially upfront to him but I knew well ahead of time and it was explained and my choice.  My surgeries were in NYC, HSS....

[Ms X]

@chrystaltree  Thank you for the explanation.  This is certainly a confusing situation.  I hope OP gets it straightened out.  One person in one of the offices said it was handled wrong at least at one point. so maybe she needs it fixed.  I've generally called the insurer when there were problems with basic coverage denied in error (sometimes I wonder how much of an error it is, since once they denied the yearly physical!).  Then I call the billing department at the practice once they tell me what code they want them to use.  I buy my own insurance, so I like to know that BC/BS is giving me what I paid for.

You have a very complicated job!

[ValuSkr]

I'm sorry to hear about this.  But it's the system we have; it's all about the money.  People who don't like it should support politicians who want to change the system.

[Ms X]

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@ValuSkr wrote:

I'm sorry to hear about this.  But it's the system we have; it's all about the money.  People who don't like it should support politicians who want to change the system.

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People who go to school for 20 years and then train for three or more require a good salary.  If they aren't paid well, they'll do something else and care will suffer.  Doctors work very hard for the money they get.  That's the case for other medical workers, who are paid even less.  So many other occupations pay more!  Practices are under increasing financial stress these days as well.  I've read quite a few news articles about it.