Community Chat

[onlyshopsonline]

I've never run into any problems like this.  However, we have a pretty decent insurance plan.  And, the doctors need to agree to the insurance company's terms in order to participate.  Most doctors in the area participate, so there's never been an issue.

If there's a copay, we pay that up front.  We don't pay anything else until it has been submitted through our insurance plan.  No doctor is allowed to charge us anything else until it has been submitted.

I usually use Quest for my lab tests.  They do have a sign that they require payment up front, but that doesn't include our insurance.  Once they told me I had a balance coming due and asked if I wanted to pay it then.  I told them I would wait for the bill.  And that was the end of that.

[LTT1]

@Jordan2@onlyshopsonline@SahmIam@Carmie@CaryH

Adding this info here in case anybody can use it.

My colonoscopy (ROUTINE) was billed and invoiced as a medical procedure.  After many hours on the phone yesterday, the doctor's office credited the FULL AMOUNT WE WERE BEING BILLED FOR.

We were told that the insurance rules changed last year and lots of billing confusion ensued.

I will continue the process of asking, asking, asking until I understand my bill!

[Jordan2]

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@LTT1 wrote:

@Jordan2@onlyshopsonline@SahmIam@Carmie@CaryH

Adding this info here in case anybody can use it.

My colonoscopy (ROUTINE) was billed and invoiced as a medical procedure.  After many hours on the phone yesterday, the doctor's office credited the FULL AMOUNT WE WERE BEING BILLED FOR.

We were told that the insurance rules changed last year and lots of billing confusion ensued.

I will continue the process of asking, asking, asking until I understand my bill!

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@LTT1, I actually got an EOB and don't owe the doctor anything for the colonoscopy. I guess this is covered as a preventive procedure and he accepts what the insurance company pays him. 

[onlyshopsonline]

Colonoscopies are fully covered if they are screening colonoscopies, under the ACA.   However, if they remove a polyp it then becomes a medical procedure, and you pay a portion depending on your insurance plan.  When you go in, you won't know how it will be billed until after the procedure 

Medical billing departments and doctor's offices are having a hard time with the new codes.  

You really have to know this yourself so you can keep track of what you are being billed.  It's crazy!   

[Carmie]

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@onlyshopsonline wrote:

Colonoscopies are fully covered if they are screening colonoscopies, under the ACA.   However, if they remove a polyp it then becomes a medical procedure, and you pay a portion depending on your insurance plan.  When you go in, you won't know how it will be billed until after the procedure 

Medical billing departments and doctor's offices are having a hard time with the new codes.  

You really have to know this yourself so you can keep track of what you are being billed.  It's crazy!   

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You are 100% correct, but this way of billing is not new.  This problem also exists with mammograms.  If something unusual was found on your mammogram, the provider must bill all future mammograms as diagnostic and not routine.

[valgators]

My sister lives in central Florida in a relatively small town.    She regularly goes to two doctors she has seen for years.     She told me last year that they now make her pay upon her visit and then she gets the reimbursement from Medicare.     I told her the doctors were making this decision to get their money immediately instead of having to wait maybe 3-4 weeks.     She thought Medicare was the culprit.     But no, it is the doctors who must need their money in a big hurry.      I live in north Florida and I have never had a doctor, imaging center, etc. ask for anything up front.    Guess it depends on what the doctors want to do.

[LTT1]

@Jordan2@valgators@Carmie@onlyshopsonline@SahmIam

This is more medical insurance information for anyone who might want it.

We have had I guessing about 6 different insurance companies over the years. In our area, it used to be a smooth sail with insurance. Then, there was the "donut-hole plan" next came various company insurance plans; now it will be Medicare for me in a few months. Right now I know little!

At one time we were dealing with "payments" up front, and only one specialist practice asked this of us...

[Jordan2]

OP here! I will let you know if and when the hospital reimburses me my $400. Believe me I'm not letting this go!

[Carmie]

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@valgators wrote:

My sister lives in central Florida in a relatively small town.    She regularly goes to two doctors she has seen for years.     She told me last year that they now make her pay upon her visit and then she gets the reimbursement from Medicare.     I told her the doctors were making this decision to get their money immediately instead of having to wait maybe 3-4 weeks.     She thought Medicare was the culprit.     But no, it is the doctors who must need their money in a big hurry.      I live in north Florida and I have never had a doctor, imaging center, etc. ask for anything up front.    Guess it depends on what the doctors want to do.

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This tells me that the doctors do not participate in Medicare.  IF they did, it would be unlawful for them to charge upfront.

[Jordan2]

I'm the OP and I'm still waiting for my refund of $400 from the hospital. The hospital has gotten paid by my health insurance and is aware they are to refund me my money. I don't know what the hold up is, I was told to give it 2 weeks which will be Monday. I paid them on July 26, so this is going on 2 months. I wonder if I need to threaten the hospital with legal action? I'm losing patience.