Community Chat

[Jordan2]

I took my elderly mother to the ophthalmologist about a month ago. She has a managed senior care health insurance. She gets a call prior to her appointment that something happened with the insurance (an error not being in network). They told her it would be $75 but she would get it back. Yesterday she gets a check for $25. I called today and she told me there was a co-payment of $50 for a specialist (she claimed she told me that in advance, she did not). She then says to look at the insurance card. My mother never pays co-payments, and this card says PCP $0 and Spec $0! She then tells me I'm right she was misinformed! She will send out the $50 check. Moral of the story you need to be aware of everything and don't let someone take advantage of you. 

[151949]

Wow your Mom has an advantage plan with 0 copays?? Who does she have that with?  what is her premium?

[wvumountiefan]

I agree! Thank goodness she has you to help her! @Jordan2

[tobes]

thankfully your mother has you to run interferance - I am sure seniors are often taken advantage of and yet do not even know it.  I have had similar experiences with doctors in the past, most recently with an opthamologist's office as well.   my insurance company, AETNA , helped me settle it with the doctor's office.  But you have to know what your coverage is so you can ask for help.  Always be vigilant. Sorry for those seniors who do not have backup.

[151949]

Every uyear when I go to the only place in my town to get a mammo they tell me there is a $50 copay and I tell them they are wrong because medicare pays 100% for mammograms. I have resorted to now taking my medicare and you book with me to prove I'm right. They want you to pay the $50 then it takes about 6 months to get your refund! Baloney. I take my book and refuse to pay it. I see the business manager and finally they do the mammo. We go through this EVERY YEAR.

[KYToby]

I agree it is important to be watchful and vigilant, but I think this is a mischaracterization in regards to the person at the doctor's office.

Unfortunately, the insurance coordinators in doctor's offices have to deal with hundreds of different insurance policies as do the insurance companies who issue them.  The practice may have 300 patients with the same insurance company -- each with its own copays, standards, etc.  In this environment, it is easy for mistakes to happen.

While it is good that you were vigilant and followed up, please do not let someone's mistake paint her as some schemic, nefarious thief

[luvmygirls]

You are so right! It's horrible!! 

My mother had a similar situation. I took her to a lung specialist after she had a bout with pneumonia. Her PCP received prior approval from her Healthcare company to go to this doctor since he was out of network. During her visit the specialist ordered a blood test and blood was drawn during this visit in the exam room. Now, her healthcare will not pay for the blood test $675 because apparently the phlebotomist was "out of network" and she did not have prior approval for this service.

These companies will take advantage any way possible. 

[123SuzyQ123]

I am just barely into my second year of being covered by Medicare, so I am still not aware of some of the items that are covered, or NOT covered!!  In February when I had my mammogram, I received a bill from the radiologist who "read" my mammo results.  I thought that was very odd, since I have had a few different insurances over my last 40 years and I have never had to pay anything for a mammo, which is deemed to be "preventative" and is usually not charged.

So I let it go for a few days, but something kept niggling at my mind and I finally called Medicare and they told me that I do NOT have to pay that bill.  Finally got it all straightened out.

But the OP is correct, we need to pay attention and check everything!!

[PINKdogWOOD]

I totally agree - we MUST be our own advocates for our healthcare, insurance, how we are billed, co-pays or not, who's the PCP and who's the specialists, who gets the higher co-pay, who does not.  Did our Dr offices bill correctly to the insurance company? 

Just yesterday I received a bill totalling a whopping $878.00 for a simple blood test done for my thyroid because the Dr's office did not bill accurately, did not code it correctly, insurance needed more info. 

I found all of this info out after a number of calls, the last and most important being to my insurance.  After they were given the accurate info my ins CS rep informed me I now owe only $34.00.  Quite a difference between $878 & $34 I must say.

If something doesn't seem right to you, make those phone calls, question everything.  Make certain those premiums for insurance we all pay truly are working FOR US and not for them.

[sophiamarie]

I'm so glad we have Medicare and Tricare.  We pay zero, zero and zero.  The only thing that changed is the Rx copay.  That went from $3.00 to $10.00 per monthly script.