Veni.Vidi.Vici.
{{update}} Is this how the 'insured' are getting screwed by the health care act?
May 3, 2013 at 8:08 AM

Since the last quarter of 2012 we have been getting bills from our health care provider to cover the difference our insurance didn't cover.

According to our health insurance our well visits are only supposed to cost us our $25 co pay. Our insurance only covers $60 on top of the $25 co pay, but most of our doctors visits are $130+ on average so we have been billed for the difference.

This didn't happen before October of 2012. Has anyone else experienced this?

May 29, 2013:

After I thought I had handled the bill and solved the 'issue' of being charged for an annual well visit that is only supposed to cost a co-pay I got another bill from the clinic today. It was about 20% less than the original bill. I called the billing dept. at the clinic immediately. I was told that the original person I spoke to was a temp, but only after being accused of being a liar because no one by the name of 'Barbara' ever worked at the clinic. Next I was told that I was billed for an office visit because I discussed my depression with the doctor. HELLO! When the doctor asks how long I've been taking medications and what they're for I'm going to answer. Since when is over-all health not a part of the physical? Since when is listing medications and answering questions not a part of the physical? Hopefully this phone call will be my last.

With my luck the clinic will probably drop our insurance and I'll be left with the clinic and physicians I hate at the only other clinic in 200 miles that is contracted by our insurance.

Replies

  • finnbar
    by finnbar
    May 3, 2013 at 8:10 AM
    Yup
    How's that hope and change workin' out for ya?
    Me, I just keep hoping one day I'll get more change back when paying a bill....
  • moroccanmommy
    May 3, 2013 at 8:11 AM
    Sounds like your dr policy. Or your out of pocket is not reached. My dr accepts the contracted amount.
    Maybe look at your policy and ask your dr office.
    It has nothIng to do wIth the health care act of but of course you just need to thInk It does.
  • rfurlongg
    May 3, 2013 at 8:15 AM
    Call your ins company. I sign a contract with the ins co I accept stating I will not charge my patients in addition. Every ins company is different, but if your provider is in network they certainly have some kind of contract with your ins co. If they are not in network (or have recently been dropped from your network) that may explain your additional charges.
  • Veni.Vidi.Vici.
    May 3, 2013 at 8:15 AM


    Quoting moroccanmommy:

    Sounds like your dr policy. Or your out of pocket is not reached. My dr accepts the contracted amount.
    Maybe look at your policy and ask your dr office.
    It has nothIng to do wIth the health care act of but of course you just need to thInk It does.

    We switched to this practice at the beginnng of last year. I have talked with the billing department. In fact, whe we received new billing policies I asked if we were going to be billed the difference for well visits and I was told NO! Yet now the billing department will not discuss the bills we've been sent but insists we ned to take it up with the insurance company. The pay out by insurance went up about 15%. Last year our doctor accepted the $52 paid.

  • jessilin0113
    May 3, 2013 at 8:16 AM

    Did you make sure your doctor's office was contracted or in network with your insurance?  They can balance bill you if they are not, but if they are contracted providers they have to take the negotiated rate. 

  • Veni.Vidi.Vici.
    May 3, 2013 at 8:20 AM


    Quoting rfurlongg:

    Call your ins company. I sign a contract with the ins co I accept stating I will not charge my patients in addition. Every ins is company, but if your provider is in network they certainly have some kind of contract with your ins co. If they are not in network (or have recently been dropped from your network) that may explain your additional charges.

    I did ask about the contract. I was informed that I could get a list of what out insurance covered and paid. I was also informed by the insurance company that the practice wasn't contractually bound to accept payment from insurance as payment in full, even though I was told by the billing department that well visits would be considered paid in full with the insurance and co pay.

  • Roxygurl
    May 3, 2013 at 8:22 AM
    No. My pcp charges 70 bucks every time I visit him and all I have is my copay of 25. Now if I have any tests run say for strep throat for uti I get billed for those but only because I have a deductible.

    In all honesty so far the health care act has been nothing but positive for me. I pay my premiums 100% out of pocket because I am a nanny and am not offered health insurance.

    Since the new rules have gone into effect my premiums have been lowered, granted it was only a buck, but they still lowered them rather than raise them.

    I also got a check back for close to 200 bucks because the new law states they have to spend a percentage of all premiums collected on health care and if they don't they have to send everyone a check.

    Now when I go for my well woman exam I don't have to pay my copay or for the actual tests they run because its now considered preventive care. Before it would run into the thousands that I would have to pay.

    Apparently also they cover birth control and breast pumps 100% but I have no use for either at the moment (ttc) so I haven't looked further into those things.

  • rfurlongg
    May 3, 2013 at 8:24 AM
    There is something fishy about that.... If they are in network, they are contractually bound to something. If the billing the dept said your visits were paid in full then back tracked? Hmmm.... I am wondering if they are currently renegotiating the contract? I do not think this has anything to do with ACA.

    Quoting Veni.Vidi.Vici.:


    Quoting rfurlongg:

    Call your ins company. I sign a contract with the ins co I accept stating I will not charge my patients in addition. Every ins is company, but if your provider is in network they certainly have some kind of contract with your ins co. If they are not in network (or have recently been dropped from your network) that may explain your additional charges.

    I did ask about the contract. I was informed that I could get a list of what out insurance covered and paid. I was also informed by the insurance company that the practice wasn't contractually bound to accept payment from insurance as payment in full, even though I was told by the billing department that well visits would be considered paid in full with the insurance and co pay.

  • jessilin0113
    May 3, 2013 at 8:29 AM

    The billing department could have been confused.  The ACA IS supposed to cover well visits at 100%, but I think contracts still apply.  The insurance offers it as a benefit, but you only get the benefit if your doctor accepts the insurance.  It still sounds more like a contracting issue to me than the ACA.  Sounds like miscommunication in the office.

  • JoshRachelsMAMA
    JRM
    May 3, 2013 at 8:35 AM


    Quoting moroccanmommy:

    Sounds like your dr policy. Or your out of pocket is not reached. My dr accepts the contracted amount.
    Maybe look at your policy and ask your dr office.
    It has nothIng to do wIth the health care act
    of but of course you just need to thInk It does.

    Sure it does. Doctors feeling the pinch are now passing on the price difference to their patients. its happening more and more and its due to obamacare.