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#4,952
#4,952
rocytop2624 said:
Primary care physician. And it's in network. I ask my doctor and she said she used to be a specialist and she has had patients charged to much. The dang bill it starts at 2000 negotiated to 200 and then down to 125 insurance paid 75 and it says I owe like 50. And it's just principal my last insurance company did not do this. This is supposed to be better.
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If you have a contracted rate of $200 and Ins paid $125, then you will owe $75 total. So you Ins pays %75 of contracted amount? Mine is 80% but I pay on the back end rather than a co-pay. You may want to check to see if it was coded correctly but sounds like you are in the ballpark.
 
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#4,953
#4,953
VolNExile said:
Oh lawd...

What 82_Vol_83 said. What kind of insurance do you have? Is it one of those high-deductible kind that you have to pay out of pocket some gi-normous amount before it kicks in? (If so, you would have probably been hit with this already this year.)

What is the "bill", and who is it from?
- Is it from your insurance company and maybe called an EOB (Estimate of Benefits)? If so, it will have a section with columns such as provider billed / "we" (meaning insurance company) pay (the contract amount with the doctor / you have already paid (your $25) / you owe $___ / reason code (the reason why you still owe. If you see that, look toward the bottom or on the back for the reason code and the explanation.
- If this bill is from your provider (doctor), and you just recently went, then pish. Wait for your insurance company to crunch the doctor's bill and send you an EOB telling you what if anything you owe. It is possible that your doctor's office is in a year-end scramble to collect anything due, and they're not caring if it's from the insurance company (as it should be) or from you (which it shouldn't.0

Check your insurance card. There should be a phone number you can call to help you navigate through this. Do this especially if the statement has a reason code saying that you owe the $50. It is possible that they are saying that the procedure wasn't covered. Maybe the visit was coded as a routine ("how ya doin'') office visit instead of a problem (new pain, recent injury, recent new diagnosis needing follow-up) and they assigned the wrong code. Also they might have lumped some uncovered procedure in there (see superdave's question about labs.)

@82_VOL_83 : by PC I think he means PCP, primary care provider (your regular doctor or nurse practitioner, etc.)

Note: my career was in socialized medicine (the VA), and as a kid/ Army dependent, I was also part of socialized medicine, treated as a dependent at military hospitals. I am terrible at figuring out the travesty of healthcare costs that make up the US version of medicine, but I'll be happy to give this a whack if you need more help. (The VA does bill some patients, if they (a) have private insurance and (b) aren't being treated for a service connected condition, but it's rarely more than 10% of the total population that we care for, so insurance wrangling is definitely not my strong point. But I'm absolutely happy to try to help, as I did wrestle with this to some extent at my job.)
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Holy chit, I will bow out and GTFO. You gots it covered. Mine was just layman knowledge.
 
#4,954
#4,954
rocytop2624 said:
Primary care physician. And it's in network. I ask my doctor and she said she used to be a specialist and she has had patients charged to much. The dang bill it starts at 2000 negotiated to 200 and then down to 125 insurance paid 75 and it says I owe like 50. And it's just principal my last insurance company did not do this. This is supposed to be better.
Click to expand...
OK you out-typed me.
biggrin2.gif


You're in network, and your insurance has paid part and says you owe the rest, so you must be looking at an EOB (insurance statement.)

Look for a reason code on the part of the table that says "patient may owe $50." What does it say? (procedure not covered, etc.)

If your physician is in network, the price of the office visit is negotiated, and you shouldn't have to pay more than the co-pay unless you do have one of the HDHP-type plans or similar ones where the patient has a high out-of-pocket combo of co-pay and deductible to meet before insurance coughs up. That would be unusual at the end of the year though.

Your MD is an example of the way that many physicians are growing disgusted with the billing end of providing medical care.
 
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#4,955
#4,955
82_VOL_83 said:
Holy chit, I will bow out and GTFO. You gots it covered. Mine was just layman knowledge.
Click to expand...
No, you were right on target!

The scenario you quoted where the co-pay maybe should have been $75 is common with high-deductible (HDHP) type plans. rocytop, is this a new insurance plan for you, and if so, when did it start? If this is the first visit since the new insurance, maybe the front desk only collected $25 (maybe your old co-pay) instead of $75.

Since this "amount you owe" is on your insurance statement, your best bet is probably to call the customer service number on your insurance card and ask them what the deal is.
 
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#4,957
#4,957
VolNExile said:
OK you out-typed me.
biggrin2.gif


You're in network, and your insurance has paid part and says you owe the rest, so you must be looking at an EOB (insurance statement.)

Look for a reason code on the part of the table that says "patient may owe $50." What does it say? (procedure not covered, etc.)

If your physician is in network, the price of the office visit is negotiated, and you shouldn't have to pay more than the co-pay unless you do have one of the HDHP-type plans or similar ones where the patient has a high out-of-pocket combo of co-pay and deductible to meet before insurance coughs up. That would be unusual at the end of the year though.

Your MD is an example of the way that many physicians are growing disgusted with the billing end of providing medical care.
Click to expand...
I have a 500$ deductible and I am only supposed to pay a primary care visit 25$ but I will look at the bill. Thanks.
 
#4,958
#4,958
rocytop2624 said:
Primary care physician. And it's in network. I ask my doctor and she said she used to be a specialist and she has had patients charged to much. The dang bill it starts at 2000 negotiated to 200 and then down to 125 insurance paid 75 and it says I owe like 50. And it's just principal my last insurance company did not do this. This is supposed to be better.
Click to expand...
Just wait for the bill from the Dr and tell them you paid the co pay it is says 50 owed -- chances are it will show 25 paid and 25 owed -- the bill from the Dr might be different amount from the insurance EOB
 
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#4,960
#4,960
VolNExile said:
No, you were right on target!

The scenario you quoted where the co-pay maybe should have been $75 is common with high-deductible (HDHP) type plans. rocytop, is this a new insurance plan for you, and if so, when did it start? If this is the first visit since the new insurance, maybe the front desk only collected $25 (maybe your old co-pay) instead of $75.

Since this "amount you owe" is on your insurance statement, your best bet is probably to call the customer service number on your insurance card and ask them what the deal is.
Click to expand...
Oh no, wasn't being a smartass for a change. You knocked it dead. Like I said, mine was just layman knowledge.
 
#4,963
#4,963
508mikey said:
Just wait for the bill from the Dr and tell them you paid the co pay it is says 50 owed -- chances are it will show 25 paid and 25 owed -- the bill from the Dr might be different amount from the insurance EOB
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I asked the doctor and they said it was 25 and you paid and that I don't owe but insurance says I do that was last time. And on a follow up they done it again and I am not going to just pay it this time.
 
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#4,970
#4,970
VolNExile said:
Oh lawd...

What 82_Vol_83 said. What kind of insurance do you have? Is it one of those high-deductible kind that you have to pay out of pocket some gi-normous amount before it kicks in? (If so, you would have probably been hit with this already this year.)

What is the "bill", and who is it from?
- Is it from your insurance company and maybe called an EOB (Estimate of Benefits)? If so, it will have a section with columns such as provider billed / "we" (meaning insurance company) pay (the contract amount with the doctor / you have already paid (your $25) / you owe $___ / reason code (the reason why you still owe. If you see that, look toward the bottom or on the back for the reason code and the explanation.
- If this bill is from your provider (doctor), and you just recently went, then pish. Wait for your insurance company to crunch the doctor's bill and send you an EOB telling you what if anything you owe. It is possible that your doctor's office is in a year-end scramble to collect anything due, and they're not caring if it's from the insurance company (as it should be) or from you (which it shouldn't.0

Check your insurance card. There should be a phone number you can call to help you navigate through this. Do this especially if the statement has a reason code saying that you owe the $50. It is possible that they are saying that the procedure wasn't covered. Maybe the visit was coded as a routine ("how ya doin'') office visit instead of a problem (new pain, recent injury, recent new diagnosis needing follow-up) and they assigned the wrong code. Also they might have lumped some uncovered procedure in there (see superdave's question about labs.)

@82_VOL_83 : by PC I think he means PCP, primary care provider (your regular doctor or nurse practitioner, etc.)

Note: my career was in socialized medicine (the VA), and as a kid/ Army dependent, I was also part of socialized medicine, treated as a dependent at military hospitals. I am terrible at figuring out the travesty of healthcare costs that make up the US version of medicine, but I'll be happy to give this a whack if you need more help. (The VA does bill some patients, if they (a) have private insurance and (b) aren't being treated for a service connected condition, but it's rarely more than 10% of the total population that we care for, so insurance wrangling is definitely not my strong point. But I'm absolutely happy to try to help, as I did wrestle with this to some extent at my job.)
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Wow this is really nice of you. I will take your advice and if anymore questions I will let you know.

Thank you
 
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