That "one" form at the doctor's office
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You know the form I'm talking about. The one that innocuously tries to get you to sign your life way by agreeing to pay whatever they want to charge you above and beyond what they can siphon from the insurance company. The same one my wife repeatedly signs. The question is do we have to sign it? I'm pretty sure they cannot deny you treatment, or can they? Does anyone know what the law is on this?
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You know the form I'm talking about. The one that innocuously tries to get you to sign your life way by agreeing to pay whatever they want to charge you above and beyond what they can siphon from the insurance company. The same one my wife repeatedly signs. The question is do we have to sign it? I'm pretty sure they cannot deny you treatment, or can they? Does anyone know what the law is on this?
If you have insurance, why not sign it? It's probably become common practice as more and more people come in with false credentials and "stiff" the doctor's office. As far as denying you treatment, I believe they can, unless it's life threatening. The other "out" for them would be to send you to the hospital.
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You know the form I'm talking about. The one that innocuously tries to get you to sign your life way by agreeing to pay whatever they want to charge you above and beyond what they can siphon from the insurance company. The same one my wife repeatedly signs. The question is do we have to sign it? I'm pretty sure they cannot deny you treatment, or can they? Does anyone know what the law is on this?
In the U.S., if it's a public hospital's emergency room, they are obligated to provide treatment without regard to your ability to pay. In any other situation, it is perfectly legitimate for them to tell you to get lost. Practically speaking, there are three dollar amounts in any medical transaction today. The amount the provider bills, the amount your insurance pays, and the amount you have to pay. Generally, the amount you pay plus your insurance's payment do not add up to the amount billed. In some cases, the provider gets to claim that amount as a loss at tax time. The agreement you are signing is intended to protect the provider when you violate the terms of your insurance policy. For example, if you go to a doctor that's not on your insurance company's approved list, the agreement lets the doctor bill you when the insurance company fails to pay. Provders typically have an agreement with each insurance company regarding how much the company pays for a given procedure. Please note that this is not an informed legal opinion. This is based on lengthy experience with medical insurance companies and a wife with significant medical issues (as well as significant hypochondria :rolleyes:).
Software Zen:
delete this; -
If you have insurance, why not sign it? It's probably become common practice as more and more people come in with false credentials and "stiff" the doctor's office. As far as denying you treatment, I believe they can, unless it's life threatening. The other "out" for them would be to send you to the hospital.
That's not what it's about and it has nothing to do with what your insurance company will pay. It's about allowing them to charge whatever they want for a service. For instance, lets say your insurance pays $85 for a standard office visit. And you go to the doctor, pay your $15 co-payment, and they bill your insurance company for the remainder. Well, it turns out that they think they're special and their office visits are $150. Guess, what? The doctor's office will send you a bill for $50. And that form allows them to do that instead of billing what is reasonable and customary and what is agreed to through the insurance company's contracted prices. In my opinion, it also allows them to be lazy about informing you about tests and procedures that insurance companies may not pay for.
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In the U.S., if it's a public hospital's emergency room, they are obligated to provide treatment without regard to your ability to pay. In any other situation, it is perfectly legitimate for them to tell you to get lost. Practically speaking, there are three dollar amounts in any medical transaction today. The amount the provider bills, the amount your insurance pays, and the amount you have to pay. Generally, the amount you pay plus your insurance's payment do not add up to the amount billed. In some cases, the provider gets to claim that amount as a loss at tax time. The agreement you are signing is intended to protect the provider when you violate the terms of your insurance policy. For example, if you go to a doctor that's not on your insurance company's approved list, the agreement lets the doctor bill you when the insurance company fails to pay. Provders typically have an agreement with each insurance company regarding how much the company pays for a given procedure. Please note that this is not an informed legal opinion. This is based on lengthy experience with medical insurance companies and a wife with significant medical issues (as well as significant hypochondria :rolleyes:).
Software Zen:
delete this;Thank you. It was a good reply nonetheless. The problem I see is that it seems to remove any form of any need for them to disclose anything that might be otherwise billable. Case in point, my wife had to go to the ER a few years ago. I knew the hospital was a preferred provider. No problem right? Well, it turns out each department can bill separately. In this case the radiology department was not. They took x-rays which were rolled-up under the ER visit billing rules so no problem. But, then there were these ridiculous charges for reading and reporting on the results to the doctor days after the x-rays were taken -- the doctor could evaluate the x-rays on the spot. And there was no reason I could see why we'd need the reports and given the option I would have said no. That cost me a few hundred bucks and is obviously a minor thing considering what a significant hospital stay could be like. The reason for me posting this question is that we have our first baby coming in a few weeks. I want my wife and baby to get all the care they need. However, I do not want to pay for wasteful or necessary tests or procedures or get screwed in what will already be an expensive hospital visit.
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That's not what it's about and it has nothing to do with what your insurance company will pay. It's about allowing them to charge whatever they want for a service. For instance, lets say your insurance pays $85 for a standard office visit. And you go to the doctor, pay your $15 co-payment, and they bill your insurance company for the remainder. Well, it turns out that they think they're special and their office visits are $150. Guess, what? The doctor's office will send you a bill for $50. And that form allows them to do that instead of billing what is reasonable and customary and what is agreed to through the insurance company's contracted prices. In my opinion, it also allows them to be lazy about informing you about tests and procedures that insurance companies may not pay for.
tgrt wrote:
It's about allowing them to charge whatever they want for a service.
it's their way of telling you that the insurance companies don't set the prices.
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tgrt wrote:
It's about allowing them to charge whatever they want for a service.
it's their way of telling you that the insurance companies don't set the prices.
image processing toolkits | batch image processing | blogging
Absolutly
Regards, Satips.
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Thank you. It was a good reply nonetheless. The problem I see is that it seems to remove any form of any need for them to disclose anything that might be otherwise billable. Case in point, my wife had to go to the ER a few years ago. I knew the hospital was a preferred provider. No problem right? Well, it turns out each department can bill separately. In this case the radiology department was not. They took x-rays which were rolled-up under the ER visit billing rules so no problem. But, then there were these ridiculous charges for reading and reporting on the results to the doctor days after the x-rays were taken -- the doctor could evaluate the x-rays on the spot. And there was no reason I could see why we'd need the reports and given the option I would have said no. That cost me a few hundred bucks and is obviously a minor thing considering what a significant hospital stay could be like. The reason for me posting this question is that we have our first baby coming in a few weeks. I want my wife and baby to get all the care they need. However, I do not want to pay for wasteful or necessary tests or procedures or get screwed in what will already be an expensive hospital visit.
tgrt wrote:
Well, it turns out each department can bill separately. In this case the radiology department was not. They took x-rays which were rolled-up under the ER visit billing rules so no problem. But, then there were these ridiculous charges for reading and reporting on the results to the doctor days after the x-rays were taken -- the doctor could evaluate the x-rays on the spot.
the [financial side of] the health care system in the US is truly fncked. it needs to change.
image processing toolkits | batch image processing | blogging
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Thank you. It was a good reply nonetheless. The problem I see is that it seems to remove any form of any need for them to disclose anything that might be otherwise billable. Case in point, my wife had to go to the ER a few years ago. I knew the hospital was a preferred provider. No problem right? Well, it turns out each department can bill separately. In this case the radiology department was not. They took x-rays which were rolled-up under the ER visit billing rules so no problem. But, then there were these ridiculous charges for reading and reporting on the results to the doctor days after the x-rays were taken -- the doctor could evaluate the x-rays on the spot. And there was no reason I could see why we'd need the reports and given the option I would have said no. That cost me a few hundred bucks and is obviously a minor thing considering what a significant hospital stay could be like. The reason for me posting this question is that we have our first baby coming in a few weeks. I want my wife and baby to get all the care they need. However, I do not want to pay for wasteful or necessary tests or procedures or get screwed in what will already be an expensive hospital visit.
tgrt wrote:
we have our first baby coming in a few weeks
Congratulations :rose:! Since you know about this in advance, it wouldn't hurt to contact your insurance company and the hospital you are using and make sure they agree on things. You can probably get an estimate of your out-of-pocket expenses. Realize that these aren't fixed in stone. If your wife ends up having a Caesarean section or your baby needs special care, for example, the costs change. Good luck.
Software Zen:
delete this; -
tgrt wrote:
Well, it turns out each department can bill separately. In this case the radiology department was not. They took x-rays which were rolled-up under the ER visit billing rules so no problem. But, then there were these ridiculous charges for reading and reporting on the results to the doctor days after the x-rays were taken -- the doctor could evaluate the x-rays on the spot.
the [financial side of] the health care system in the US is truly fncked. it needs to change.
image processing toolkits | batch image processing | blogging
Chris Losinger wrote:
the [financial side of] the health care system in the US is truly fncked. it needs to change.
Unfortunately, it is financial. Check out California's problem will illegal aliens getting treatment on the state. Unless the current process changes, California will end up bankrupt.
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That's not what it's about and it has nothing to do with what your insurance company will pay. It's about allowing them to charge whatever they want for a service. For instance, lets say your insurance pays $85 for a standard office visit. And you go to the doctor, pay your $15 co-payment, and they bill your insurance company for the remainder. Well, it turns out that they think they're special and their office visits are $150. Guess, what? The doctor's office will send you a bill for $50. And that form allows them to do that instead of billing what is reasonable and customary and what is agreed to through the insurance company's contracted prices. In my opinion, it also allows them to be lazy about informing you about tests and procedures that insurance companies may not pay for.
tgrt - not to start an argument, but what you are saying is not entirely true. If the doctor has contracted with your plan, then he has already agreed to a set of rates for procedures. He is contracturally obligated to honor those rates. He agreed to this, because he wants the potential business traffic from the plan's members (you). The form itself is more standard procedure if the doctor is in your plan. Having said that, if you go to a doctor who isn't in the plan, then yes, *you* are obligated to pay his fee. And, yes, he/she can charge anything they want, just like us. Okay, so what's wrong with this picture? Preaching to myself now as well, how many of us will take our car into the shop for a repair and NOT ask for an estimate? We know to do this. But, how many us feel uncomfortable asking the doctor for an estimate and an explanation? I know many of the rates are inflated.... it's part of what is wrong with the medical system in the US.
Charlie Gilley Will program for food... Whoever said children were cheaper by the dozen... lied. My son's PDA is an M249 SAW. My other son commutes in an M1A2 Abrams
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tgrt wrote:
we have our first baby coming in a few weeks
Congratulations :rose:! Since you know about this in advance, it wouldn't hurt to contact your insurance company and the hospital you are using and make sure they agree on things. You can probably get an estimate of your out-of-pocket expenses. Realize that these aren't fixed in stone. If your wife ends up having a Caesarean section or your baby needs special care, for example, the costs change. Good luck.
Software Zen:
delete this;Thank you. I got the estimates from my insurance company. Basically, $100 co-payment, $500 deductible, and 20% co-insurance on the hospital chunk. The other chunk is the OB/GYN delivery portion which is part of the insurance company's global maternity care and won't cost us a dime. Luckily, there is an out-of-pocket maximum of $1000 a year (not including the deductible and co-payment) which means the most we should have to pay is $1,600. I do need to get in touch with the hospital though, so that I know what to expect. Normally, this amount would not be a big deal but we're building a house in Georgia and will be moving in a few months, will need to buy furniture, etc. etc. In the spirit of children, I've changed the words in a popular childs' song to mimic what is going to be happening: "The money in the bank goes down, down, down. Down, down, down. Down, down, down. All through the year."
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tgrt wrote:
Well, it turns out each department can bill separately. In this case the radiology department was not. They took x-rays which were rolled-up under the ER visit billing rules so no problem. But, then there were these ridiculous charges for reading and reporting on the results to the doctor days after the x-rays were taken -- the doctor could evaluate the x-rays on the spot.
the [financial side of] the health care system in the US is truly fncked. it needs to change.
image processing toolkits | batch image processing | blogging
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That's not what it's about and it has nothing to do with what your insurance company will pay. It's about allowing them to charge whatever they want for a service. For instance, lets say your insurance pays $85 for a standard office visit. And you go to the doctor, pay your $15 co-payment, and they bill your insurance company for the remainder. Well, it turns out that they think they're special and their office visits are $150. Guess, what? The doctor's office will send you a bill for $50. And that form allows them to do that instead of billing what is reasonable and customary and what is agreed to through the insurance company's contracted prices. In my opinion, it also allows them to be lazy about informing you about tests and procedures that insurance companies may not pay for.
I am 100% positive that my doctor charges more per visit than the insurance carriers payment + my co-pay, and I have never been charged a dime more for any doctor visit. The form is used to ensure you will pay for any in-house procedures that are not covered by your insurance. There are too many insurance carriers for a doctor's office to keep track of procedures that are covered by each carrier. You do have the option to postpone any procedure until you verify that your carrier covers it.
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Chris Losinger wrote:
the [financial side of] the health care system in the US is truly fncked. it needs to change.
Yeh. You know it's bad when there is an entire career path devoted to medical billing coding.
:laugh: indeed.
image processing toolkits | batch image processing | blogging
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You know the form I'm talking about. The one that innocuously tries to get you to sign your life way by agreeing to pay whatever they want to charge you above and beyond what they can siphon from the insurance company. The same one my wife repeatedly signs. The question is do we have to sign it? I'm pretty sure they cannot deny you treatment, or can they? Does anyone know what the law is on this?
tgrt wrote:
The question is do we have to sign it?
No, not at all. By the same token, they don't have to treat you either.
"Approved Workmen Are Not Ashamed" - 2 Timothy 2:15
"Judge not by the eye but by the heart." - Native American Proverb
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That's not what it's about and it has nothing to do with what your insurance company will pay. It's about allowing them to charge whatever they want for a service. For instance, lets say your insurance pays $85 for a standard office visit. And you go to the doctor, pay your $15 co-payment, and they bill your insurance company for the remainder. Well, it turns out that they think they're special and their office visits are $150. Guess, what? The doctor's office will send you a bill for $50. And that form allows them to do that instead of billing what is reasonable and customary and what is agreed to through the insurance company's contracted prices. In my opinion, it also allows them to be lazy about informing you about tests and procedures that insurance companies may not pay for.
tgrt wrote:
For instance, lets say your insurance pays $85 for a standard office visit. And you go to the doctor, pay your $15 co-payment, and they bill your insurance company for the remainder. Well, it turns out that they think they're special and their office visits are $150. Guess, what? The doctor's office will send you a bill for $50.
This is a valid scenario. Just because you have a $15 co-pay does not mean you are free of any other fees. For example, if you have a $1,000 dedeuctible that has not been met, then you are responsible for that $50 balance, and all other fees up to $1,000.
"Approved Workmen Are Not Ashamed" - 2 Timothy 2:15
"Judge not by the eye but by the heart." - Native American Proverb
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You know the form I'm talking about. The one that innocuously tries to get you to sign your life way by agreeing to pay whatever they want to charge you above and beyond what they can siphon from the insurance company. The same one my wife repeatedly signs. The question is do we have to sign it? I'm pretty sure they cannot deny you treatment, or can they? Does anyone know what the law is on this?
If they have a "cannot deny" policy they usually post it publicly. Any doctors office can and will make right off's if you can demonstrate need. When faced with $80,000 in bills and having zero income. We were able to demonstrate need and many offices jumped to write off anything they could for us. Kudo's to the medical profession for being professional to a family in hard times.:rose: I believe this might also be a state by state basis in the U.S.
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Thank you. I got the estimates from my insurance company. Basically, $100 co-payment, $500 deductible, and 20% co-insurance on the hospital chunk. The other chunk is the OB/GYN delivery portion which is part of the insurance company's global maternity care and won't cost us a dime. Luckily, there is an out-of-pocket maximum of $1000 a year (not including the deductible and co-payment) which means the most we should have to pay is $1,600. I do need to get in touch with the hospital though, so that I know what to expect. Normally, this amount would not be a big deal but we're building a house in Georgia and will be moving in a few months, will need to buy furniture, etc. etc. In the spirit of children, I've changed the words in a popular childs' song to mimic what is going to be happening: "The money in the bank goes down, down, down. Down, down, down. Down, down, down. All through the year."
tgrt wrote:
Normally, this amount would not be a big deal but we're building a house...
As long as you are making "good faith" payments to the hospital, you should have no trouble. Pay what you can per month and they won't hassle you.
"Approved Workmen Are Not Ashamed" - 2 Timothy 2:15
"Judge not by the eye but by the heart." - Native American Proverb
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If they have a "cannot deny" policy they usually post it publicly. Any doctors office can and will make right off's if you can demonstrate need. When faced with $80,000 in bills and having zero income. We were able to demonstrate need and many offices jumped to write off anything they could for us. Kudo's to the medical profession for being professional to a family in hard times.:rose: I believe this might also be a state by state basis in the U.S.
A good side point. Talk to your doctor if you're having trouble with the bills. Billing services and office personnel neither know nor care about individual circumstances.
Software Zen:
delete this;