That "one" form at the doctor's office
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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.
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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.
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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; -
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;Yeah, the stupid mistake people make is getting treatment first then saying, "I'm not paying that." this pisses the doctor and his staff off. They don't want to help you in this situation or they are *much* less likely to do so. We (when we were in very hard times) called our normal doctors and explained or circumstances ahead of time. We asked if we could seek treatment but explained we doubted we could pay for it. In almost every case (no ... :scratches head: in *every* case) they agreed to just write off the costs for care. I think the difference maker here was that we had been patients of good standing for quite a bit before and they knew when things got better we would be in good standing after. We still see all the same doctors now and of course we pay full price for care. All of these things are a factor *BUT* in most cases you can still ask and if your need is justifiable they will write it off. I've been too involved in the industry to have not heard of 100's of these examples.