i have good health insurance ( or so I thought)

[Le Gaucher]

my copays are $15 .. great pharmacy benefiits . very affordable monthly payment


last month I had my upper endoscopy done .. the doctor verified with the insurance that I am authorized for the procedure .. and when I show up - my copay is $150 - which I promptly paid. All good?


Today I get a bill for $2577 .. which is the balance due after the money paid by the insurance (4480.12 ) and their adjustment ( $3554)


The total charge for a 20 minute procedure is $10,762

Here is my problem - WHY THE FUCK wasnt I told upfront about it - I may have shopped around or not have it done


I am super pissed. Who has so much money laying around .. this is seriously fucked up .. I am not paying for this on principle .. They are welcome to sent it to collections and ruin my credit. I dont give a fuck ..

This country is SUPER FUCKED UP .. I cant believe this shit !!!

[Nonhlanhla]

1. I'm so sorry

The health industry in this country is seriously messed up. My cousin's hubby was in a serious crash last year (another guy ran into him). He was airlifted to a hospital, had very severe injuries; it's a miracle he survived; took months to recover (still not 100%). And then recently they got sued by the insurance co for a million bucks for the air ambulance. They've consulted lawyers, but it looks like they will lose everything. Young couple with 2 small kids. My mom just told me about it yesterday - I'm still in shock.

I can't understand why they could not have been upfront with you about the costs. I hope there is some way you can fight this.

[Mariana]

2. Have you called the insurance company about it? It may be an error. nt.

[spooky3]

3. If you went to an in-network provider, they should not

Be charging an amount beyond what the plan paid. Is there a possible mistake?

[Le Gaucher]

4. my doctor is "in network" .. i checked many times

its too late to make phone calls - but will try to sort it out tomorrow

[still_one]

8. Who is the insurance company, and what is the name of the policy

[Le Gaucher]

10. aetna .. NJ state employee's plan ..

I have this through my wife

[still_one]

11. Wow, something isn't right there. State employer plans are usually good. Keep us posted on what

you find out.

I hope this works out for you

[Squinch]

12. Was the anesthesiologist in network? My hospital pulled that on me once.

The doc was in network, and they knew what my network was but they gave me an anesthesiologist who was not in my network.

I refused to pay it, and they never came after me for it and I have had procedures since in the same hospital.

[Le Gaucher]

13. the anesthesia part of the bill is $574

this biggest part is the Ambulatory surgery - $5881.48 ( which is for the procedure I guess)

[spooky3]

14. So this would leave only the anesthesiologist and the facility.

(See Squinch’s post).

When I had a procedure last year, there were two possible locations (a hospital outpatient site and a specialty site). Insurance said they were OK with either. Even if you didn’t ask this, chances are good that your doctor’s office knew that the site used was also in-network.

I’m optimistic that this is a billing error and/or they are hoping you won’t question it and just pay up. I’ve had this happen at least twice.

[Horse with no Name]

5. That would be your coinsurance amount

But why stiff the Doc?
It’s your policy and you should be aware of how much it pays (or in your case, doesn’t pay).

[Le Gaucher]

9. my coinsurance is 10 % ..

I have no deductible .. the doctor is charging me over and above what I am supposed to pay

[Horse with no Name]

15. He can only charge you what he has contracted

With the insurance company to accept.
Something isn’t right.
Good luck figuring it out.

[still_one]

6. First of all 10000 dollars for an endoscopy is way too much. For those without insurance, 3500 is

should be about the maximum one would pay full cost.

I am not sure where the 10000 dollar cost from

Without no the specifics of the plan, deductables, etc. it would be difficult understnad what is happening.

You will need to find out why you have to pay so much.

It is well within your rights to appeal also

I am asuming the endoscopy was a recommended procedure

You need to get more information before assuming anything

Insurance companies do make mistakes

[PoindexterOglethorpe]

7. Who has so much money lying around?

The very people who set these rates.

Do fight them. One of the many despicable things that people say about health insurance is that people need to have some skin in the game, and they need to shop around. Well, you asked the right question, although apparently skipped several other questions, such as, What will the total bill be? And that's through no fault of your own. You got all the information you thought you needed.

Oh, and while at least in theory you could have shopped around, an awful lot of the time shopping around isn't possible because it's some sort of emergency situation.

[trixie2]

16. Since Trump's election the insurance companies have quietly been gutting us

My Dr. won't listen to me. Under Obama you could get preventative tests free of charge. Now you have to pay for them. The insurance companies are playing fast and loose with the rules.

Examples:
My sister works at a hospital and has good insurance. She was told that it was time for her colonoscopy exam being that she turned 50. She was then presented with the entire bill for they said since they didn't find anything it wasn't a preventative exam. She might have paid a co-pay.

My friend with pretty good insurance also turned 50 and was sent in for her colonoscopy. They found a polyp and removed it right there and she too was presented with the cost minus the co-pay she already paid. She was told since they found something it made her a new patient with the new doctor and that waived the preventative status.

I had an overall eye health exam as one of the preventative exams for those in their 50s and paid the co-pay and it has been 1 1/2 years and the eye doctor still hasn't been paid. I had a referral from my regular doctor with the blessing of the insurance company, they even sent me the eye doctor's phone number. The insurance company say they never agreed to the referral. Both doctor offices are fighting it but I will have to pay that bill.

I was with Humana off the market place and I was at a good rate and was satisfied with my services and co-pays. Once Trump took office I was re-contracted 3 times and my rates sky rocketed and my benefits plummeted. They are truly collapsing healthcare from the inside out.

[lunasun]

17. did you ever sign something there at the office saying you would pay?

this happened to me once but in my case they were asking me to sign a form saying I would pay full charge and have to make up for the insurance discount!! I never heard of this and not your case but is that even legal??
So, when I returned the filled out form to the front desk unsigned they told me I needed to sign the statement that said they wanted full charge and the pt would have to make up what the insur. did not pay regardless of adjustment
I told them they were in network and had agreed to a discounted amount already negotiated I'm not paying extra and is that legal??
This was a specialist
They took every other patient before me but I had work to do with me and stayed . It was a one time visit and I didnt want to start all over with another referral etc. Then they said that the dr was leaving I'd have to come back . I raised my voice and the nurse came out to the front desk to see what was going on
I told her what was going on and I was not leaving I had been there for 2 hours waiting past my appt time

I complained to the doctor when I saw him then I heard the nurse tell him off in an area that I was slow and had trouble filling out the report !!!
Thats a lie I told him and if you have security lets run the tape and see I handed it back 5 mins after I was handed the form 2 hours ago and doctor, I came in 10 mins early for my appt . so dont even try to say I was late either, another stereotype.
The doctor was nice but a money shark and I did not have to return so at this point I didnt give a fuck and said
Do you get some kind of cut for lying and harassing people who understand insurance? to the front desk lady as I left.

I also complained to my gp doctor who said there were not many of this specialty in my network.
I never got a bill so I could not report them to the insur. network or see if it was legal.. guessing it would be if I signed!

I have also been double billed (by a differnt specialist) who were not asking for money from me, but billing the insurance twice for 2 payments of the same procedure. I think they expect you will see you do not owe anything and do not care if they double bill but I called the insurance and took the time to report it as fraud.

I know this is not the same for you, and in your case, they took off the network discount

I hope it is just a mistake, if not when threatened with collections , call the dr and ask for a discount from them .
They lose up to 33% to an collection agency anyway so see if they will take 10% and negotiate from there.
Mention you may be claiming bankruptcy anyway (not a lie, anyone MAY at some point) so you'd like to settle this before they have to be added on to that list in the future but if you do have $258, see if you can tell them that's what you have for them and if they will take it .
Always check with insurance AND the doctor on cost /payout pre appt. (they have the codes and know what they are going to charge )and be aware of additional attempts to get extra $$ like what I have ran into or fraud also. (This was years ago both times with private insurance not a medicare scam and pre Obama)

[spooky3]

18. Did you have any luck today? Nt

[Le Gaucher]

19. Insurance company explained that I have $1500 deductible and 10% coinsurance

So this is legit.

Still I would have liked to have known about it in advance .. I probably would have skipped the endoscopy.

I feel blindsided and am angry.

[spooky3]

20. Strange since you thought there was no deductible. I hope

You were able to determine whether they were correct.

Sorry you were blindsided. I hope that the results of the endoscopy turn out to be good.