Feel like I got hosed by a doctor

RickM · RickM's Garage

Just a vent on my part...

So, I'm talking to my Doc and ask about a sudden swelling in one of my knuckles. He recommends a local hand orthopedist/surgeon and suggests I have it looked at. I go to pay my $20 co-pay and the admin writes the surgeons name down for me and says something to the effect of "call and make sure they accept your insurance before you go. You don't want to find out when it's too late" I thought it was odd that she'd make a point of telling me this and in this way.....

Next day I call and ask the office worker if they accept XYZ insurance...."yes we do". I then go on to make an appointment.

Feeling lucky to get this appointment before the end of the year I fill out the several forms handed to me as I'm here for the first time. I fill the forms out, reading most of what handed to me. I hand the forms back and hand over my insurance card so a copy can be made...pretty much par for the course.

I spend a good 40 minutes with X-Rays and exam. Doc say he can't figure what caused the swelling but suggests I take some anti-inflammatory and keep an eye on it.

I walk up to the admin and expect her to say.."OK, that'll be $30 (Specialist co-pay)....well instead she says "OK, your total comes to $425".

"Heh heh , I know that's the total, what's my co-pay?" I ask.
"Sir, we don't participate in your plan". I then explain that I called and verified that XYZ insurance is accepted.

"Oh we do. But not with the plan you have".

I'm pissed.......

masraum · 02-06-2006, 12:21 PM

damn, that's a real *****. Medical is getting more and more f'ed up these days.

Dave L · 02-06-2006, 12:34 PM

I hope you gave her $30 and thanked her for her time.

RickM · RickM's Garage

Nope, I already had my Debit card out...I paid cash....I'm kicking myself. Big time.

That was my G@D Damned Tial Wastegate.

Why am I venting now? I submitted it to my insurance and it was totally eaten up by deductible. Just found out.

on-ramp · 02-06-2006, 12:42 PM

medical costs sometimes hurt more than the actual problem.

Jims5543 · 02-06-2006, 12:45 PM

Yup, sounds about right.

When I had my knee scoped the total billing to me and insurance neared $20,000. It is cheaper to have a baby.

teenerted1 · 02-06-2006, 12:46 PM

send a copy of the bill to your insurance co. maybe they will re-emburse you?

on-ramp · 02-06-2006, 12:48 PM

i'd be mad as hell. next time ask them to put it in writing....for evidence in court.

RickM · RickM's Garage

Quote:

Originally posted by teenerted1
send a copy of the bill to your insurance co. maybe they will re-emburse you?

That's the thing. I did. However, the deductible ate the entire $425.

RickM · RickM's Garage

Why didn't I tell her to bill me...damn.

I'm not used to getting caught with my pants down.

(Wait, that was the Urologist last Friday.)

on-ramp · 02-06-2006, 12:53 PM

deductibles are another scam...who ever thought up of that one? if I pay for insurance, and i file a claim , why do I still have to pay? ha ha..

aap1966 · aap1966's Garage

Quote:

Originally posted by RickM

I'm pissed.......

You should be.

89911 · 02-06-2006, 01:26 PM

Although I usually don't give out advice on not paying for medical services, I think your case is deserving of attention. If you have already paid for this, then you will have difficulty getting the money back I'm sure. Your best bet is to go after your insurance company but that will be next to impossible. If you haven't already paid, write a letter explaining your situation, how you were given approval by that office, and why you are not going to pay for it. Tell them the name of who had given you the approval if possible. Being that they also had taken your card and verified you insurance prior to being seen, they had full opportunity to inform you that the appointment would not be covered. Also tell them that if they come after you with any legal means or collection agencies, they will be contacted by your lawyer. Send this letter certified. They screwed up and will most likely write off the charges. Also let you primary care office now how they have incorrectly given you advice on having you procedure covered. They didn't tell you to specify what exact plan you have.

89911 · 02-06-2006, 01:28 PM

Quote:

Originally posted by on-ramp
deductibles are another scam...who ever thought up of that one? if I pay for insurance, and i file a claim , why do I still have to pay? ha ha..

To stop you from filing claims.

on-ramp · 02-06-2006, 01:40 PM

Quote:

Originally posted by 89911
To stop you from filing claims.

just like I said, it's a scam.

RickM · RickM's Garage

Quote:

Originally posted by 89911
Although I usually don't give out advice on not paying for medical services, I think your case is deserving of attention. If you have already paid for this, then you will have difficulty getting the money back I'm sure. Your best bet is to go after your insurance company but that will be next to impossible. If you haven't already paid, write a letter explaining your situation, how you were given approval by that office, and why you are not going to pay for it. Tell them the name of who had given you the approval if possible. Being that they also had taken your card and verified you insurance prior to being seen, they had full opportunity to inform you that the appointment would not be covered. Also tell them that if they come after you with any legal means or collection agencies, they will be contacted by your lawyer. Send this letter certified. They screwed up and will most likely write off the charges. Also let you primary care office now how they have incorrectly given you advice on having you procedure covered. They didn't tell you to specify what exact plan you have.

Thanks for the advice. I agree that the insurance company is likely to blow me off. After all it's the patients responsibilty to understand what's covered and what's not. I believe that's one of the documents I signed.

I may however write a letter to the physician and attempt to appeal to his sense of fairness.

Moses · 02-06-2006, 02:01 PM

Quote:

Originally posted by on-ramp
deductibles are another scam...who ever thought up of that one? if I pay for insurance, and i file a claim , why do I still have to pay? ha ha..

The deductible is designed to discourage you from seeking medical care for trivial conditions.

on-ramp · 02-06-2006, 02:06 PM

Quote:

Originally posted by Moses
The deductible is designed to discourage you from seeking medical care for trivial conditions.

this is what the insurance companies have brainwashed people to believe

how do you make a judgement when it's a trivial condition? Something "trivial" can sometimes lead to a major problem.

Moses · 02-06-2006, 02:12 PM

Quote:

Originally posted by on-ramp
this is what the insurance companies have brainwashed people to believe

how do you make a judgement when it's a trivial condition? Something "trivial" can sometimes lead to a major problem.

It's pretty simple. Big deductible=low premiums. Low deductible=high premiums.

Quality, cost, convenience. You can have any two.

In this example, the doctors office should refund the bill as they mislead the patient. This isn't Rick's fault, or the insurance companys. The specialists office gave bad info and should make it right.

89911 · 02-06-2006, 03:13 PM

Quote:

Originally posted by on-ramp
this is what the insurance companies have brainwashed people to believe

how do you make a judgement when it's a trivial condition? Something "trivial" can sometimes lead to a major problem.

Ever been to an ER lately? You'll see trauma from car accidents next to people with head colds. Then they expect the insurance company to pay $600 for a presciption and pain pills. There is no right answer all the time. Having a competent primary care physician is a start.