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Wed Sep 18, 2019, 09:32 PM

Stuff like this is why our healthcare is overpriced.

I recently went in for a stress echocardiogram. This was to be scheduled on a day my cardiologist was in the office (the lab is adjoining the office itself) so he could review and consult with me after the test.

I never made it to the stress part of the test because they couldn't get good enough images from the initial echo. So, they reschedule me for a nuclear stress test (coming up next week).

I fully expected to get a bill for the echo from the lab and did. No surprise there.

The surprising part is my cardiologist's office charged almost $200 dollars to my insurance for a separate office visit claim (separate from lab explanation of benefits) that never even happened. I literally never saw him the day of the failed echo at all.

And the insurance actually paid for the "office visit".

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Reply Stuff like this is why our healthcare is overpriced. (Original post)
Liberal Veteran Sep 18 OP
wasupaloopa Sep 18 #1
Liberal Veteran Sep 18 #2
Hoyt Sep 18 #3
Liberal Veteran Sep 18 #4
fescuerescue Sep 18 #5
Hoyt Sep 18 #6
fescuerescue Sep 19 #8
Massacure Sep 18 #7
fescuerescue Sep 19 #9

Response to Liberal Veteran (Original post)

Wed Sep 18, 2019, 09:34 PM

1. Was his staff working with you?

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Response to wasupaloopa (Reply #1)

Wed Sep 18, 2019, 09:38 PM

2. Not that I am aware of.

I literally saw the lab tech and the receptionist. It's possible they made a quick message over to the MD and said "this ain't working, should we go nuclear?".

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Response to Liberal Veteran (Original post)

Wed Sep 18, 2019, 09:43 PM

3. The office probably bills from the daily schedule, and the biller didn't know,

or didn't care, if the doc actually saw you. Alternatively, once you signed in, that triggered the charge. Actually, happens quite frequently.

If you like the doc, call them up and complain. They should reverse the claim.

If you don't like the doc, call the insurance company and complain.

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Response to Hoyt (Reply #3)

Wed Sep 18, 2019, 09:53 PM

4. That makes more sense than is obvious on the surface. I didn't think of that.

On one hand, I really don't care except in the abstract idea of being billed for something that didn't happen (since I didn't have a copay on the office visit).

On the other hand, I wonder how many times a day something gets billed, paid for by the insurance companies, and is never noticed by anyone until next year when premiums go up.

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Response to Hoyt (Reply #3)

Wed Sep 18, 2019, 10:44 PM

5. Calling the insurance company has a catch

Say the insurance company reveres the claim. Now the doctor sticks you with the full bill because claim was denied.

Now you gotta fight the doctor's office too.

There is literally no reward for saving the insurance company money, and highly likely - a big penalty.

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Response to fescuerescue (Reply #5)

Wed Sep 18, 2019, 10:55 PM

6. Not if doc is smart. Patient didn't see the doc, so doc shouldn't have billed for an office

consultation. Any decent docís billing staff would apologize and write it off. The doc made money of the test, but didnít discuss the results with the patient because it wasnít readable. Doc will also make Monet off retesting and any consultation at that point.

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Response to Hoyt (Reply #6)

Thu Sep 19, 2019, 12:44 AM

8. Right. But that still doesn't change the equation

At best there is zero benefit.

But there is significant risk of having a brand new hassle that will cost either your time, your credit or your pocketbook.

And it's not as doctor billing offices are universally smart.

This is a beehive not worth poking, hoping the bees are smart.

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Response to fescuerescue (Reply #5)

Wed Sep 18, 2019, 11:40 PM

7. That depends on how the contract is written

A lot of insurance plans prohibit providers and facilities from balancing billing their members if they want to be participate in the plan's network.

My brother was admitted to a hospital for three days a couple years back and it took the hospital nearly a day between the time test results showed his vitals were stable and the time they actually released him. United Health Care deemed the last day of admission not medically necessary and declined to pay for it, which resulted in the hospital sending my brother a rather hefty bill. When my brother appealed to United Health Care, UHC told him the hospital was contractually prohibited from doing that and that they would deal with it.

My brother is lucky his roommates brought him to an in-network facility; had the hospital been out-of-network he probably wouldn't have been able to have United Health Care go and lay the boom down on his behalf.

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Response to Massacure (Reply #7)

Thu Sep 19, 2019, 12:55 AM

9. Yes but that is irrelevant way to many times.

It's still a zero benefit with a risk of losing your time, your credit or your money. And the contract is between the provider and the insurance company to which you aren't a party.

My wife and I have spent many hours on the phone with bill offices explaining that their contract doesn't allow them to bill me. We've always won that argument so we didn't lose money, but nobody can refund that time and aggravation. I've had to deal SO MANY times with insurance not paying, that it just seems crazy to ask the insurer to not do so.

In your brothers case, he knew how to fight and deal and win the issue. But he still had to deal with all that hassle and multiple phone calls. No one can refund his time.

In your brothers case he didn't instigate the dispute - the dispute found him. In the message I'm replying to the writer is suggesting instigating a dispute that nets zero reward, and has the potential be a giant hassle.

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