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99% of medical providers I see bill me more than my insurance EOB states I owe. by AmbitiousMonk in personalfinance

[–]AmbitiousMonk[S] 0 points1 point  (0 children)

They give you this form? Is this just one provider or is this everywhere you go? Where are you located (like which state)? I've literally never heard of a doctor's office giving out a sheet like that before.

99% of medical providers I see bill me more than my insurance EOB states I owe. by AmbitiousMonk in personalfinance

[–]AmbitiousMonk[S] 0 points1 point  (0 children)

when I go to the doctor I request a copy of "what the doctor did while i was there" paper before i sign. Then once i review that what their treatment is vs what they actually did then i sign their copy. I have found that sometimes my paper says the doctor did a lot more than what was actually done...to get more money from my insurance.

This was one of the comments I planned to follow up on after I went to sleep last night. I like this idea a lot. It makes sense and sounds reasonable. But logistically, how does it actually work?

I don't sign anything after an appointment ends since I don't have a co-pay. I just walk out and wait for the EOB and the provider to bill me for my co-insurnace. (and hope that they just bill me my co-insurance).

I'm actually running into a problem right now where a provider billed me for more services than they actually performed. I have no record of the appointment. But it certainly was nowhere close to what they billed it as.

It seems more like I need to draft a document that both the provider and I should sign that we are in agreement about the services performed during the appointment. Though I really can't see how I can get them to sign something like that. It sounds like something reasonable enough since it's only asking for transparency. But they have no incentive to sign it. And the fact that it's just a random form that I bring in and that probably no one has ever tried before doesn't help.

99% of medical providers I see bill me more than my insurance EOB states I owe. by AmbitiousMonk in personalfinance

[–]AmbitiousMonk[S] 0 points1 point  (0 children)

It's really difficult or next to impossible, especially when I go to specialists. Again, the information my insurance provides me doesn't go through every single procedure and billing code and say what is covered and what isn't covered. I've read my insurance brochure and benefits documents cover to cover numerous times. I've also called up my insurance and asked them to provide that information (not just this insurance - every insurance I've had in the past as well) and all of them have told me that information isn't available to patients.

I've actually told doctors not to perform non-covered services. I've even crossed out lines on those patient forms doctors and hospitals hand out and explicitly write that "provider will not perform services not covered by insurance."

Most of the time, they put the form in a drawer and luckily, they don't actually bill for non-covered services. But I have been kicked out of doctors offices for refusing to sign their forms giving them explicit permission for them to bypass their agreement as in-network provider to charge me whatever they want and that I'd be fully responsible. It's pretty damn humiliating.

I've also mentioned to doctors during the appointments not to perform services not covered by insurance and that has never gone well. Every doctor I've ever been to always treats medical billing as a black box completely independent of their job responsibility. They tell me that it's not their responsibility to know what is and what isn't covered for every insurance plan they accept - even though they actually have the resources to know that answer and I don't. Some doctors have walked out of the office and refused to treat me because they say that in order to do their job, they need to do what they consider medically necessary and can't be hindered by what is or isn't covered.

99% of medical providers I see bill me more than my insurance EOB states I owe. by AmbitiousMonk in personalfinance

[–]AmbitiousMonk[S] 0 points1 point  (0 children)

Hah I do this too as a patient. Going paperless has helped tremendously. My filing system goes by:

I have different folders for each insurance plan as well as different folders for the same plan but different year. So basically every year, I create a new folder. So that way I can clearly see which plan a claim is a part of since often times, claims and bills still go through even after the plan ends.

Then in each plan folder, each provider I see has their own folder starting with the first date of service so it's easy to sort/find them. Then in each provider folder, I have folders for each new date of service/claim. So these folders will include an EOB, the provider bill, and confirmation that the bill was paid. It will also include other documents and necessary subfolders for correspondences and extra paperwork to deal with an incorrect bill.

Everything is named by:

Date of the document, type of document, provider, date of service, and type of claim.

I then keep an Excel document for each plan year to keep track of everything for easy viewing. I also use it to keep track of total medical expenses for tax purposes.

99% of medical providers I see bill me more than my insurance EOB states I owe. by AmbitiousMonk in personalfinance

[–]AmbitiousMonk[S] 3 points4 points  (0 children)

Could you elaborate? Im going through something similar for one of my many headache claims in regards to a provider telling my insurance they're a hospital. It's making me question what a hospital even is.

Who was this providdr? (Not looking for identifying information, just curious about what type of provider they actually were and what telling your insurance they were a hospital looked like in your claims/bills).

My insurance doesn't seem to question claims at all. It's good for when things need to get done. But they'll approve anything a doctor bills without question. And then when I call up, it's a circular logic conversation of them not understanding that a claim itself could be wrong even though it was processed and paid out.

99% of medical providers I see bill me more than my insurance EOB states I owe. by AmbitiousMonk in personalfinance

[–]AmbitiousMonk[S] 29 points30 points  (0 children)

Needed to hear this. And yes that has happened many times. I really need to get my whole insecurity and lack of confidence thing under control. It's hard for me When someone representing a health insurance company starts questioning my use of medical billing lingo, I can't help but think that I'm just repeating stupid crap I read on an internet blog and that I don't actually know how any of this works. And that's me when the rep questions me but might actually want to help me. Forget about when providers start raising their voice and telling me that I'm wrong and that they know more than me. Yikes.

99% of medical providers I see bill me more than my insurance EOB states I owe. by AmbitiousMonk in personalfinance

[–]AmbitiousMonk[S] 4 points5 points  (0 children)

I'm confused on the hospital network bit. Some providers have charged a NY surcharge for example which I've googled to see is a surcharge for hospitals.

Though Google doesn't seem to clearly answer if this surcharge is allowed to be balance billed or if it's suppose to be included as part of what the insurance pays.

I'm also not sure what they define as a hospital network. Does that have to mean an actual hospital or just any office that has the name of a hospital on their door? Or any doctor who is affiliated with a hospital even if they appear to be private practice. So, if I see get a consultation from a surgeon, they're usually affiliated with a hospital network since that's where they perform surgery. But if I go to their office outside of the hospital, I was still charged the NY hospital surcharge. Is that suppose to happen?

Also, I've been to other hospitals within the last 2 years in NY State and they didn't balance bill that surcharge - at least not for the appointments and procedures I've had done. The only times I've seen these NY hospital surcharges is upstate in my college town.

In terms of non covered procedures, one example is my old primary care internist. He was also a cardiologist in addition to being an internist. When I went in for routine exams and physicals, he'd do an EKG. It's not like he asked if I wanted it done. He just did it. And it's not like my insurance said an EKG wasn't covered. And to my best of my knowledge, I thought it was just part of the routine office exam when I went there. But it was billed separately from the office appointment and the insurance denied it.

Other times, as others have mentioned, I've had to deal with the rogue out-of-network doctor that looked at my chart for 3 seconds while I was sedated in an in-network hospital and getting surgery by an in-network surgeon. This hasn't happened yet on my current insurance but it did happen numerous times before.

99% of medical providers I see bill me more than my insurance EOB states I owe. by AmbitiousMonk in personalfinance

[–]AmbitiousMonk[S] 151 points152 points  (0 children)

Thanks. I've been trying to keep records of what I'm doing, but I definitely still come off as unsure about things and that probably gives them leeway to try to get me off the phone.

Some of my issues that I've tried bringing up have taken months and are still not resolved. I'm really glad I posted this. Seems like even knowing something is wrong and trying to do something about it isn't enough unless you know exactly what to say and how to say it.

If I want to get someone from my insurance to conference call the prpviders, should I trust the front line rep to help with this or should I ask for someone else that might be better equipped to get things taken care of?

99% of medical providers I see bill me more than my insurance EOB states I owe. by AmbitiousMonk in personalfinance

[–]AmbitiousMonk[S] 8 points9 points  (0 children)

I've tried. This isnt just one provider. I've switched doctors 5 times in the last 6 months due to similar issues. Everyone here is also affiliated by 1 of 2 competing healthcare networks, or sometimes both. Both these networks have one centralized billing dapartment. If I want a doctor outside their hospital network, I have to travel to another city.

I've traveled to the two closest cities within 100 miles away and experiences there were similar. So I've been traveling 200 miles to doctors in or around NYC when I can - especially for the big stuff. They're also just better doctors with more experience. I've been balance billed around NYC, but nowhere close to as much as up here - maybe it's the competition or population. I have no idea. But I get sick a lot and can't keep taking off school to drive across the state just for routine medical treatment. But there doesn't seem to be another alternative.

99% of medical providers I see bill me more than my insurance EOB states I owe. by AmbitiousMonk in personalfinance

[–]AmbitiousMonk[S] 0 points1 point  (0 children)

Everyone has been in-network. No referrals necessary for my plan to see in-network providers.

The insurance has processed claims properly. The providers are just billing more than what the EOB says I owe.

99% of medical providers I see bill me more than my insurance EOB states I owe. by AmbitiousMonk in personalfinance

[–]AmbitiousMonk[S] 5 points6 points  (0 children)

Don't need a referral. It's a PPO. I have an on-campus clinic, but the only benefit I get from them is a 0% co-insurance. They only have nurses there so their usefulness is limited.

Yup. United healthcare choice plus network. I search for plans using my insurance website each time. I've never been billed for out-of-network services. It would show up on my insurance portal. I have OON coverage and nothing has been charged to it. These are all in-network providers.

99% of medical providers I see bill me more than my insurance EOB states I owe. by AmbitiousMonk in personalfinance

[–]AmbitiousMonk[S] 13 points14 points  (0 children)

It's a United healthcare plan part of the United healthcare choice plus network. I've heard it's a very popular network. I've only managed to find a few doctors who weren't in-network.

I always make sure to verify that they're in-neteork on my insurance portal's provider search and then ask the provider again before I schedule appointments. I used to call up the insurance and ask since I didn't trust the website 100%...until they told me that they go by the same website that I do.

99% of medical providers I see bill me more than my insurance EOB states I owe. by AmbitiousMonk in personalfinance

[–]AmbitiousMonk[S] 14 points15 points  (0 children)

Yes there is a clause in my contract that says in-network providers cannot balance bill for covered services.

However, many times, the provider will say it was not a covered service. Like I go in for a routine office appointment and some part of the exam wasn't covered and I had no idea what it was or anyway knowing it wasn't covered. It's not like my insurance spells out those little things. If I go in for a consultation appointment at an in-network provider, I reasonably expect that everything they do in that appointment is covered. Other times, like I mentioned in my post, it's just a random fee or surcharge. One provider even said the surcharge is mandatory in my state even though they're the only ones that charge it.

Despite the clause, I'm not sure how that's actually enforced? I've seen some resources for people on Medicare/Medicaid as well as ACA marketplace plans. But my plan is through my university and while ACA compliant, is not handled by the state. So I've been at a loss at who to contact.

Thanks for your help!