by lucifer » Mon Sep 10, 2007 01:43 am
went to my eye doctor and when my exam was finished, the doctor told me it would be $25.00. I had already given my insurance information to the receptionist prior to my exam. She said they would bill my insurance. When I checked my insurance information they had billed my insurance for $68.00. Why would they say $25.00 and bill my insurance for $68.00? I wasn't sure my insurance would cover the exam but she said they would submit it anyway. This doesn't sound right. :shock: :shock:
Posted: Mon Sep 10, 2007 01:47 am Post Subject:
It probably is right because when you give your insurance you usually have a co-payment? We do ours is $15 and then they bill the insurance. Like today I went to a dr. office and it was $15 even though the office visit is almost $100 I only had to pay the fifteen today and then they will send it through to insurance and if they don't cover everything which they usually do then we will have to pay a little more. I am sure your exam was 68 dollars or more and the 25 was just your co-pay amount.
Posted: Mon Sep 10, 2007 02:24 am Post Subject:
This is typical for doctors and one reason why there is a problem with health care costs. They have their "every day normal cost" that you and I might be able to afford. They then have their "bill the insurance company" price. Insurance companies pay the "reasonable and customary" amount, regardless of what they are billed. Sp many health care providers simply bill huge amounts knowing that as long as they bill too much, they will be paid the max by the carrier.
Posted: Mon Sep 10, 2007 06:57 am Post Subject:
Hi Lucifer, I empathize with your situation. These kinds of events are quite shocking. Either of the situations described by life and tcope could be a possibility in your case.
Anyways, what kind of health insurance you carry? Because co-payment is a regular feature of HMO and POS kind of health plans. If you carry either of these two then you should re-read the policy document and find out the clauses related to co-payment. The co-payment amount normally varies between $5 and $25.
On the other hand, I'll also second tcope. Health care frauds are no longer illusive in this modern society. Doctors often try to churn out money form the patient's insurance policy. If you are not understanding the bill amount you can contact the doctor's chamber and ask for clarification. If he or his office fails to give you a satisfactory answer, ask your insurance company to review the claim before paying out for it. Hope it will solve your problem.
Take care
Juanita
Posted: Mon Sep 10, 2007 09:29 am Post Subject:
I worked for an eye doctor for several years. I don't know how this office does things but we often billed insurance for the health part of the eye exam (check for cataracts, glaucoma, etc.) because some insurances would pay on that but would not on the refraction ( part of the exam to determine if you need glasses and the strength.) The refraction is usually around $25 so maybe they charged you that because they knew the insurance would not pay for it.
Posted: Mon Sep 10, 2007 09:37 am Post Subject:
I didn't pay the $25.00 because she said she was going to send it to my insurance. The doctor said I owed $25.00 and the lady said that I didn't because she had my insurance information. I don't know if they collect up front but it didn't seem like it because she said I didnt have to pay. So I didn't pay it. thank you and I am going to check into it more.
Posted: Tue Sep 11, 2007 05:33 am Post Subject:
Yeah I would too. Sometimes doctors do overbill insurance companies. That's one thing that makes our premiums so high.
Posted: Tue Sep 11, 2007 10:34 am Post Subject:
I need to check into it more. They are probably doing the right thing but I am not sure since this is only my second time there. The first time I paid cash and this appointment was the one I gave my insurance information too. I didn't pay the $25.00 because the lady said that she was going to send the bill to my insurance. So it couldn't have been a copay because I didn't pay it or payment for an office visit.
Posted: Wed Sep 12, 2007 02:06 am Post Subject:
Hi Lucifer, I empathize with your situation. These kinds of events are quite shocking. Either of the situations described by life and tcope could be a possibility in your case.
Anyways, what kind of health insurance you carry? Because co-payment is a regular feature of HMO and POS kind of health plans. If you carry either of these two then you should re-read the policy document and find out the clauses related to co-payment. The co-payment amount normally varies between $5 and $25.
On the other hand, I'll also second tcope. Health care frauds are no longer illusive in this modern society. Doctors often try to churn out money form the patient's insurance policy. If you are not understanding the bill amount you can contact the doctor's chamber and ask for clarification. If he or his office fails to give you a satisfactory answer, ask your insurance company to review the claim before paying out for it. Hope it will solve your problem.
My insurance doesn't cover vision. I paid cash for my first visit because I don't have vision insurance. On this second appointment I was able to call the same day and get in right away because I was having a problem with my right eye..I didn't have the cash and I told her that but I needed to be seen so she said maybe my medical insurance would cover it. I doubted it but I thought what the heck..$25.00 would have been all that I would have had to pay that day if she hadn't taken my insurance information. So why did they charge my insurance $68.00? My insurance paid $14.00 and the eye doctor wants me to pay the rest..any way I am going to call them and find out what is going on...Thank you for your response.
It probably is right because when you give your insurance you usually have a co-payment? We do ours is $15 and then they bill the insurance. Like today I went to a dr. office and it was $15 even though the office visit is almost $100 I only had to pay the fifteen today and then they will send it through to insurance and if they don't cover everything which they usually do then we will have to pay a little more. I am sure your exam was 68 dollars or more and the 25 was just your co-pay amount.
This is only the second appointment that I have had. I know that my insurance doesn't cover eye exams, so I paid for the exam out of my own pocket. The first exam was because I had starting seeing Auras. He told me if it happens again to come in and he will check it out. I was experiencing another episode so I called first and I told them my insurance would not cover it. She said they would because it was a medical reason, not vision. So I took my insurance into her and now I see that I only have to pay, according to what is in the statement from my insurance, $14.00. With my insurance my copayment isn't paid up front. I am going to wait until I get the actual bill from my eye doctor and go from there. I do understand what you are saying. Thank you
Posted: Wed Sep 12, 2007 02:54 pm Post Subject:
That is weird then if it was different the first time you went in. I would definately check things out when you get the bill. Maybe it is all in how they bill things for different reasons. I know our dr. office has a sign to check with your insurance for some tests and such because who knows any more what they do and don't cover it is so crazy it has to be such a hassle to get things taken care of.
Posted: Thu Sep 13, 2007 05:54 am Post Subject:
Hi life,
I am Susan. I am very new to this arena of insurance. Your posts have helped me a lot so far in understanding the business of insurance. But still there are many a things which I don't understand. Can you explain to me little more about co-insurance? I have created a new thread on this topic ( the URL of which I have given below). Hope you will help me.
ampminsure.org/start/about3082.html#9883
Thanks,
Susan
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