Prepare for dealing with the costs of health problems, and info on preparing for a specialist office visit.
The costs of health problems
As someone with a chronic medical condition, and the parent of a special needs child, I have seen first hand just how expensive medical costs can be. Doctors have earned the right to a premium fee, after putting in hours and hours over the course of many years of studying, training, and preparation for their field. My issue is primarily with the excessive costs that come from facilities and sometimes procedures. Obviously, they need to cover their costs (overhead, salaries, etc), but often fees can be outrageous. In researching costs for an upcoming procedure, I found many people reporting on forums that their surgeon fee would be about $1500, similar for anesthesia, but $15,000 for a facility fee – for a one-hour outpatient procedure. Not a breakdown of charges for the staff, physical resources, etc, just a blanket fee of $15,000 for the procedure. The arrival time for this is usually 1 hour in advance, start an IV with saline, 1-hour procedure, 1-hour recovery with one nurse attending to needs. Most nurses I know are well compensated (rightfully so) for their work, but they are only getting a slight fraction of that fee.
My advice to is to do your research! Make sure you are choosing the best health care plan for your specific medical and financial circumstances – but don’t stop there! KNOW what your plan covers, what facilities/specialists are within your network of preferred choices and use them, and know what costs will be your responsibility. Then, negotiate! Once the insurance pays their portion of a bill and you know what amount you are responsible for, call the facility and ask for a discount if you pay in full within x number of days, or just ask outright if they can discount that amount. The worst that can happen is they say no, but you won’t get a discount if you don’t ask!
IMPORTANT INFO TO PREPARE FOR A MEDICAL SPECIALIST OFFICE VISIT
UPDATE: We had a family member that had a health issue pop up, almost 2 years ago. The primary care doctor evaluated the situation and felt like a specialist was necessary. I called the insurance company to get the name of a preferred provider, verified on the website what the copay amount would be ($60), printed them off for my records and called to make an appointment. When I called, I documented our conversation in my records (time of the call, who I spoke to, details of conversation). I re-verified that they were a preferred provider, the amount of the copay, let them know we required an outside lab for any tests, and what tests had already been run. The day of the appointment, the patient had these notes and re-verified with the office staff. They requested tests be run and were again told that an outside lab was needed. However, they instead chose to run the tests themselves, in house. Upon checkout, the office staff indicated that a bill would be mailed for the copay, and nothing was due at the time of service. Fast forward a few weeks, and two bills totaling over $1500 arrived. I immediately called to dispute, and they were adamant that this was the amount due. I sent in a written dispute, with documentation, and they denied it. I filed a dispute with my insurance company, and they denied it. I called the insurance company and requested a mediator, and they denied it. Instead of billing us the agreed upon fee for an in-office visit, they billed it as an outpatient hospital procedure, but the visit was IN AN OFFICE, as an initial visit, not a follow-up, and no procedures were performed. The patient merely had a 5-minute conversation with the doctor, who sent a prescription for the issue to the pharmacy and left the room.
I took action myself, to get the issue resolved. My opinion is that if a medical provider is contracted with an insurance company to provide a service for a set fee, then that is what they need to abide by. You should not be allowed to change the type of service rendered from what actually occurs, just to get more money from the insurance company and patient. The procedure they claim was performed takes approximately 90 minutes, with a 60-minute recovery. The patient arrived at 3 pm and was on record signing for his prescription at the pharmacy at 3:25 – that would be impossible if he was, in fact, having a procedure performed from 3-4:30 pm.
I spent TWELVE HOURS scouring the internet and finally found the name and contact information for the CEO and CFO of the hospital associated with this specialist. After a significant back and forth, submitting documentation, etc. they finally agreed to “settle” the account for $60. When I took the payment IN CASH to the office, they were very rude and snarky with me, and I demanded the CFO come down and accept the payment himself AND give me a written document confirming that our accounts with them were in fact PAID IN FULL. At the time, I had not read any books on How to deal with medical billing disputes, but they probably would’ve saved me hours of work.
I encourage everyone to keep a file for every doctor or specialist you see. Always keep copies of the forms you sign/fill out, and be sure to DOCUMENT all conversations, you never know when/if you’ll need it, and having it on file can literally save you thousands of dollars. DO NOT BE AFRAID of asking for itemized billing statements, and to ask questions about the length/policy of procedures listed on the receipts. I’ll admit, the ethical side of me really wanted this specialist office to admit that they were wrong, and mistakes had been made in how they handle their billing. In the end, I had to settle for getting them to simply agree to the amount they’d initially quoted me for the services rendered. I DID file complaints with medical boards, our state medical/ethics department, and give them negative reviews on health grade websites.
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