Author Topic: Can anyone explain medical billing (before I stab someone?)  (Read 4450 times)

RosieTR

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Medical billing is just like, WTF. Here's my situation, and it's REALLY SIMPLE. I went to the dentist for a 6mo cleaning and checkup. Simple. They took xrays and cleaned my teeth. I was cavity and problem-free so that was the sum total of what happened.

Because my insurance pays me back directly for some reason, I paid the dentist at the time: $145.

A week or so later I get a check from the dental insurance for...wait for it...$200. Wut. The billing detail on the detail from the insurance was for a grand total of $290 (apparently this was what the dentist charges? Or what the insurance finds acceptable to pay? IDK).

Does this make the least bit of sense to anyone here? I shudder to think of navigating even a routine surgery's bills, given that this is about as freaking simple as it could possibly get.

rubybeth

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Re: Can anyone explain medical billing (before I stab someone?)
« Reply #1 on: May 17, 2016, 06:31:00 AM »
My mom worked in a dental office for her entire career (chairside and doing reception/insurance). It makes sense to me, because what the provider can charge insurance and what they might charge you are different.

Paul der Krake

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Re: Can anyone explain medical billing (before I stab someone?)
« Reply #2 on: May 17, 2016, 06:38:08 AM »
A few years back there was a large game of musical chairs at the local hospital of the quaint college town I was living in at the time. The article in the local student paper said 800 employees were affected by the move to a new building.

800! I thought. That's gotta be most doctors and nurses!

Noooope. It was just the paper-pushing billing department.

catccc

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Re: Can anyone explain medical billing (before I stab someone?)
« Reply #3 on: May 17, 2016, 08:36:28 AM »
There are usually several numbers on my dental EOBs.

For a single service (not visit, but just one billable line item, the cleaning for example) there will be multiple figures:
Dentist's billed amount
Allowable amount by insurance
Amount paid by insurance
amount paid by patient.

Usually it goes something like this
Dentist bills: $200
Insurance allows: $150
Insurance covers 80%: $120
Patient covers 20% + balance billing (my dentist is out of network): $80

I'm kind of curious what your EOB says since you were reimbursed in excess of what you paid.  That is weird.

ETBen

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Re: Can anyone explain medical billing (before I stab someone?)
« Reply #4 on: May 17, 2016, 09:26:14 AM »
There are usually several numbers on my dental EOBs.

For a single service (not visit, but just one billable line item, the cleaning for example) there will be multiple figures:
Dentist's billed amount
Allowable amount by insurance
Amount paid by insurance
amount paid by patient.

Usually it goes something like this
Dentist bills: $200
Insurance allows: $150
Insurance covers 80%: $120
Patient covers 20% + balance billing (my dentist is out of network): $80

I'm kind of curious what your EOB says since you were reimbursed in excess of what you paid.  That is weird.


That.  Most providers have one rate they bill to all insurances and self-pay.  The insurance only allows a smaller amount, with some portion coming from you and the rest paid to the provider by them.  In this case, it seems like they under-billed you OR have a lower self-pay rate than they have for insurance companies AND the insurance actually allows more than either of those. 

Did you submit the claim or did the dentist?  Whoever submitted is most responsible to reconcile it.  If they submitted the claim, they would likely contact you for the remainder.

Noahjoe

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Re: Can anyone explain medical billing (before I stab someone?)
« Reply #5 on: May 17, 2016, 09:28:54 AM »
Some dental insurances have what they call a "generally acceptable rate" for services. Your insurances seems to be $200. The dentist charged you $145. You keep the difference.

Consider it one of those times that insurance didn't pull one over on you and enjoy it ;)

iris lily

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Re: Can anyone explain medical billing (before I stab someone?)
« Reply #6 on: May 17, 2016, 09:36:32 AM »
Some dental insurances have what they call a "generally acceptable rate" for services. Your insurances seems to be $200. The dentist charged you $145. You keep the difference.

Consider it one of those times that insurance didn't pull one over on you and enjoy it ;)
Dude, people n the OP's pool are paying for this.

We dont have dental insurance and never have. Insuring for cleanings is not sensble. They are predictible and usual, just pay for them.




Noahjoe

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Re: Can anyone explain medical billing (before I stab someone?)
« Reply #7 on: May 17, 2016, 09:39:38 AM »
What I'm saying is that this is how some insurance companies handle paying for services like dental cleanings. It's an expected payout for them, for this expected amount. Nothing shady - it just is what it is.

Source: I sold insurance (and dental insurance). I was licensed in my state.

catccc

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Re: Can anyone explain medical billing (before I stab someone?)
« Reply #8 on: May 17, 2016, 09:56:06 AM »
Some dental insurances have what they call a "generally acceptable rate" for services. Your insurances seems to be $200. The dentist charged you $145. You keep the difference.

Consider it one of those times that insurance didn't pull one over on you and enjoy it ;)
Dude, people n the OP's pool are paying for this.

We dont have dental insurance and never have. Insuring for cleanings is not sensble. They are predictible and usual, just pay for them.

Great for you, but I'm sure there are some people that have and really benefit from dental insurance.  Some people need treatments or procedures beyond cleanings, and the need is not always due to lack of self-care.

I'm a red panda

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Re: Can anyone explain medical billing (before I stab someone?)
« Reply #9 on: May 17, 2016, 10:26:04 AM »

We dont have dental insurance and never have. Insuring for cleanings is not sensble. They are predictible and usual, just pay for them.

My annual premiums for dental insurance cost less than 2 cleanings. Why would I pay out of pocket for them?
(It also is capped at like $2,000- so it's pretty worthless if you have huge dental needs.)

I also get vision insurance in the years I plan to get new glasses. The screening + amount paid toward glasses are more than the premiums. It would be silly to not get it. I don't get it in years I don't need new glasses.

forummm

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Re: Can anyone explain medical billing (before I stab someone?)
« Reply #10 on: May 17, 2016, 10:32:18 AM »
It's routine for providers to bill for some very large amount of money for a service. And also routine for the contracted rate with the insurance provider to be much lower. Occasionally the cash price for people without insurance is lower than the insurance reimbursement rate (although this is pretty rare for medical care without negotiating it down in advance--dental care is a bit different).

therethere

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Re: Can anyone explain medical billing (before I stab someone?)
« Reply #11 on: May 17, 2016, 11:03:55 AM »

[/quote]


We dont have dental insurance and never have. Insuring for cleanings is not sensible for me. They are predictible and usual, Ijust pay for them.
[/quote]

I fixed your post for you!

Every employer I've ever worked for has had cheap dental insurance. Like, $5 single or $9 family per paycheck before tax. I even had one that covered 3 cleanings a year per person. So people flat out saying dental insurance isn't worth it is not correct for everyone. DH and I have awful, soft teeth, and have had a shady dentist put a bunch of crap fillings in too. I count it as a necessity because we will need more fillings, crowns, etc. I can honestly say I probably would not go to the dentist if I didn't have insurance. Now, those 2 years right out of school I paid for insurance but never bothered to find a dentist. Yes, that was a waste. But it was minimal.

neo von retorch

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Re: Can anyone explain medical billing (before I stab someone?)
« Reply #12 on: May 17, 2016, 11:13:16 AM »
Yes - that's like saying "Insurance for ONLY cleanings is not sensible." Sure. OK. For my wife, that's probably true. Strong teeth, healthy gums. My mouth threatens to disintegrate because I had that milk shake five years ago with sugar in it. I was hesitant to pay $600 for insurance, but my check-up and cleanings have already gobbled it up, and I've got some cavities to fill yet. It will certainly pay for itself twice over this year. Now if I'm confident that my teeth will be amazingly better as I get older, and it's just going to be some basic cleanings in the future, then I might hesitate once more to pay insurance.

iris lily

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Re: Can anyone explain medical billing (before I stab someone?)
« Reply #13 on: May 17, 2016, 11:27:32 AM »



We dont have dental insurance and never have. Insuring for cleanings is not sensible for me. They are predictible and usual, Ijust pay for them.
[/quote]

I fixed your post for you!

Every employer I've ever worked for has had cheap dental insurance. Like, $5 single or $9 family per paycheck before tax. I even had one that covered 3 cleanings a year per person. So people flat out saying dental insurance isn't worth it is not correct for everyone. DH and I have awful, soft teeth, and have had a shady dentist put a bunch of crap fillings in too. I count it as a necessity because we will need more fillings, crowns, etc. I can honestly say I probably would not go to the dentist if I didn't have insurance. Now, those 2 years right out of school I paid for insurance but never bothered to find a dentist. Yes, that was a waste. But it was minimal.
[/quote]

Usng your math,
I would pay an insurance cost of $234. Last year my dental bills were $244. Its been that way for ten years for me, two cleanings a year and nothing more.

But the insurance at my place of work was higher than yours, so it was not a win the one time I did the math.

I am only suggestng that insurance often is not useful for routine exams/cleanings and people need to do the math.

My dentist as well as optomitrist give discounts for cash payment. People need to consider that, thats all.

« Last Edit: May 17, 2016, 11:29:41 AM by iris lily »

catccc

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Re: Can anyone explain medical billing (before I stab someone?)
« Reply #14 on: May 17, 2016, 11:41:35 AM »
My cost share of dental for my family of 4 is $240 a year through my employer.  A cleaning and exam before insurance is $154 at my dentist's office.  $154 x 2 cleanings x 4 people = $1,232.  That's stellar deal.  I am also one of those people that needs procedures beyond cleanings, so it makes it an even better deal.

I'm actually in the process of procuring secondary dental insurance purchased individually because my dentist is out of network, so the balance billing on the procedures I need can get spendy. Yes, I could just go to a different dentist in network, but since I trust my current provider I'll see what savings the secondary insurance will bring me...

RosieTR

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Re: Can anyone explain medical billing (before I stab someone?)
« Reply #15 on: May 17, 2016, 12:39:08 PM »


Usng your math,
I would pay an insurance cost of $234. Last year my dental bills were $244. Its been that way for ten years for me, two cleanings a year and nothing more.

But the insurance at my place of work was higher than yours, so it was not a win the one time I did the math.

I am only suggestng that insurance often is not useful for routine exams/cleanings and people need to do the math.

My dentist as well as optomitrist give discounts for cash payment. People need to consider that, thats all.

That makes a lot more sense than the previous post. I have cheap insurance through work, and fairly frequently need something more done than routine cleaning, so it makes sense for me. After FIRE I would consider just skipping insurance and planning on an occasional steep bill.

I suppose I should contact the dentist to figure out more. It still doesn't make sense because I thought the dentist was charging me the whole amount they would normally charge, knowing my insurance would send the payment directly to me. The dentist submitted the claim on my behalf, I did not.
The attachment to the check from the insurance had nothing about what they normally pay, what the dentist billed, etc. Instead, it was just a list of the different items that happened (ie "flossing" or "consultation with dentist" etc). Very weird. Probably I owe the dentist more money, but if my total payment should be $90, 90/290=31.03% which is a weird number. I would think it would be an even 20% or 30%. I would expect the check would have been $203, not an even $200 (because 290-203=87, which is 30% of 290). It's also possible someone messed up somewhere-either the receptionist at the dentist didn't submit correctly, didn't bill me correctly, or someone from the insurance did the wrong figure.

elaine amj

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Re: Can anyone explain medical billing (before I stab someone?)
« Reply #16 on: May 17, 2016, 06:24:40 PM »
Have fun :) We have just spent months sorting out a tangle of insurance billings from our optometrist and physiotherapist. We are used to my insurance company, which pays the providers directly. DH's new insurance company has an antiquated, confusing process - and insists on paying us. They also combine payments for multiple providers into one single payout (Eg $40 for optometrist + $15 for physio visit #1 and $15 for physio visit #2 = $70 payout). And it takes several steps for me to put the paper trail together. Combine that with inefficient billing departments (our optometrist didn't contact us until over 6 months later) and it was a mess to figure out.

I think everyone is paid out now. Sure makes me reluctant to use any of the covered services!


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Retire-Canada

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Re: Can anyone explain medical billing (before I stab someone?)
« Reply #17 on: May 17, 2016, 07:59:56 PM »
Does this make the least bit of sense to anyone here? I shudder to think of navigating even a routine surgery's bills, given that this is about as freaking simple as it could possibly get.

Just so I understand you want to stab someone because an insurance company reimbursed you a few dollars more than you paid for a dental visit?

#firstworldproblems

RosieTR

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Re: Can anyone explain medical billing (before I stab someone?)
« Reply #18 on: May 17, 2016, 09:32:42 PM »
Does this make the least bit of sense to anyone here? I shudder to think of navigating even a routine surgery's bills, given that this is about as freaking simple as it could possibly get.

Just so I understand you want to stab someone because an insurance company reimbursed you a few dollars more than you paid for a dental visit?

#firstworldproblems

No, I want to stab someone because the math makes no sense and it SHOULD. This is endemic to the US health-care system. No one can understand the billing. Not the insurance companies, not the people actually sending out the bills, not the doctors/dentists/etc, not the hospital administrators and the like. Every single time I've even gone to one of those "what changes are on the way this year" little talks that work has for our health insurance, it makes me want to stab someone because the billing is purposely obfuscated.

How is it that I can take my car to a mechanic and the following happens: I ask for an oil change (non-Mustachian but worth not lying in oil-covered snow for 2 hrs for me). They tell me it will be about $35 unless there's more work to be done. Halfway through the day, they call and tell me the laundry list my 1999 Sentra needs done, I tell them to go ahead with the most critical one, they tell me it will be about $300 total, give or take 20, with the oil change and whatever other thing. I get to the dealer at the end of the day and low and behold, the bill is $314.37.

OTOH, I go to the dentist. First of all, they don't even say how much it will likely be for the cleaning. Just "we'll call you in". I get the tooth thing done. I pay. Then I get money in excess of what I paid, which in no way matches what the itemized billing activities add up to.
Since so far it's unclear from anyone else what the hell is going on, I'd say that it's not that I missed something. It's that is is inscrutable to begin with. And when things are confusing, it's easy to dupe people. It's not the dentist, it's the entire stupid system.

seattlecyclone

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Re: Can anyone explain medical billing (before I stab someone?)
« Reply #19 on: May 17, 2016, 10:23:44 PM »
Medical billing is a black box and I hate it. We have computers and stuff now. Why is it impossible for a doctor to tell you in advance what a procedure is going to cost, given which insurance you'll be running the bill through? It shouldn't be rocket science, it's just a database. Like, if we're having a baby the hospital should be able to provide me a sheet saying they will bill my insurance $x for a bare-bones vaginal delivery, add $y if you need a c-section, $z if you need an epidural, $w for each additional night in the hospital, etc. You could even ask multiple hospitals for their similar price list and make an informed decision. If we are actually serious about getting costs under control, telling patients what stuff will cost in advance wherever possible could be a huge win.

Scandium

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Re: Can anyone explain medical billing (before I stab someone?)
« Reply #20 on: May 18, 2016, 08:15:16 AM »
Every employer I've ever worked for has had cheap dental insurance. Like, $5 single or $9 family per paycheck before tax.

Then you have insanely cheap dental! My current employer is $35/month. Another place I've talked to was $63/month! So $400-700 per year. And they both have deductibles of couple hundred for non-routine work, and cap out at $2000/year! So if you need some serious work done there only a window of about $1,000 where you'd benefit. If you need that work within any given year. Dental insurance simply don't make a whole lot of sense to me, for almost anyone.

1) healthy teeth; paying OOP for cleaning is cheaper
2) bad teeth: the premium/deductible/cap means you may come out ahead by $1,000 or so, maybe. If they pay, don't overcharge, and you happen to have insurance the year you need it. And the premium you pay over 2-3 years would more than cover any one-time payout.

DeltaBond

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Re: Can anyone explain medical billing (before I stab someone?)
« Reply #21 on: May 18, 2016, 09:58:31 AM »
Insurance companies have deals with the providers as to what they'll charge for each thing, its in a contract.  What's left is adjusted and they will charge you the remainder.  Its not good, but all that may change in January.