Author Topic: anyone know anything about negotiating Medical Bills?  (Read 885 times)

icyappraiser

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anyone know anything about negotiating Medical Bills?
« on: May 08, 2019, 12:41:32 PM »
I had a annual preventative visit with a new doctor since I switched insurance companies this year. My preventative care is covered in full in-network. My insurance company gave me the contact info of the office I went to as an in-network provider, but now insurance is telling me the specific doctor I saw at that office was not in network and that they will not pay the claim.

The doctor's office says they can't answer any questions about billing and to call their third party billing company. The billing company says they cannot help at all and to call the doctor's office if I take any issue with it. I asked if there was a pay in full discount should I have to pay out of pocket and they said no.

Basically I don't know what other routes I can take. It's not a problematic amount of money for me to pay but I'm trying to pursue any routes I can out of principle.

Any other ideas or does it sound like I am SOL at this point?

Thanks!

RetireAbroadAt35

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Re: anyone know anything about negotiating Medical Bills?
« Reply #1 on: May 08, 2019, 03:25:11 PM »
I'm following along.  In my case, the doc was in network, but decided to bill me for both the preventative exam (covered) plus some bullshit simultaneous "office visit" that they are biling me an extra $500 for (not covered).  WTF.

FireHiker

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Re: anyone know anything about negotiating Medical Bills?
« Reply #2 on: May 08, 2019, 04:48:46 PM »
I recently dealt with this when I went to a new doctor and rather than code the visit as annual/preventive (included at zero cost) they billed it as "new patient" and charged me hundreds of dollars. I called their billing and challenged it, especially since we had 5 visits within a week (one each for the 5 members of our family), and they properly coded my two young kids as preventive but not my husband, myself, or my 18 year old. I haven't actually gotten a response back, and they did say they would call back within ten days, but if I go to my HSA account the claims are now shown as $0 instead of unpaid with a balance, so I guess it's been resolved.

Good luck.

BeanCounter

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Re: anyone know anything about negotiating Medical Bills?
« Reply #3 on: May 08, 2019, 05:04:03 PM »
Call the insurance company back and tell them that you called and spoke to someone before your visit and that they told you the physician was in network. They should have record that you called.
In the future always make sure you keep proof that they told you a physician was in network. My preferred method for this is to look it up on the insurers online provider lookup tool and screen shot all of it.
Also call the physician’s biller because they may say that they are in network.
Annoying as it is, this may just be an error that can be fixed with a few phone calls. Network administraton is difficult for both the insurance company and the providers. Just another reason we need Medicare for all.

icyappraiser

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Re: anyone know anything about negotiating Medical Bills?
« Reply #4 on: May 08, 2019, 07:28:39 PM »
Thanks for all the feedback.

The doctor's office never told me the doc was in-network--probably my mistake for not confirming. Basically now they are saying they don't know who's in my network, that they billed it as preventative and beyond that it is out of their hands.

The third party billing company confirmed it was submitted to insurance as a preventative visit code and can offer no more help.

And the insurance company says that another doctor at the same office was in-network but not the doctor I saw. I just assumed the whole office was in-network when I was looking for a doctor previously.

So there's definitely not a billing error, I just feel I was misled by my insurance company. A lesson learned either way.

AMandM

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Re: anyone know anything about negotiating Medical Bills?
« Reply #5 on: May 08, 2019, 07:38:08 PM »
Someone just sent me this. Maybe it will help?

https://www.advisory.com/daily-briefing/2019/04/04/medical-bills

Psychstache

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Re: anyone know anything about negotiating Medical Bills?
« Reply #6 on: May 08, 2019, 07:41:23 PM »
You can try contacting your states health and human services department. Many have a "getting jerked around by the medical billing industrial complex" department that can help with this kind of beauraucratic BS.

formerlydivorcedmom

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Re: anyone know anything about negotiating Medical Bills?
« Reply #7 on: May 09, 2019, 01:04:54 PM »
That's frustrating.  If it is a single practice, it doesn't make any sense that some of their doctors would be in-network and some are not. 

This is also something the doctor's office should have told you up front.  I would be really pushing back on the office manager.

I once went to a doctor who had been listed as in-network when I booked the appointment but who was out of network by the time I went to the office.  When I complained after receiving a large bill, they refunded the money and said it was their  policy to inform patients of the up-to-date in-network status, and since they hadn't they'd basically eat the money.

Proud Foot

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Re: anyone know anything about negotiating Medical Bills?
« Reply #8 on: May 13, 2019, 01:40:52 PM »
When you called your insurance prior to the visit did you ask about a specific doctor or just for the clinic? Each individual doctor has to get enrolled with each insurance company. If this is a new doctor it is possible the practice manager has not completed all the paperwork to get this doctor enrolled with your insurance provider. There also could be a reason why your insurance provider did not approve them as well. I would also push back on the practice manager as it sounds like the issue is not with the actual coding/billing of the visit.