Can I Ignore this Medical Bill?

[wageslave23]

I threw my back out a few months ago and went to Urgent Care.  My copay for Urgent Care is $75.  I paid that at the time of the visit.  Now I got a bill from the Dr. who saw me for a "specialist office visit".  This is not covered until I meet my deductible.  Its such bullshit.  One visit to urgent care and I'm recieving a bill for a specialist office visit.  I contacted insurance and they contacted each of the billing companies who each had their own reason for billing and couldn't speak for the other company.  I don't really feel like putting more time into this.  Can I just ignore the $189 specialist office visit bill?  I read that since its less than $500 it can't go on your credit report.  Anyone have any info on any of this?  I'm so sick of Dr's bullshit billing practices and the billing specialists who don't know how to do their jobs.

As a side note, my wife had a positive pregnancy test this summer.  She scheduled her first prenatal appointment and ultrasound and then found out during the ultrasound that it was a blighted ovum "basically miscarriage of embryo that was fertilized but never developed beyond that".  The office billed her for a specialist visit and not prenatal.  Shouldn't the initial visit at least be considered prenatal for insurance purposes?  The billing manager said that all first visits for pregnancy are always considered diagnostic office visit.  I can see where there would be some grey area in the case of miscarriage, but if she gets pregnant again and all all prenatal visits are supposed to be 100% covered, I'm going to lose my shit if she gets charged for the initial office visit because it was "diagnostic" and not prenatal.

[tj]

Ignoring medical bills is not advisable, no

[wageslave23]

Ignoring medical bills is not advisable, no

Can you elaborate?

[bacchi]

For 1) Your urgent care should include all services for the back. Did you also ask about another problem? If not, I'd ignore the bill. Fuck 'em.

As for 2) It can reach BS levels but a visit can morph as circumstances dictate. If you go in for a diagnostic visit, and they find something wrong, it's coded differently. If there's nothing wrong with the original coding, it stays the original coding.

[NaN]

That sucks. And sorry about your wife's miscarriage. That is a double whammy.

I can not think of a single person in the USA who enjoys working with medical billing and health insurance companies. Some people squeak by without any issue, but I bet the far majority, if not near 100%, have had to deal with something terribly infuriating (and at a usually very stressful time). My favorite example is dealing with the newborn hearing screening tests (paywall). I just ended up paying the $300 because it was not worth the hassle because it was before the 2022 No Surprises Act went into effect. I don't know all the details but you should check this out: https://www.cms.gov/newsroom/fact-sheets/no-surprises-understand-your-rights-against-surprise-medical-bills

But generally you have to find a way to deal with it in a healthy way and not paying and 'losing your shit' seems pretty unhealthy.

[use2betrix]

1st of all, I 100% share your plight in how much insurance sucks. I’ve been through many of these ordeals myself in the last years & months.

Regarding the pregnancy, first, so very sorry about your miscarriage. Pregnancy problems are a very tough thing to deal with. As the billing manager said with all first visits being “diagnostic” this is likely because they have to actually confirm and “diagnose” the pregnancy. I would assume that every first visit to a doctor of a ‘suspected’ pregnancy, will always be diagnostic. While a woman can get a positive pregnancy test, “feel/look” pregnant, the doctors office still has their own methods which they have to confirm/diagnose. I may be off, but this would be my understanding and hopefully this can prepare you some if this is correct as it comes around next time.

I had a previous doctor that I had to see every other month for a prescription. I also had to get an annual physical to get lowered insurance premiums. I scheduled the physical and prescription refill to coincide.. They wouldn’t let me do it. I had to book two appts, on separate days, because of billing. I told them that I literally didn’t care. I would even be happy to pay two separate co-pays. Just don’t waste my time for having to come back again.. They wouldn’t.. Had to come back the following day.. Terrible practice (it may not have actually been “them”, but likely the healthcare “system).

[Rob_bob]

I threw my back out a few months ago and went to Urgent Care.  My copay for Urgent Care is $75.  I paid that at the time of the visit.  Now I got a bill from the Dr. who saw me for a "specialist office visit".  This is not covered until I meet my deductible

Did you get a statement showing what services were covered by insurance and an explanation for why this expense wasn't covered?

[zygote]

Medical billing is so convoluted.

I split my eyebrow open after slipping in the shower around 8 PM one night. There was one urgent care near me that was still open, so I went there. The cut needed stiches, but the urgent care doc didn't feel comfortable doing them on my face. They suggested bringing in the on-call plastic surgeon, who was out of network. I actually have pretty good coverage out of network, so I decided to take my chances. The plastic surgeon cut it open a little more so the wound was straight, and then did a great job stitching me up. You'd never be able to see the scar unless you were looking for it. He ended up being super kind about the billing. His office "charged" me a huge amount to get the max they could from my insurance company, and then wrote off the rest and zeroed out my account. I don't think they ever even asked for a copay or coinsurance, even for the follow-up visit at his main practice to take the stiches out.

Any chance you did see an unusual specialist at your urgent care visit? Though they should have notified you if they were bringing in someone who wasn't covered under a normal urgent care visit. Also, have you tried contacting the urgent care itself, or the doctor? Insurance can't change how the visit is coded, they can only tell you what they owe for the code used. Hopefully a conversation with the office's billing department can clear things up. Maybe they're charging you to get money from insurance and aren't expecting you to actually pay. But whatever happens, I wouldn't just ignore the bill. At least whatever happens it's cheaper than an ER visit.

[wageslave23]

Thank you for the responses and condolences.  I spoke with both the Dr billing and urgent care billing.  Neither were helpful.  This was a routine urgent care visit. The Dr, who is contracted by the urgent care facility, walked into my room, asked me what happened. I told him my back spasmed after bending over and it wasn't releasing.  He asked me to move my legs a couple of different ways and if it hurt to do so. Then prescribed me a muscle relaxer.  The whole visit lasted 5 minutes. No special tests or specialists involved.

[Monkey Uncle]

I threw my back out a few months ago and went to Urgent Care.  My copay for Urgent Care is $75.  I paid that at the time of the visit.  Now I got a bill from the Dr. who saw me for a "specialist office visit".  This is not covered until I meet my deductible

Did you get a statement showing what services were covered by insurance and an explanation for why this expense wasn't covered?

Wageslave23, this is where you need to start.  Was the urgent care in your insurance network?  If so, they have an agreement with your insurance company for how much they get paid for each coded service.  The EOB from your insurance company should show you what they billed for, how much they billed for it, how much the insurance company paid based on the network agreement, your co-pay, and any amount that is not patient responsibility due to it being billed in excess of the agreed upon amount.  If you are lucky, some or all of the specialist fee might fall in that last category.  If that's not the case, try calling your insurer and see if there's a way it could have been coded that would have caused them to cover it.  Then maybe you can talk to the urgent care's billing people and suggest that they revise the coding.

I've been through this drill many times, and so far have never failed at getting the bill reduced or eliminated.

[zygote]

And those docs working in urgent care are all billing separately. But you can still try to negotiate with the specialist if you like.

As with most things medical, urgent care billing structure must vary a lot by location and practice. I've never had to pay anything other than my urgent care co-pay (and radiology/bloodwork co-pays where applicable) at an urgent care. The doctors that work there bill it as an urgent care visit, not an office visit.

Where I am, primary doctors and specialists book weeks/months out, so if you need assistance or a prescription within a few days (even if relatively "minor"), urgent care is the best option.* I usually end up there a few times a year for antibiotics or an X-ray (I am relatively illness prone). To me, life- or limb-threatening injuries or stitches/surgery means an ER visit.

*Sometimes I can message my PCP for a prescription if it's a recurring issue, but he's not going to prescribe something new if he can't see me first. Just in the last year or two, my insurance added coverage for telemedicine, which I've found hit or miss. Again, there are some issues they don't want to prescribe for without a physical exam/tests.

[charis]

Regarding the pregnancy, first, so very sorry about your miscarriage. Pregnancy problems are a very tough thing to deal with. As the billing manager said with all first visits being “diagnostic” this is likely because they have to actually confirm and “diagnose” the pregnancy. I would assume that every first visit to a doctor of a ‘suspected’ pregnancy, will always be diagnostic. While a woman can get a positive pregnancy test, “feel/look” pregnant, the doctors office still has their own methods which they have to confirm/diagnose. I may be off, but this would be my understanding and hopefully this can prepare you some if this is correct as it comes around next time.

Went through similar visit once.  Positive test at home but the ultrasound suggested an early miscarriage (not physically evident until later that day).  It's annoying but makes sense that they wouldn't code that as a prenatal appointment.

[reeshau]

Thank you for the responses and condolences.  I spoke with both the Dr billing and urgent care billing.  Neither were helpful.  This was a routine urgent care visit. The Dr, who is contracted by the urgent care facility, walked into my room, asked me what happened. I told him my back spasmed after bending over and it wasn't releasing.  He asked me to move my legs a couple of different ways and if it hurt to do so. Then prescribed me a muscle relaxer.  The whole visit lasted 5 minutes. No special tests or specialists involved.

One thing beyond billing and credit score: do you ever think you will need to go back there?  They may refuse service until you are up-to-date on billing.  Not something I would want to be in the the way of a difficult time, for the sake of a moral victory over the convoluted medical system.

[wageslave23]

routine urgent care visit

A gentle suggestion for future savings: Urgent care should not be considered routine.

This was not routine doctor visit. It was the prototypical urgent care visit. Not life threatening but needed immediate care because I could not walk or any other function.

[wageslave23]

Regarding the pregnancy, first, so very sorry about your miscarriage. Pregnancy problems are a very tough thing to deal with. As the billing manager said with all first visits being “diagnostic” this is likely because they have to actually confirm and “diagnose” the pregnancy. I would assume that every first visit to a doctor of a ‘suspected’ pregnancy, will always be diagnostic. While a woman can get a positive pregnancy test, “feel/look” pregnant, the doctors office still has their own methods which they have to confirm/diagnose. I may be off, but this would be my understanding and hopefully this can prepare you some if this is correct as it comes around next time.

Went through similar visit once.  Positive test at home but the ultrasound suggested an early miscarriage (not physically evident until later that day).  It's annoying but makes sense that they wouldn't code that as a prenatal appointment.

As I said, I understand not billing this as prenatal. But she said that even if it was a healthy pregnancy, the first prenatal visit is not billed as prenatal which makes no sense. The whole point of the aca rule that prenatal be 100% covered is that they don't want people not going to the doctor for prenatal treatment because they can't afford it.

[wageslave23]

Thank you for the responses and condolences.  I spoke with both the Dr billing and urgent care billing.  Neither were helpful.  This was a routine urgent care visit. The Dr, who is contracted by the urgent care facility, walked into my room, asked me what happened. I told him my back spasmed after bending over and it wasn't releasing.  He asked me to move my legs a couple of different ways and if it hurt to do so. Then prescribed me a muscle relaxer.  The whole visit lasted 5 minutes. No special tests or specialists involved.

One thing beyond billing and credit score: do you ever think you will need to go back there?  They may refuse service until you are up-to-date on billing.  Not something I would want to be in the the way of a difficult time, for the sake of a moral victory over the convoluted medical system.

That's a good point. In this case, no I will never be back there. There are several other urgent cares near me who don't charge two invoices for one simple visit.

[Fru-Gal]

Refusing service due to past billing or anything else is illegal

[Josiecat22222]

@Fru-Gal, actually it's not illegal to refuse care to a patient due to past billing.  If a health system takes federal money (medicare or medicaid) they are required to see patients and care for them and treat life threatening emergencies without requiring ability to pay (EMTALA rules).   EMTALA requires a screening for an emergency condition and to treat for that.  If no life-threatening emergency is identified, they are not required to continue care free of charge.  Most hospitals do, as a policy and to serve their local community, but then bill later. However, private self funded facilities (even urgent care) or doctor's offices ABSOLUTELY have the right to refuse to care for a patient who has not paid prior bills.  These are businesses and the product they sell is healthcare.  Much like you wouldn't get a plumber to come to your home if you owed them money from a prior service. 
    We can discuss if it should be this way in the US as a matter of philosophy or public policy, however, this is the current state of the healthcare system.   (spoiler alert: I think it is utter BS that the insurance companies have forced the care providers into this jacked up manner of providing care)

[Fru-Gal]

Yes, I should have said refusing care “in emergencies”.

“In emergency situations, responding doctors and other healthcare providers are required to stabilize the patient’s condition regardless of the patient’s ability to pay for the treatment or provide proof of insurance. This is required by the Emergency Medical Treatment and Active Labor Act (EMTALA).“

[reeshau]

Yeah, that's one reason why walking in the ER is so expensive; they have to cover everyone who can't pay.

Some helicopter services will make you sign for personal responsibility (I.e. not just the insurance amount) before they will take you.  That gets borderline, to me.  But it's the same problem.

[use2betrix]

Regarding the pregnancy, first, so very sorry about your miscarriage. Pregnancy problems are a very tough thing to deal with. As the billing manager said with all first visits being “diagnostic” this is likely because they have to actually confirm and “diagnose” the pregnancy. I would assume that every first visit to a doctor of a ‘suspected’ pregnancy, will always be diagnostic. While a woman can get a positive pregnancy test, “feel/look” pregnant, the doctors office still has their own methods which they have to confirm/diagnose. I may be off, but this would be my understanding and hopefully this can prepare you some if this is correct as it comes around next time.

Went through similar visit once.  Positive test at home but the ultrasound suggested an early miscarriage (not physically evident until later that day).  It's annoying but makes sense that they wouldn't code that as a prenatal appointment.

As I said, I understand not billing this as prenatal. But she said that even if it was a healthy pregnancy, the first prenatal visit is not billed as prenatal which makes no sense. The whole point of the aca rule that prenatal be 100% covered is that they don't want people not going to the doctor for prenatal treatment because they can't afford it.

It has nothing to do with the viability of the pregnancy. It’s a matter that they are “diagnosing” that a patient is pregnant. That is why it’s diagnostic.

What’s your copay for a diagnostic service - shouldn’t it be like a routine visit, $25 or so?

[SmartyCat]

One thing that may be regional - in my area, urgent care is not the same thing as a hospital emergency room. Urgent care (what we used to refer to as a "doc in the box") is a standalone clinic where you can walk in and be seen for something that is not life-threatening but also can't wait several days or weeks for an appointment with your regular physician.

[NaN]

I have found urgent care facilities to be mostly underwhelming in the USA. They seem like an antibiotic and pill dispensary, and usually the doctors or NPs are never happy to be there or actually want to help you. And their billing practices are atrocious as much as the rest of them. They also shed liability at every turn because they are not supposed to deal with emergencies. So what good are they? I haven't found what they are good for. I dunno, maybe if my kid needed stiches.

[wageslave23]

Thank you to those who provided thoughtful replies. I have to say though, at least half of the responders didn't even read the OP.  It's very disappointing. The quality of this forum has really deteriorated.

[charis]

Regarding the pregnancy, first, so very sorry about your miscarriage. Pregnancy problems are a very tough thing to deal with. As the billing manager said with all first visits being “diagnostic” this is likely because they have to actually confirm and “diagnose” the pregnancy. I would assume that every first visit to a doctor of a ‘suspected’ pregnancy, will always be diagnostic. While a woman can get a positive pregnancy test, “feel/look” pregnant, the doctors office still has their own methods which they have to confirm/diagnose. I may be off, but this would be my understanding and hopefully this can prepare you some if this is correct as it comes around next time.

Went through similar visit once.  Positive test at home but the ultrasound suggested an early miscarriage (not physically evident until later that day).  It's annoying but makes sense that they wouldn't code that as a prenatal appointment.

As I said, I understand not billing this as prenatal. But she said that even if it was a healthy pregnancy, the first prenatal visit is not billed as prenatal which makes no sense. The whole point of the aca rule that prenatal be 100% covered is that they don't want people not going to the doctor for prenatal treatment because they can't afford it.

It has nothing to do with the viability of the pregnancy. It’s a matter that they are “diagnosing” that a patient is pregnant. That is why it’s diagnostic.

What’s your copay for a diagnostic service - shouldn’t it be like a routine visit, $25 or so?

I'm with the OP on this one.  My first viable pregnancy appointment was treated as a prenatal visit by my provider.  I did not pay for it, all my prenatal appointments were covered in full by my insurance at the time.

[index]

@wageslave23 you might want to price out Direct Primary Care/Concierge Doctor. My wife and I switched to this model paired with an HDHP and it has ended up as a breakeven for us with much better care versus urgent care and primary care office visits. My wife threw her back out on a Saturday night at 7p. We texted the doc and got a prescription for muscle relaxers called into a 24-hr pharmacy, then he met us at 8a Sunday morning and gave her a Tramadol shot. Similarly for me, I've been able to get my medication honed in through repeated quick visits and got my leg stitched up when I had a box-cutter mishap. We pay $180/month for both of us (out of our HSA) paired with a $60/month HDHP. The fee covers all generic drugs, office visits, and in-office procedures. He also has direct pay relationships labs and radiology places around town where the cost is a small % of what I would pay running the procedure through my insurance. For instance, I get the same blood labs done every year and the cost is about $200 with my insurance. The same labs + a few additional tests were $41 at the same phlebotomy lab paying through the DPC.   

[Dibbels81]

Similar situation. Back in 2020 I was charged a BS $190 fee at a quick care clinic, despite me checking prior with my insurance that everything was covered. They required a nurse practitioner read me the results of my covid test over video chat, which wasn't covered. I said screw that. A received a couple of bills, and a few half-assed email from a collection company, but that was it. Never showed up on my credit report.

[Josiecat22222]

After a 20 year career in the healthcare industry (as a physician) I can say that that the lack of billing transparency in healthcare is an absolute shitshow.

We literally permit this in *no other industry*.  While I understand that an ER cannot accurately predict pricing up front as they have no idea what they will need to do and thus bill for, the remainder of the industry has no excuse.  There is no reason for there not to be a chart of prices immediately available to patients for services at facilities.  So if you need to have your knee replaced, your gallbladder removed etc, you should know up front what is the cost by a given doctor and facility. 

Just my 2cents.

[Raenia]

Regarding the pregnancy, first, so very sorry about your miscarriage. Pregnancy problems are a very tough thing to deal with. As the billing manager said with all first visits being “diagnostic” this is likely because they have to actually confirm and “diagnose” the pregnancy. I would assume that every first visit to a doctor of a ‘suspected’ pregnancy, will always be diagnostic. While a woman can get a positive pregnancy test, “feel/look” pregnant, the doctors office still has their own methods which they have to confirm/diagnose. I may be off, but this would be my understanding and hopefully this can prepare you some if this is correct as it comes around next time.

Went through similar visit once.  Positive test at home but the ultrasound suggested an early miscarriage (not physically evident until later that day).  It's annoying but makes sense that they wouldn't code that as a prenatal appointment.

As I said, I understand not billing this as prenatal. But she said that even if it was a healthy pregnancy, the first prenatal visit is not billed as prenatal which makes no sense. The whole point of the aca rule that prenatal be 100% covered is that they don't want people not going to the doctor for prenatal treatment because they can't afford it.

It has nothing to do with the viability of the pregnancy. It’s a matter that they are “diagnosing” that a patient is pregnant. That is why it’s diagnostic.

What’s your copay for a diagnostic service - shouldn’t it be like a routine visit, $25 or so?

I'm with the OP on this one.  My first viable pregnancy appointment was treated as a prenatal visit by my provider.  I did not pay for it, all my prenatal appointments were covered in full by my insurance at the time.

My first pregnancy appointment was also treated as prenatal, for what it's worth (this year, so should be under current law/policy). I paid nothing. My ultrasounds, on the other hand, were not treated as prenatal and I was surprised by a bill for ~$800, so watch out for that.

[wageslave23]

Regarding the pregnancy, first, so very sorry about your miscarriage. Pregnancy problems are a very tough thing to deal with. As the billing manager said with all first visits being “diagnostic” this is likely because they have to actually confirm and “diagnose” the pregnancy. I would assume that every first visit to a doctor of a ‘suspected’ pregnancy, will always be diagnostic. While a woman can get a positive pregnancy test, “feel/look” pregnant, the doctors office still has their own methods which they have to confirm/diagnose. I may be off, but this would be my understanding and hopefully this can prepare you some if this is correct as it comes around next time.

Went through similar visit once.  Positive test at home but the ultrasound suggested an early miscarriage (not physically evident until later that day).  It's annoying but makes sense that they wouldn't code that as a prenatal appointment.

As I said, I understand not billing this as prenatal. But she said that even if it was a healthy pregnancy, the first prenatal visit is not billed as prenatal which makes no sense. The whole point of the aca rule that prenatal be 100% covered is that they don't want people not going to the doctor for prenatal treatment because they can't afford it.

It has nothing to do with the viability of the pregnancy. It’s a matter that they are “diagnosing” that a patient is pregnant. That is why it’s diagnostic.

What’s your copay for a diagnostic service - shouldn’t it be like a routine visit, $25 or so?

I'm with the OP on this one.  My first viable pregnancy appointment was treated as a prenatal visit by my provider.  I did not pay for it, all my prenatal appointments were covered in full by my insurance at the time.

My first pregnancy appointment was also treated as prenatal, for what it's worth (this year, so should be under current law/policy). I paid nothing. My ultrasounds, on the other hand, were not treated as prenatal and I was surprised by a bill for ~$800, so watch out for that.

Thank you. Yes, this how it was for our first child with a different dr.  And the way it is supposed to work. Unfortunately we have this dumbass billing manager who doesn't understand how it's supposed to work. And it's not like I'm going sue or something for $200. Just annoying that there is no transparency and no one to go above them to.

[partgypsy]

A friend went to urgent care (broken ankle). Talked to receptionist when checking in, whether should be here, or ER. A Dr stepped into waiting room glanced at ankle, said yeah you should go to the ER instead. We turned around went to ER. He got a bill for 150 Dr bill from urgent care "specialty consultation". To me that seems like BS.

[Davnasty]

I recently went to an appointment (which was scheduled by my surgeon) and when the surgeon saw me:

Surgeon: Why are you here?
Me: For my pre-op appointment (Which you scheduled)
Surgeon: Your last appointment was your pre-op
Me: So I didn't need to come in today?
Surgeon: Nope

So I left and the receptionists apologized saying there must have been a mix-up and there would be no co-pay. Pretty annoying that I had to take off work and drive there but hey, mistakes happen. Then I get a charge for the appointment a few days later. Just spoke to the billing department to explain the situation and she says technically I spoke to the surgeon so it has to be billed. FFS

Good news is she was actually helpful and is going to look into it and let me know if she can refund the co-pay portion. Not holding my breath but I am wondering like OP if I should just not pay.

[ATtiny85]

I recently went to an appointment (which was scheduled by my surgeon) and when the surgeon saw me:

Surgeon: Why are you here?
Me: For my pre-op appointment (Which you scheduled)
Surgeon: Your last appointment was your pre-op
Me: So I didn't need to come in today?
Surgeon: Nope

So I left and the receptionists apologized saying there must have been a mix-up and there would be no co-pay. Pretty annoying that I had to take off work and drive there but hey, mistakes happen. Then I get a charge for the appointment a few days later. Just spoke to the billing department to explain the situation and she says technically I spoke to the surgeon so it has to be billed. FFS

Good news is she was actually helpful and is going to look into it and let me know if she can refund the co-pay portion. Not holding my breath but I am wondering like OP if I should just not pay.

These sorts of stories are why I occasionally daydream of going to law school after retirement. Both to be able to handle my affairs and to help out friends. Might not do any good, but I think I would take pleasure in writing official, stern letters to places that slight me (or outright try to cheat me like the last couple posts.)

[bacchi]

I recently went to an appointment (which was scheduled by my surgeon) and when the surgeon saw me:

Surgeon: Why are you here?
Me: For my pre-op appointment (Which you scheduled)
Surgeon: Your last appointment was your pre-op
Me: So I didn't need to come in today?
Surgeon: Nope

So I left and the receptionists apologized saying there must have been a mix-up and there would be no co-pay. Pretty annoying that I had to take off work and drive there but hey, mistakes happen. Then I get a charge for the appointment a few days later. Just spoke to the billing department to explain the situation and she says technically I spoke to the surgeon so it has to be billed. FFS

Good news is she was actually helpful and is going to look into it and let me know if she can refund the co-pay portion. Not holding my breath but I am wondering like OP if I should just not pay.

These sorts of stories are why I occasionally daydream of going to law school after retirement. Both to be able to handle my affairs and to help out friends. Might not do any good, but I think I would take pleasure in writing official, stern letters to places that slight me (or outright try to cheat me like the last couple posts.)

I had an ER charge me for services that they didn't provide (like a back brace for stiches on the hand. wtf?). They refused to budge, insurance didn't care -- it was under the deductible and the end of the year -- so a lawyer was recruited. The hospital ran like a cat facing a large dog. A letter with legal letterhead, quoting some legalese, is a powerful force. It was free, too, as the lawyer was in the family.

[RedmondStash]

After a 20 year career in the healthcare industry (as a physician) I can say that that the lack of billing transparency in healthcare is an absolute shitshow.

We literally permit this in *no other industry*.  While I understand that an ER cannot accurately predict pricing up front as they have no idea what they will need to do and thus bill for, the remainder of the industry has no excuse.  There is no reason for there not to be a chart of prices immediately available to patients for services at facilities.  So if you need to have your knee replaced, your gallbladder removed etc, you should know up front what is the cost by a given doctor and facility. 

Just my 2cents.

I could not agree more.

I've called doctors' offices to ask how much an appointment will be, in case my insurance doesn't cover it, and *they won't tell me.* They say they can't tell me, because it depends on so many factors. Getting even an estimate or range is like pulling teeth.

I'm sure it's no more fun on the doctors' side. Seems like upper management of health insurance companies are the only ones who benefit from the current system.

[reeshau]

It's at a higher level, but it seems like a lot of hospitals are willfully dragging their feet in providing price transparency, even taking (relatively small) fines vs. clearing up compliance.

https://www.healthcarefinancenews.com/news/cms-steps-enforcement-and-fines-hospitals-non-compliance-transparency-rule

[Anon-E-Mouze]

Is there any chance that your healthcare plan includes a service with a name something like "Healthcare advocate"? When I worked in the US, my megacorp healthcare plan had such a service. Among other things, they had people who knew a lot about billing and would investigate and negotiate on your behalf with insurance companies and service providers.

I used that assistance once, with amazing results. I had surgery done on a quasi-emergent basis, with my doctor fitting me into his schedule at the end of a long day. I ended up staying overnight, even though the procedure was ordinarily set up for day surgery, because the procedure happened so late in the day and because my pain was hard to manage. Afterward, I started getting a cascading set of bills saying things like "Overnight stay - unnecessary", "Anaesthesia - unnecessary", etc. (It seemed like the first "unnecessary service" - the overnight stay for a day surgery procedure - triggered something in the billing system and almost everything else got classified as unnecessary.) I was facing a $45,000 bill for the portion not covered by insurance.

My health care advocate sorted it out, and my ultimate out of pocket cost was a reasonable $500 or so.

[Raenia]

Is there any chance that your healthcare plan includes a service with a name something like "Healthcare advocate"? When I worked in the US, my megacorp healthcare plan had such a service. Among other things, they had people who knew a lot about billing and would investigate and negotiate on your behalf with insurance companies and service providers.

I used that assistance once, with amazing results. I had surgery done on a quasi-emergent basis, with my doctor fitting me into his schedule at the end of a long day. I ended up staying overnight, even though the procedure was ordinarily set up for day surgery, because the procedure happened so late in the day and because my pain was hard to manage. Afterward, I started getting a cascading set of bills saying things like "Overnight stay - unnecessary", "Anaesthesia - unnecessary", etc. (It seemed like the first "unnecessary service" - the overnight stay for a day surgery procedure - triggered something in the billing system and almost everything else got classified as unnecessary.) I was facing a $45,000 bill for the portion not covered by insurance.

My health care advocate sorted it out, and my ultimate out of pocket cost was a reasonable $500 or so.

I had something like this during my pregnancy - an "OB Coordinator" was assigned to me after my first appointment, and she reviewed all the bills I received to verify they were coded correctly before we paid them.

[alohaKane]

Well I did. Got a notice from a specialist billing $575 after a year or so. Didn't respond to it then it went to "collections." 1st lawyer tried to collect, I responded with a generic template (confirmation of debt/ you can google search this). this gives them 30 days to respond. They will respond sending the itemized bill. Do nothing. then a 2nd lawyer will send a 'collection notice'. send the same response to this letter. i think you get it by now.

Anyway, its been a while now. i think the debt got sold 3x. I still didn't pay. So far, doesn't show anything on my credit and currently standing 820. lol then again, this depends if you want to take that risk.

[ohsnap]

I threw my back out a few months ago and went to Urgent Care.  My copay for Urgent Care is $75.  I paid that at the time of the visit.  Now I got a bill from the Dr. who saw me for a "specialist office visit".  This is not covered until I meet my deductible....

What type of plan do you have? (HMO/PPO/HSA ?)  I was at urgent care last week and paid $75, which is what they said was the copay. But I don't have a co-pay - I have a high deductible plan that pays nothing until I hit my deductible. I fully expect to be billed at least another $75 (seems like last time I was there, Anthem BCBS allowed over $150 for the visit, and I haven't hit my deductible. )