I went to a podiatrist in 2013 to have an ingrown toe nail cut out. It was $30 for my copay, and insurance paid the rest. According to my explanation of benefits they paid $125.
Then my insurance changed multiple times with the new legislation. It seemed like they were changing it every few weeks and giving me a new insurance card and a new packet of documents. It happened about 4 times, and was really frustrating. I didn't read the entire thing over, it seemed pretty much the same.
I went back in 2014 for the same procedure and I assumed my insurance still covered it (I know, I already face punched myself for assuming this and not checking on it). Turns out the podiatrist got reclassified as a "specialist" which is no longer fully covered. Insurance will cover 80% of the bill after my $1,000 deductible is met - I was unaware of this at the time. So I went in, told the dr I what I needed, specifically asked him not to cut the corner of the nail off to give me temporary relief (I had already done this at home - I still needed the surgery to permanently correct it or else I was going to have problems in the coming weeks) and he went ahead and did it anyway and scheduled the actual surgery for the following week. I came back for the surgery, and later for 2 more follow up appointments.
Then I got the bills. $112.36 for the initial visit, and each of the 2 follow ups, and $307.88 for the actual procedure. I called to question them, but was not satisfied. I explained that i'm aware I am responsible for the bills instead my insurance company because of the reclassification, and not having paid anything towards my deductible, but my issues were:
1. Why are my charges 500% more than what the insurance provider paid last time?
2. Why are follow up visits not included in the price of the procedure? (I have never encountered this for any procedure my family or I have gone in for - and in fact when I had the procedure done in 2013 my explanation of benefits listed only a single charge)
3. Why I was being charged so much for such minimal effort on the doctors part. The procedure took less than 20 minutes of the doctors time (I did wait approximately 20 minutes for the toe to numb before he came back to do the actual procedure), and each follow up visit was less than 2 minutes of actual doctor time (not an exaggeration. He came in, scraped at it with a metal instrument, put a band aid on, and said to schedule another follow up. The next was the exact same except he said it was good - no follow up. LITERALLY less than 2 minutes). The initial visit was closer to 5 minutes of the doctors time.
I was told that the insurance company paid substantially more than $125 last time, and she rattled off several large charges totaling around $600. I explained that I was looking at my explanation of benefits and it clearly listed a single payment of $125, and she said it was wrong she was looking at multiple payments totaling closer to $600. If they received payments, why was it not listed on my explanation of benefits? Also, why would my explanation of benefits list a weird round number like $125 when none of the charges were even close to that value? I am still confused by the whole situation.
I was not really given satisfactory answers for my other questions either, which I fully expected. I was still cordial with the lady even though I was frustrated. She explained that they always make sure to run someone's insurance card to ensure that they are covered before they do any procedures, so I had some follow up questions for her:
1. Are you able to see exactly what (and how much) is covered when you checked my insurance (ie what i'm personally going to be responsible for)? If the procedure is less than $1000, and my deductible is $1000, then what does it even mean that I am "covered" by insurance? I always though running the insurance was a "cover your ass" policy for them, so they don't provide service to a dead beat without insurance. But in my case it didn't cover their ass at all because I am liable for 100% of the charges. She didn't have an answer, and i'm not sure if that question is better directed at my insurance provider than the doctors office.
2. I settled my bill (or so I thought, it was only for 3 of the 4 charges) several months ago during my last follow up. Why am I just getting another bill several months later? She said it was sent to insurance and just got kicked back to them this week. I'm unsure why they would directly charge me for 3 of the bills on my last visit (presumably after the insurance instructed them to bill me because my deductible was not met and they were covering 0% of the cost), but then send the 4th to my insurance provider (knowing damn well insurance wasn't going to cover it since they were currently billing me for 3 of the visits).
Had I been fully aware of the charges it would have influenced my decision and I would have gone to a regular physician. My own fault for being ignorant of exactly what my insurance covered, but I am still outraged at the prices and the way it went down. Oh well, live and learn.