Price of fills?

WOW!  I'm not liking this at all. I do have insurance thru my union BCBS ppo. We have specific coverage, only 70% for WLS. They do pay for fills but at 70%. So I get billed from my surgeon and was ok with my cost, like 140.00. Then to my surprise I get a bill from the facility for 281.00. My insurance paid them 675.00. Of course I call them and totally went off. I asked what do the peeps with out insurance pay, WELL they pay 250.00
That's the surgeon and facility charge combined. WTF!! So I am being penalized for having insurance.
Why do I have to pay almost twice as much out of my pocket and they already pocketed 675 from my insurance. Well guess who's not getting paid. This is why our insurance premiums are so high. Doctors and hospitals are cleaning up big time on insurance and they pay it and we consumers/patients aren't stepping up to do something about these outrageous costs. Then they wonder why people aren't paying their bills.

 My insurance has Pre Approved the Surgery and fill treatments at 100%. But when I went to the consultation with Dr T.Simpson This month I was advised by his Office Manager Greg that I would have to pay $1250.00. for his aftercare books, pen, waterbottle, newsletter ect.  Let me include  I had to pay $ 3800  Out of Pocket before the insurance would approve and too pay at 100% for a In-Network Provider.  I am on a monthly disability income. and can not afford to pay any extra bills each month. I asked them to please wave this non-medical expense, "Greg" the Office manager; said he would ask the dcctor but the Dr will not schedule the proceedure with out this being paid. Gregg said he would call back if he would waive the 1250.  He never called.  I Call this "EXTORTION" you have an obese person who has jumped though hoops, paid insurance and medical bills to get this taken care of 100%. Then when asked the front office if there were any charges not covered by ins. was told no, then asked Doctor if any charges or services not covered was told no, then when set down to schedule with "the closer"   out comes the "Pay $1250 pay or you can't have this....... I felt cheated and lied to. Called my insurance company because I thought this was Unethical. BCBS said no Doctor Simpson can ask you to pay anything he wants that doesnt have to do with medical services. Its his business and I can choose not to pay and he can deny me my surgery... I wanted the Best Doctor in town But he comes at a extra price. One price I can't afford. A price I could pay if I could go back to work. I could go back to work if I lost all the wieght.. Can't pay can't lose the wieght. Catch 22.....
 

Thats horrible, run away now.

That sound totally immoral to me.  Hospitals making a big profit out of insurers who pass the cost on to ordinary people. Making money out of people's misfortune and at the same time making sure they get their own profit.

Not saying our NHS is perfect, but at least it is ethical and non-profit making!

And your example is particularly bad. I now get my fills etc free on the NHS but when i was first banded, I was self-pay and my doc charged me the full rate for fills - about $100 each! Don't remember the cost of living in the US being 6X the cost of living in the UK!!

Kate

On March 22, 2011 at 2:46 AM Pacific Time, kate P wrote:
That sound totally immoral to me.  Hospitals making a big profit out of insurers who pass the cost on to ordinary people. Making money out of people's misfortune and at the same time making sure they get their own profit.

Not saying our NHS is perfect, but at least it is ethical and non-profit making!

And your example is particularly bad. I now get my fills etc free on the NHS but when i was first banded, I was self-pay and my doc charged me the full rate for fills - about $100 each! Don't remember the cost of living in the US being 6X the cost of living in the UK!!

Kate
  The cost of living isn't 6x higher...but the cost of medical care often is!  It's enough to make you nuts.

I dont have insurance and because of that my doc only charges me 75 bucks per fill to get one .  If you have insurance its only 120 so he gives me a little discount to help matters .

My son had allergy testing done well since I dont have insurance they billed me like 1200 bucks well I saw the paper and if I had insurance they was going to bill them at  2200 bucks !!

I asked the doc if you bill me 1200 why cant you do that for insurance then ? He said they will pay that amount so that is why we bill it *sigh*.

Like you said no wonder people cant afford insurance because of people doing things like this . Its awful and so wrong .

That stinks!

I feel fortunate.  I either pay $15 if I see the PA or $40 if I see the surgeon when I have an appt. and a fill if I want it.

Jean:

Having working in HR benefits, my question to you is; when you get your statement from the insurance company saying what they paid, is there a section that says usual and customary fee and have a section that says, "you are not responsible for this portion?" Just wondering because I had BCBS of Missouri and that is what the form that I receive from the insurance company says on it.

Is it possible the facility is no longer in your insurance plan so you are paying out of network price? Just trying to help figure out why they are racking you over the coals!

Having been thru the ringer with medical bills, I can tell you that sending them $10 a month is fine. Unless they are making you pay up front for them. Then that won't help much!

Hopefully you can figure something out!

Pam

Oh yeah, I have the EOB from 2-17 fill from the surgery center. Their submitted charge was 3099.27 then the ppo discount brought it down to 939.08, so my  co insurance responsibility is 281.72.
Now the Dr. bills a seperate fee of 500 for the adjustment and 200 for radiology then my PPO discount brought it down to 438.00 so I have to pay 138.40 to the surgeon.

I would be fine paying the 138.40 but add the 281.72 thats 420.12.
ONE HUNDRED SEVENTY MORE THAN SELF PAYERS, AND THEY ( the surgery center) ALREADY GOT 657.36 from my insurance.

Is it just this way at the moment because you have not reached your deductible for the year? I have an 800 deductible so until I reach that I have out of pocket expenses.

But usually the insurance has a negotiated fee with the hospital and doctor and they have to accept that fee and not be able to rake you over the coals with your part of the bill.