ping
With the Federal Blue Cross/Blue Shield they tell you that you don’t have to pay the balance because they have paid the agreed amount when the doctor/dentist signed up with them.
Had some of the places try to collect, threaten a bill collector, and then I tell them to check with Federal BC/BS and give them the number and then call the local Federal BC/BS — their calls and letters stop.
They do it to my Mom all the time and I refuse to pay her bills like this but if I wasn’t handling it, I am sure she would pay.
We had one that threatened to ruin my Dad’s credit so he couldnt’ buy a car last year and he died in May ‘97. ou should have heard my comment to that remark. Believe they prey on senior citizens.
Last year I put too much eye cream on my eyes....they puffed up and I ended up going to emergency thinking I would get quartazone or something.....Emergency room wait 2 Hours....Bill was covered.....Seeing the doctor for 15 minutes telling me your eyes will heal themselves....$380.00....I ended up paying $75.00 because I have 2 coverages.....Oh and I’m still paying for the one night stay back in “06” and Hunterdon Medical Center for 1/2 of my thyroid being removed...the bill was $13,000....my balance $1,000......Unbelieveable......
It should be pointed out, however, that patients are only exempt from paying the balance IF the provider has signed a contract with the insurance company whereby he/she agrees to accept the insurance benefit as payment in full.
if the anesthesiologist was not a contracted provider of the health insurer, then the balance due is owed by the patient.
when having any kind of medical examination or procedure, the patient needs to verify that ALL of the participants in the procedure are contracted providers of the health insurer.
sometimes, the primary care physician is a contracted provider but the other members of team are not.
this puts an unreasonable burden on the patient who is not in a position to determine the status of all the providers.
IMHO
A co-worker had a similar problem with a dental group. She ended up getting a lot back once she figured out what they were doing. She had to get our insurance carrier involved.
If they do so, and they are prohibited from doing so by law, then they have just committed mail fraud. This gives you VERY good leverage to get them to back down.
In my state (New York) balance billing is legal as long as you do not participate in an insurance plan (Medicare excepted - see below).
For example, I see a patient in the office as an out-of network patient (i.e. I am not participating in their insurance plan). My bill is for $500.00. The insurance pays the patient $400.00 - what they “allow” for my services. Because the patient has the contract with the insurance company, not me, I legally bill for the balance of $100.00, and the patient is legally bound to pay it.
Now, if I participate with the patient’s insurance, I am legally bound to accept the insurance plan’s payment (of course, if there is a deductible or a co-pay, the patient must pay that).
Medicare is different inasmuch Medicare limits what a doctor can charge for a given service. So, of my usual $500.00 fee, Medicare my say that I can only charge $250.00 - so I write off the other $250.00. Of the $250.00 that Medicare allows, most plans pay 80% (unless the annual deductible has not yet been met). Medicare requires that I bill the patient for that 20% and any deductible, and the patient is bound to pay that, either out-of-pocket or by secondary insurance.
Moreover, Medicare requires that a patient sign a waiver at every time of service, indicating that if Medicare rejects a claim as being non-covered, that the patient will be responsible for the bill.
This applies to things like Travel consultations and immunizations - if I don’t get that waiver signed, I cannot legally bill the patient for the consultation, and any vaccines administered (yellow fever, typhoid, polio, hepatitis A, etc), even though I have provided the service in good faith.
Medicare rules apply to all beneficiaries, no matter their income - the pensioner on a fixed income pays the same as the retired CEO with 5 homes and 4 cars.
thank you for posting this thread. I had never heard of the practice before..... I have heard of billing patients prior to billing the insurance company though. I heard that was a big no no too.
The above case I don’t know why the woman didn’t just call her insurer, they would have explained it and told her whether she owed anything or not.
This whole credit rating thing is nothing but a 21st Century Mafia scam, intimidation and extortion scheme. Live frugally, eliminate your debt and tell them to stick it where the sun doesn’t shine.
My cousin a GP in New Mexico says that ‘balance billing’ is simply charging the difference between the paltry amounts insurance or medicaid pays and the ACTUAL charge. She gets about $47/hr medicaid — compared to her plumber who gets $100 (cash with no paper work or office staff)!
$6500
My health insurance provider actually sent me a letter advising me not to pay any additional invoices.
I would love to be able to demand an itemized bill from that hospital, just like I can from that $100-an-hour plumber.
Illegals don't have to deal with any of this, by the way, and they use emergency rooms as the family doctor. The word gets around. If it works, why not?
I do know that I have paid income taxes for 46 years, and "welfare" of all kinds are included already. I don't really feel guilty about not paying another $6000 "contribution" on a $500 visit.