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Home > A long $53.75 rant about doctors!
 

A long $53.75 rant about doctors!

January 12th, 2009 at 08:01 pm

OK, I rarely post two times in one day, but I couldn't wait until tomorrow to vent about my experiences with the people who manage doctor offices! Apologies for the long post.

My obgyn insists that she sees me twice per year for a checkup because I'm on birth control pills. No medical history / age / other reason. If you're on the pill, you come twice a year. She only writes the RX for the pills out for 6 months at a time to insist you come back.

So I went in June, no problem. When I went in December, they charged me a $20 copay. I didn't think much about it at the time, because I never really paid much attention to these things (boy is that changing!).

The receipt the office gave me clearly checked off the box for routine exam. At some point it dawned on me that preventative exams should be covered 100%, so I called the insurance company for clarification. According the the electronic file the doctor's office submitted to them, it wasn't a routine office visit, it was an office visit for menstrual cramps, and as such a copay was warranted.

So I called up the office and they explained that the insurance company only covers 1 preventative office visit per year, so by charging it this way, I only have to pay the copay instead of the whole bill, so it's actually better for me.

Hello, can you say insurance fraud?! The reason that the insurance company only pays for one preventative is because that's all that's needed. She shouldn't be seeing me 2x/year without some overriding medical reason. And if she insists, she should be up front about it, and let me decide if I want to see her the 2nd time at full price or change doctors.

So I spent a good deal of time ranting about this to my extended family and they basically said, small potatoes, insurance companies will never pursue this kind of fraud, and it's probably an isolated incident.

Fast forward to late December, I went to the dentist for a root canal. Office manager told me that they charge $1275 and my insurance will pick up 75%, so I owe them $318.75. Sounded right to me, so I paid it. Now that I'm comparing my old and new plans to see my savings, I pulled up this claim. Turns out, the insurance company paid them 75% of the AGREED UPON RATE OF $910!! So $910 minus my $50 deductible = $840 * 75%. They were reimbursed $645 and they should have charged me $265. That's a difference of $53.75!

I called Met Life and was told that the doctor may wait until they get reimbursed to make the adjustment, and that the check was mailed to them on 1/6, so they may not have it yet. Maybe I'm cynical, but I have a hard time believing that they will call me up next week to credit me for the difference.

You can bet I'm going to call them first thing tomorrow, at which point they'll likely credit me promptly. But how many other people don't bother or don't realize that they should be checking this stuff? It disturbs me that I have to spend time checking to make sure others don't make mistakes / rip me off. At the same time, I can't afford to let $53 go to them instead of me. Ugh!

5 Responses to “A long $53.75 rant about doctors!”

  1. crazyliblady Says:

    My gp doctor did the same kind of thing to me. I don't take birth control and don't need to see the doc 2 x per year. But, when I went in for the yearly exam, the nurse asked me how well I sleep. I told her that truthfully, I sleep fitfully and have all of my life. The doctor did not even ask me about it, prescribe medication, or even suggest not drinking caffeine. I had forgotten that yearly exams are covered 100% and did not even blink when they asked for my co-pay of $20.00. Later, they sent me a bill for $12.00. When I remember about the 100% coverage, I contacted them and the insurance company. They claimed it was billed that way because I had a "sleep disorder." I made a complaint to the insurance department within my state government who agreed with me that this is nonsense, but they did not bother to get my money back. I finally gave up, but I will not go back to that doctor again. I find it be absolutely shameful that you can't even mention a simple problem without being charged for it. I can understand being charged if I said it was bothering me and I wanted to do something about it.

  2. pearlieq Says:

    That's nuts! My GP and OB/GYN will both happily write out a full year script for the pill. I can't think of any reason why a normal, healthy woman would need 6 month checkups.

    Even if they wanted to monitor your blood pressure, that can be done via a quick (and often free for regular patients) nurse visit.

    How frustrating!

  3. ladymiller Says:

    Perhaps it's time for a new doctor???? I am glad you mentioned these incidents about the "over charges" by the doctor's offices. I will be on the lookout when I go to the doctor andf make sure I am charged correctly.

  4. Petunia Says:

    Having insurance produces some interesting results with doctors, doesn't it? I've run into my share of this irritating stuff with doctor's offices. . . getting it straightened out has a pretty high hassle factor. Good luck.

  5. frugaltexan75 Says:

    I hope you have an easy time getting the money refunded to you.

    Last year when I had a root canal, I had a *terrible* time getting my money refunded to me. I knew up front that I was going to have to pay the full cost, and that once the insurance paid them I'd get the leftover amount back. But the runaround I got drove me nuts! Hopefully I'll not have another root canal, but if I do, THIS is one place I will not return to!

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