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!
A long $53.75 rant about doctors!
January 13th, 2009 at 04:01 am
January 13th, 2009 at 04:13 am 1231820001
January 13th, 2009 at 05:08 am 1231823334
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!
January 13th, 2009 at 01:19 pm 1231852790
January 13th, 2009 at 03:42 pm 1231861370
January 14th, 2009 at 02:38 am 1231900685
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!