Paid total due, then they say the price is something else months later.

[Seaglass]

California

In August 2005, I started to go to therapy appointments with Kaiser. I went to about 10 visits. I was told the appointments had to be paid in full at each visit because I hadn't met my high deductible. The cost was $95 per visit. Each bill I received in this office was for $95 and it showed the previous balance due of 0. Each visit I paid $95.

Now, January 2006. Kaiser is coming to me saying that each visit was $140 per visit and they are claiming that I owe them an additional $45 for each visit I had. They claim to send me to a collection agency if I don't pay.

However I know that what they are doing is illegal. They cannot charge me one price and then come back later and say the cost was something else. If the price is indeed $140 and they made a big goof, that is not my problem. Had I been given the proper information in the beginning that the cost was $140 per visit no way in heck would I have continued with Kaiser. I would have gone to the private practive therapist outside my door who charges $85.

Any advice or legal terminology that allows me to quiet them down and dismiss their claims would be appreciated. Or any advice on best course of action. I have filed a "greivance" and thus far I have been denied.

I still have all the reciepts from my visits with the bill indicating $95 due, $95 paid. 0 Balance due now. 0 previous balance.

 

[cbg]

On what basis have they claimed that the price should have been $140?

 

[Seaglass]

They say that the normal rate was always $140.. but that the rate they had me pay was only an estimate (no where on any of the invoices or bills is the $95 mentioned to be an estimate). I am not sure why the appointments were more, I am not on any medication, nor do I have a psychological disorder..etc. Just normal problems to work out.

 

[cbg]

If I were in your shoes the first thing I'd do would be call the state insurance commission and see what they say. I'd probably be calling a lawyer after that.

 

[averad]

Is your deductible higher then $950? Are you currently covered under a Kaiser HMO* or PPO** policy? Is this a personal policy or supplied through your employer (group coverage)?

*HMO - Health Maintenance Organization. Members is locked into a specific doctor network. (I.E members can only go to Kaiser facilities)

**PPO - Preferred Provider Organization. Members have the option to go to any doctor. If a member goes to a non contracted (non ppo) doctor a lesser benefit may be paid.

 

[Seaglass]

I am HMO Kaiser plan. This is individual insurance coverage with a deductible of $1500. The therapist I saw was with Kaiser. They billed me $95 per visit before seeing the therapist. All invoices say paid in full. I called the medical offices facility for the therapy in this Kaiser facility which is not in the hospital. The manager of this facility called back and confirmed that I had paid all full amounts due and that I owed no money. The billing administration has "changed" the price.

Apparently all the people I talked to said that Kaiser has a clause in the health insurance contract that says all prices are "estimates" and Kaiser may reevaluate and bill the patient more if they feel necessary!

I could understand if this was a medical procedure with ambulance, x-rays, tests, scans and surgery etc, but this is a bloody therapy appt with a "fixed" rate.

I can't beleive a clause like this could be legal. Good suggestion about the state commission. I will look into this.