Unfair Charges for Medical Service??

[hsa1]

What is the name of your state (only U.S. law)? TX

* My Dr. presribed a sleep study
* I was contacted by the firm that conducts the study and was told my insurance would pay for the study in full (verbal only), I was not given a written quote only a verbal explanation
* The information packet stated the fee for the service would be due at the time of service. There was no charge at the time of the study.
* ~ 1 month later I started receiving a bill for the sleep study for $2700.
* When I contacted the firm, they stated that since I have an HSA account and I had not reached my deductible, that this is the amount I owe. If I would have reached my deductible, then the amount would have been covered in full by the insurance company. This was the first that I heard this from the firm.
* If I would have known that the cost was going to be $2700, I would have requested a second opinion
* I did find that the information packet does have a FAQ that states I should contact my insurance company to find out about charges

Do I have any recourse, or should I just pay the bill?What is the name of your state (only U.S. law)?

[You Are Guilty]

Your bad for not contacting your own insurance company first to inquire. You can't rely on the word of someone else to tell you your benefits.

That said, you may be able to negotiate with the facility to get charged a lower rate based on the fact that insurance isn't covering the bill. Never hurts to ask.

[cbg]

The firm that does the study is not the one who manages your insurance benefits. They have nothing whatsoever to lose by telling you that your insurance will cover it, whether it does or not, because once you have the service you are legally obligated to pay the bill regardless of what your insurance says. And how would they know anyway? Why would THEY have a copy of YOUR insurance policy to review?

Pay the bill and next time, confirm for YOURSELF what your insurance will cover.

[Zigner]

And, to be clear: Your insurance DID cover this. They covered it per the terms of your plan, which happens to have a deductible.

[hsa1]

I agree I should have contacted my insurance company prior to the service; however, the patient coordinator at the company (who I was told was going to check with my insurance) told me she contacted the insurance and that it would be covered 100%. What she failed to realize is that it only covers 100% once the deductible has been met. I asked her on several occations what the charges would be and she said it was covered 100%.

I am new to having an HSA account, so having to check with the insurance on stuff is new for me, but in the future I will definitely do so.

I contacted the insurance company after the service, once I recieved the bill, and they told me that they discussed the charges with the coordinator on a date prior to when I talked with the coordinator, and the insurance company told that person what the charges would be. So my complaint, is that they knew teh charges were going to be more than $0, but on several occations including at the time of the study I was told it was going to be $0.

Going from $0 to $2700 is a big estimate mistake in my opinion.

[xylene]

Originally Posted by hsa1

Going from $0 to $2700 is a big estimate mistake in my opinion.

Sadly, the medical and insurance industry does not care about your opinion of what is 'just' and neither will most of the posters here who are insiders of those industries.

They are right however - you have no recourse.

Vote for nationalized healthcare, it is really the only way.

[cbg]

Except that it is not their job to get you an estimate at all. It is YOUR responsibility to find out what your insurance will cover.

[Zigner]

Originally Posted by hsa1

I agree I should have contacted my insurance company prior to the service; however, the patient coordinator at the company (who I was told was going to check with my insurance) told me she contacted the insurance and that it would be covered 100%. What she failed to realize is that it only covers 100% once the deductible has been met. I asked her on several occations what the charges would be and she said it was covered 100%.

I am new to having an HSA account, so having to check with the insurance on stuff is new for me, but in the future I will definitely do so.

I contacted the insurance company after the service, once I recieved the bill, and they told me that they discussed the charges with the coordinator on a date prior to when I talked with the coordinator, and the insurance company told that person what the charges would be. So my complaint, is that they knew teh charges were going to be more than $0, but on several occations including at the time of the study I was told it was going to be $0.

Going from $0 to $2700 is a big estimate mistake in my opinion.

Um, no. The insurance company advised what they would pay. The person on the phone doesn't know how much of your deductible is remaining. That's YOUR job.

So, to sum it up, the medical office called the insurance and said "We've got $2,700 worth of service xyz, will it be covered". The insurance company replied "Yes, 100%". The confusion on the deductible is YOUR fault.

[hsa1]

I don't agree that the company is free of fault. The explanation of benefits and charges was not clear and should have been in written form. According to the information packet I received it states that the patient coordinator will contact me and "provide and explanation of benefits". This was done verbally and again I asked several times,"how much will I have to pay" and the answer was $0 becuase the insurance is covering the service. To me that is a misleading statement. There was no discussion of whether the deductible had been met or not. I signed a forma the time of service that stated the charges were $0, so again my understanding was that the services were covered by the insurance.


To say that the coordinator did not know how much of my deductible had been met and that he/she did not know that the charges were going to be greater than $0 is not a true statement. I know for a fact that the patient coordinator did know how much of my deductibel had been met at the time because my insurance company told me that they disclosed this information to the company so that they could provide an estimate of the cost.

So again, I realize my mistake, but it seems that the coordinator could have done a better job of explaining the benefits to me since that is her role and responsibility according to the company process documents.

[lealea1005]

What makes you so sure the insurance company rep was being truthful? It's certainly not unheard of them giving providers the wrong information.

The provider called the insurance company and was told the service was covered at 100% (of the reasonable and customary, no doubt)....and it was covered....and applied to your HSA deductible. Isn't the $$$ in your HSA to be dispersed?

As stated several times already...YOU are ultimately responsible for knowing the specifics of your insurance plan. You must accept some responsibility for not thoroughly reading, and understanding how your HSA works. It's always best to call the insurance company yourself.

[Zigner]

Originally Posted by hsa1

I don't agree that the company is free of fault. The explanation of benefits and charges was not clear and should have been in written form. According to the information packet I received it states that the patient coordinator will contact me and "provide and explanation of benefits". This was done verbally and again I asked several times,"how much will I have to pay" and the answer was $0 becuase the insurance is covering the service. To me that is a misleading statement. There was no discussion of whether the deductible had been met or not. I signed a forma the time of service that stated the charges were $0, so again my understanding was that the services were covered by the insurance.


To say that the coordinator did not know how much of my deductible had been met and that he/she did not know that the charges were going to be greater than $0 is not a true statement. I know for a fact that the patient coordinator did know how much of my deductibel had been met at the time because my insurance company told me that they disclosed this information to the company so that they could provide an estimate of the cost.

So again, I realize my mistake, but it seems that the coordinator could have done a better job of explaining the benefits to me since that is her role and responsibility according to the company process documents.

Well, you've been told the reality. I'm sorry that your opinion differs.

[hsa1]

How is the patient supposed to know what information to request from the insurance company?? For instance, there are codes and terminology that I am sure that the patient coordinator and the insurance agent will know that the lay person will not. This information was not provided to me.

Also,
Why is the medical/insurance industry different than another service industry such as auto repair, home repair service, or any contractor type of service where a quote or estimate is provided. Typically these service companies provide a quote or estimate for a service of which the consumer can then choose which company to go with or use the information to make an informed decision whether to go through with the work or not. Ususally this estimate is close to the final charges or if there is a drastic change the consumer is notified prior to the work being completed. In the case of this medical service company the estimate was $ 2700 different than the estimate they provided and I did not have a choice as to return or not do the service. Couldn't they have told me the amount they were going to charge the insurance company as a maximum amount that I may have to pay depending on my deductible? It just seems logical that they should have provided as much information as possible so that the customer can make an informed decision. If that is not the case, why even have a patient coordinator, it sounds like they really are not responsible for providing the patient with the correct information.

To the person that asked about dispensing the funds from my HSA, those funds are my personal money to be used for what I choose. These are funds that come out of my paycheck, they are not just magical funds that show up. I can either choose to use the funds or I can keep them to to use on other services of my choice. To me that is the point of an HSA, that is to be able to make better choices about the medical services we recieve and not just think that big brother will be the provider for all.

That is my last comment and I'll shut up. Thanks for the feedback to all those that replied.

[Zigner]

Originally Posted by hsa1

In the case of this medical service company the estimate was $ 2700 different than the estimate they provided

They didn't provide you an out-of-pocket estimate. They provided an estimate of what your insurance would cover. Your insurance DID cover the procedure at 100%. However, you are obligated to meet your deductible. That is not a matter between you and the medical provider. That is a matter between you and your insurance company.

[cbg]

Except that you're expecting Big Brother (in another sense of the term) to take all the responsibility and lead you by the hand and get all the information and do all the work for you, and all you have to do is sit back and let them do it. And when it doesn't work that way, you absolve yourself of all responsibility because they were supposed to have all the answers and you shouldn't have to pay anything because after all, THEY SAID.

It's time to grow up and live in the real world for a while. In the real world this was YOUR responsibility, not theirs. YOU did not take the responsibility to find out what was payable, and YOU are responsible for paying the balance of the bill.

This is the legal answer and it isn't going to change because of your opinion that someone else should have gotten you better information.

[hsa1]

cbg,
What are patient coordinators for? The description is that these are the personel that are to provide an explanation of insurance benefits and out of pocket expenses. However, your making it sound like they have no accountability in ensuring that the information they provide is correct and they don't have a responsibility in explaining or helping the customer in understanding the insurance benefits.

If that is the case, then what are they there for?

I am not obsolving my responsibility and I do think I need to pay for services. But if I knew from the beginning it was going to cost me out of pocket $2700 I WOULD NOT HAVE DONE IT and we would not be having this discussion. I do feel that it is the responsibility of the coordinator to ensure the information the are providing is correct and if they are not going to do so, then they need not be in the loop. I was told my OUT OF POCKET EXPENSES WOULD BE $0, and IT WAS NOT. That information was INCORRECT. Why does the company not have any responsibility in explaining to the customer what the charges will be and how he/she will be billed? Are we supposed to double and triple check everyones responsibilites and work? That makes no sense to me.

I don't think the coordinator withheld information intentionally, the companies whole process of explaining benefits and costs is terrible. If other companies were run that way, they would not be in business very long.