Shocking surprise medical bill copay is 378% more than estimated.

[Startech]

I have cancer and am on Medicare. I qualified for a F-18 Axumin Scan which was pre-approved by Medicare. I also qualified for a clinical trial F-18 Axumin Scan in Bethesda, VA which included travel, lodging and a food allowance at no cost to me. I went to the local cancer center to get an estimate of my copay on Medicare to decide where to have the scan done. I was a little disappointed that my estimated copay here in San Antonio, TX was so low because I also wanted to spend about 3 days vacation in Washington DC while doing the trial. Alas, I decided to support the local cancer center and spend the $292.72 to have the scan done here. I paid the estimated $292.72 at the time of the scan. The following month, I received a statement from the local cancer center stating that I had a balance of $811.80. I called to inquire about the huge balance and was told that was my 20% responsibility according to Medicare. They gave no explanation for the low estimate.

If I had been quoted $1104.52, I would have gone to DC. This is not a case of balance billing because I was not out of network. This cancer center accepts Medicare assignment and nothing extra or unforeseen was done. I explained this to them and it took until yesterday for them to get back with me with the Radiology Department Managers decision. She maintains that I still owe the $811.80 and would be sent to collections if not paid promptly.

What are my options? Thank you.

 

[adjusterjack]

Pay it. You're not going to win this. Never trust anything you are told about medical bills in advance. The person you talk to on the phone likely has nothing to do with the actual billing after the fact as the billing is done by third party billing companies that don't give a crap what you were told before you got the procedure done.

I had a similar issue some years ago. I called around on the cost of a procedure. I got told by the providers to call my insurance. I got told by insurance to call the providers. I finally was able to piece together the costs. After the procedure I got the bill and it cost me a lot more than expected. Trying to get an explanation was like talking to a wall.

 

[ajkroy]

Normally I would agree, except Medicare is the one exception. Medicare publishes all of their fees every year, so everyone involved can know upfront how much something will be.

Call the office again and ask for the CPT/HCPCS codes used to bill Medicare. From there, you should be able to just input those/that code into Google and see how much Medicare pays for it and can figure out 20% from there. If it not accurate, make an appointment with the office manager and ask that person to explain it to you. If you have anyone who is an advocate for the elderly in your town who can go with you, ask that person to attend. Even a phone call with an advocate in advance would be helpful.

Finally, if you can prove that it would be a hardship for you to pay that amount, Medicare has a reduction process.

Good luck.

 

[Startech]

Thank you both for your replies. Jack, sorry you went through that. But, I'm not gonna just pay it. I based my decision on their estimate. Evidently this is a national issue and it won't improve just by paying them. I can afford to pay, but I'm taking a stand.

I have no issue with the Medicare adjusted price and agree that their estimate should have been more accurate. Maybe no laws broken, but this is negligent and I'm going to demand an explanation. I am thinking maybe contacting the consumer department of some local news stations

 

[Just Blue]

Thank you both for your replies. Jack, sorry you went through that. But, I'm not gonna just pay it. I based my decision on their estimate. Evidently this is a national issue and it won't improve just by paying them. I can afford to pay, but I'm taking a stand.

I have no issue with the Medicare adjusted price and agree that their estimate should have been more accurate. Maybe no laws broken, but this is negligent and I'm going to demand an explanation. I am thinking maybe contacting the consumer department of some local news stations

Ajkroy gave you excellent advice in post 3. I suggest you follow it.

 

[Zigner]

Thank you both for your replies. Jack, sorry you went through that. But, I'm not gonna just pay it. I based my decision on their estimate. Evidently this is a national issue and it won't improve just by paying them. I can afford to pay, but I'm taking a stand.

You are choosing the wrong thing to take a stand on. An estimate, by definition, is not the actual amount you need to pay. It is an estimate, with the final amount being determined by your coverage.

I have no issue with the Medicare adjusted price and agree that their estimate should have been more accurate. Maybe no laws broken, but this is negligent and I'm going to demand an explanation. I am thinking maybe contacting the consumer department of some local news stations

Have at it.

 

[Startech]

Just got a phone call from the director of Radiology. She was very apologetic and agreed to honor the original quote. They are writing off the balance.

 

[Zigner]

Just got a phone call from the director of Radiology. She was very apologetic and agreed to honor the original quote. They are writing off the balance.

Congratulations on the successful outcome. Communication is a great tool!

 

[LdiJ]

Just got a phone call from the director of Radiology. She was very apologetic and agreed to honor the original quote. They are writing off the balance.

Congrats. I was able to successfully do the same thing myself. I am glad it worked for you.