How can I negotiated the bill with the doctor

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dyin
dyin Member Posts: 2
edited June 2014 in Employment, Insurance, and Other Financial Issues
How can I negotiated the bill with the doctor
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  • dyin
    dyin Member Posts: 2
    edited April 2012

    I found out I have BC. My surgeon made me an appointment with the PS who is in the same office with her. I met with the man on the 1/24 and never saw the claim on the insurance website. I had UMX with TE on 2/15 with the BS and PS. On 2/17, I found the PS submited the bill on the 2/16 and he was a PS out of network for me. I never thought about he is a out of network doctor for me because he share the office with my BS, and their office took my insurance card the first time they met me.

    I talked to my BS about this and told her I was worried about the bill. She told me not to worry because the PS is out of network for everyone, so they will work out with me. She did mention normally they talk to the paient before the surgery about the payment. In my case, no one ever talk to me and they happen to submitted the 1/24 office visit bill one day after my surgery. I saw the PS a week later, he told me don't worry and he will match the innetwork doctor. I was so happy that time.  

    I have a nice PPO insurance. They cover 90% for innetwork and 70% for out of network doctor. And I have a annul max out of pocket cap $1000. With all the test I did before the surgery, I hit my cap already. This PS chargerd about $7000( insurance paid 1100 for this part) for surgery and another $7000(insurance paid 100 for this part) for as a asistant for my BS during her part. Last week, when I saw him and ask him about how much I should pay. He said he match the innetwork doctor, he ask me to pay 10% of the 14,000 which is $1400.

    I guess all of you know how insurance works. If it's innetwork , if the doctor ask for 3000, they cut down to 1000, then I will need to pay 10% of 1000 which is 100 in this case. I hit my cap already, that means I don't need to pay anthing right now. My BS got total about 1200 from the insurance, the PS got 1200 from the insurance too. I talk to the bill person and told them they never told me I will have such a big bill, and I could not afford it. The lady just keep on saying that she is sorry, she will talk to the doctor and never call me back.

     I was so angry about this PS, having a caner is very unlucky, how can he try to cheat money from a cancer paient. It's very easy to find a innetwork doctor for me, a much better doctor. The only reason I used him is because I like the BS that time, and they are partner. And I thought the first step is easy, just put the TE in, that's why I didn't think abut getting someone else.

     Tomorrow, I have a appointment with him. I will use the time to discuess the bill with him instead of my body. Anyone has any suggestion what should I do? 

    Thanks a lot.  

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  • Buttons2
    Buttons2 Member Posts: 72
    edited April 2012

    Unfortunately about the only thing you can do is appeal to the PS and see if he will cut back more money, also try asking if he/she has considered a contract?

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  • Chocolaterocks
    Chocolaterocks Member Posts: 364
    edited April 2012

    hi Dyin,

    Sorry you are in this position but I have been there and  have negotiated with them all. So  I would simply tell them the bill is asking for this  (1400) and you can pay:

    so much now per month 

    or pay blank at this time.

    Basically, most not all but most make a pretty good living by working by volume therefore they just want to get paid whatever they can.

     for ex my  $1500.00 bill I paid $1200.00 (ins said I should pay 1500)- I paid 1200 they took it.

    Think if it this way  you already had the surgery- what can they do to you or yes, try to ruin your credit.  So you  pay $10.00 per month and there is nothing they can do since you are paying... for 10 years .....

    hope this helps...

     

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  • dunesleeper
    dunesleeper Member Posts: 2,060
    edited May 2012

    Man! I don't even know what all these tests are. I was just looking at some EOBs and there were 2 where the insurance wouldn't pay anything for those tests because they were done out of network. I don't even know who sent what to this place. I think the place is in Arizona. I'm in Maryland. The lab is called MOLECULAR PROFILING INST. This bill is going to be over $2000.00. Has anyone else had a similar experience?

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  • itsjustme10
    itsjustme10 Member Posts: 796
    edited May 2012

    I have a stupid HMO, something I had never dealt with before, so every time I had to have a test or see a doctor, I was really paranoid about checking 1001 times that everything was in-network, as my plan doesn't cover out-of-network at all.

    The radiology group I had all my testing done at assured me everything would be fine.Well, a couple of months later, I get a $2 or $3,000 bill from some genetic dna lab that the radiology and pathology labs used to make sure they had the right samples.  I ended up calling these people, and they took my infor, and agreed that they would take whatever, if anything, my insurance paid.  Ultimately, I don't think they were paid, but they never billed me again..

     A few months after that, I get another bill in the same range, from a different testing lab - back on the phone to the radiology group, who had me call the pathology lab.  It turns out that the bill was from a company they sent my sample to, who had stopped accepting my insurance 3 days before my sample went there.  The pathologist ended up having me send them the bill, and I never heard from anyone again on that bill either.

    My point is - call whomever ordered the original test, and let them tell you who to speak to - stress to them that your contract was with them, to provide you with in-network benefits, and while you have no control over who they send things out to, since they are the ones making the selections, it's their rresponsibility to make sure they comply with the insurnace companies they have contracts with.  That you cannot be responsible for their error in sending your samples to the wrong labs  And that if they had to do that, it was their obligation to tell you before they did so, so that you could choose to use them or another in-network provider..  See what happens. It saved me about $6,000 out of my pocket just by making a couple of phone calls. :)

     Good luck!! :)

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  • dunesleeper
    dunesleeper Member Posts: 2,060
    edited May 2012

    Thanks itsjustme! I am still waiting for the actual bill to come. At this point I have no idea who sent bits of my body to this lab. When I get the bill, I hope to see the information I need to resolve this. Especially after reading your post, it does not make sense that everything else is covered and then there would be this strange lab showing up with such a large fee. I will definitely try to fight it.

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