Why I have to pay out-of-pocket maximum up front??

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clarecy
clarecy Member Posts: 31
edited June 2014 in Employment, Insurance, and Other Financial Issues

I'm seeing doctor now in MSKCC, New York. After my first visit, my financial account is being held. The reason is that I have to pay the deductible ($350) and out-of-pocket maximum ($7500) up front. As a foreigner student, I really cannot understand why I have to do this.....Any advice.

BTW, the staff in financial department has really unfriendly attitude. They kept transferring my phone calls, and it has been nearly two week when I finanlly got informed of the real problem. They said the manager will call me this morning. NOPE!!!

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  • Chickadee
    Chickadee Member Posts: 4,467
    edited September 2013

    Really frustrating experience. You certainly dont need that added stress. Hopefully someone familiar with the billing practices will respond. The manager needs to help you understand their processes.



    I can only assume that they bill those fixed costs upfront.

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  • dogsandjogs
    dogsandjogs Member Posts: 1,907
    edited September 2013

    I have had to pay the $400 yearly deductible up front two times. Both times it was for expensive surgery - skin cancer and hip fracture; but what if you don't have it?

    I think it is very wrong for a provider to do this.

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  • Delilahbear
    Delilahbear Member Posts: 466
    edited September 2013

    I have had 2 reconstruction surgeries at a local hospital's same day surgery center and had to pay my upfront deductible each time. Today when I went in it was 3X my deductible. The receptionist didn't know why and said that someone had spoken with my husband yesterday about it. The thing with talking to him is that he doesn't understand anything about insurance as I take care of everything (he is not well enough to deal with it and truly doesn't want to). He did leave me a message on my cell phone that I needed to call surgery center yesterday but by the time I was able to check cell (can't have in lab at work), it was too late to call. Fortunately they only did charge the original amount.

    Of course the insurance has paid exactly "$0" for my July surgery and say they need more information.It can be frustrating as they need to assure they get paid something, thus the upfront charge, and then need to be reassured that the surgery is also reconstruction vs. cosmetic. You would think the insurance companies could see that I had BMX 4 years ago and multiple recon surgeries. The hoops they make you jump through on top of all the other crap is amazing. My theory is that at least they don't have to pay for chemo and radiation but maybe that would have made it easier to get these things covered. Guess we are lucky to have any insurance right now.

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  • edwards750
    edwards750 Member Posts: 3,761
    edited September 2013

    clarecy - that is absurd but what do you mean holding your financial account...as in not processing anything until you pay the deductible and the out of pocket maximum upfront? Never heard of that. Just so you know we have Blue Cross/Blue Shield of Tennessee. We have a $5k out of pocket maximum but I didnt have to pay our deductible or the out of pocket money upfront with the exception of the lumpectomy surgery and that was only $200. Not that that isnt a lot when you are facing what all of us are but given what others have been charged I got a bargain. I used doctors who are part of the network and they knew upfront what they could charge for the procedures. BC/BS just sent me the EOB(explanation of benefits) and what they were paying each doctor and procedure. After I amassed 5k in charges they started paying 100% which was a godsend because I can only imagine what my 33 Radiation treatments would have cost or what my Breast surgeon charged. I would not pay that without doing my homework. No excuse for them being rude so go over their head and talk to their supervisor. You dont have to put up with that at all. We all know the last thing we need is financial stress on top of everything else. Good luck. Diane

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  • susan_02143
    susan_02143 Member Posts: 7,209
    edited September 2013

    My doctor friend calls this the "wallet biopsy" and it is becoming more and more common, especially in ER's. Don't know what your options are. Things don't work this way in Massachusetts.

    *susan*

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  • clarecy
    clarecy Member Posts: 31
    edited September 2013

    Thank you all for your suggestions and sharing. I went to the hospital and finally paid all the money up front. It seems that I have no choice; otherwise I couldn't make any further appointment with doctors or have those medical tests (e.g. MRI). It seems that the hospital may worry that I will not pay for the amount of money I should be reponsible and want to have them up front. I still thinks it's unfair; I mean, I'm lucky to have those money at this time, but what if I don't? Then I have to wait for sth bad happen to me....

    BTW, I'm a foreign student, that might be the reason the hospital lacks trust on me.....

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