I switched jobs and moved to a new area. New insurance, new provider, etc. Went in for my first checkup, had bloodwork done, went over some ongoing health issues. Pretty normal office visit. I recieved the bill today and it is about 2x what I expected it to be, even after the insurance deduction. The bill was right around $1200. Insurance adjustments for the allowable rate only brought it down to about $1050. My portion was right around half of that, which on the surface doesn't seem that bad.

However, I dug up one of my old bills from my previous provider and insurance and found that the insurance adjustment was much larger. On my previous provider/insurance an identical visit was $1500, insurance adjustments for allowable billing brought it down to $500 and I payed about half of that.

I moved from a more expensive healthcare market and was going to a higher tier provider into a cheaper market and going to a larger middle rated provider. Deductables are the same for both plans. I would have expected a large decrease in cost. But it appears that my current health insurance did a horrible very poor job negotiating their allowable rates with their providers. Either that or the insurance I had before was the gold standard of awesomeness and completely atypical.

Is there anything I can do about this? Negotiate directly with the Hospital/clinic? I have bills from other providers and know what they should be charging for their services, so I know I am getting a poor deal. There isn't anything abnormal on the bill, everything is straight forward and there are no odd line items.

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C(-)ris
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Edited 1 time(s). Last edit at 02/05/2015 09:39PM by C(-)ris.

I don't have any practical advice, sorry. good luck.

One story though: My father in law from Romania visited, broke his foot. his tourist medical insurance only paid for emergencies. So we went to ER first. They took X-rays and put a cast and refereed to an orthopedist. Next day we went to an orthopedist who looked at X-rays and took cast off and gave him a special shoe ($$$).

orthopedist bill was $300-ist, X-ray was something (don't recall) and hospital/ER bill was $1500, but because he didn't have "insurance" they reduced it to $400 (that's how we received the bill). His tourist insurance from Romania paid all these bills (we were pleasantly surprised). We paid all bills. all was fair and square.

then about a year later we get a check from hospital, $400 refund, with a latter saying that they didn't really expect payment for that bill, and were offering a refund. We still don't understand why they did that.

now sure how this is gonna help you, but I wish you good luck

Have you received an Explanation of Benefits (EOB) statement yet from your insurer? That should outline what the allowable charges are and list what your responsibility is. It will also list what amounts are being charged to you as copays and what are going to your deductible if there is one for your insurance policy.

Flex plan.

[en.wikipedia.org]

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Saint Cloud, Minnesota, where the weather is wonderful even when it isn't.

Call your state insurance commissioner for starters. If they can't do anything they might tell you what your options are. Talk to more than one person in case one of them is not helpful enough.

Just bend over but be careful they may try to charge for that.

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JoeH
Have you received an Explanation of Benefits (EOB) statement yet from your insurer? That should outline what the allowable charges are and list what your responsibility is. It will also list what amounts are being charged to you as copays and what are going to your deductible if there is one for your insurance policy.

Yes, the allowables listed are higher dollar amounts for most every item than what my previous plan had. I just assumed that most insurance plans got close to the same allowables, apparently not. And yes, I am going to the prefered providers that are supposed to give the best rates for the plan I am in.

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C(-)ris
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I agree, check with the state insurance commish's office.

Wow. Your normal office visit costs $1500????

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I'm confused why you're paying so much. do you have a high deductible plan?

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It looks like your new provider either doesn't have very good negotiated rates or perhaps prices went up even with your old provider, and you just don't know. Either way, I don't see how there is a lot you can do. You can call you insurance company and ask for an explanation, but I doubt you will get much info.

Now, I know with the advent of the ACA that all plans purchased by an individual give you one free yearly physical at no cost or deductible to the covered individual. Does it not work that way with employer sponsored plans?

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Roswell, GA (Atlanta suburb)

rgC-- the "Physical" is 'paid for'. Labs ? Nope. Much like the Colonoscopy is paid for. But if they go and get ONE eeny little polyp ? BAM ! Surgery !

Go to Vegas ? The house always wins.

Declare bankruptcy - that is probably the only time they'd be willing to negotiate. Perhaps if you told them that this will tip you over the edge, the might be willing to do something, but more likely, they'll wait you out.

sorry, that's all I got...

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cbelt3
rgC-- the "Physical" is 'paid for'. Labs ? Nope. Much like the Colonoscopy is paid for. But if they go and get ONE eeny little polyp ? BAM ! Surgery !

Go to Vegas ? The house always wins.

Yes, but he seemed to indicate that all he had was a physical and blood work. I don't think the blood work part was $1050.

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Roswell, GA (Atlanta suburb)

Physical, blood work, vaccines, flu shot. It all added up. The office visit was about $120 if I would have gone in to talk with no tests, shots. Some items were covered 100% as preventative. My deductible hasn't been met yet, so I am paying for the full cost after negotiated discount and the preventative's. I had 3 different labs run, each was around $100. So of the $1500 they billed, $1000 of it was covered as preventative or with discounts, and $500 was my responsibility since my deductible hasn't been met.

I've just never had labs cost that much before. I may investigate having the routine labs done elsewhere and the results sent in.

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C(-)ris
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Yow! I don't think I'll complain about my recent $200. doctor's bill after reading about your charges.

My insurance allows six PCP (Primary Care Provider) visits this year with a $25. co-pay. Up from four allowed visits last year. I visited the Doc for a follow up visit on Dec. 31st, and that was over my four visit limit for the year. Hence the $200. charge for the last visit of the year.

If only I knew, I could have waited 2-3 days more!

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Mr. Lahey: A lot of people, don’t know how to drink. They drink against the grain of the liquor. And when you drink against the grain of the liquor? You lose.

Randy: What the @#$%& are you talking about?

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C(-)ris
I've just never had labs cost that much before. I may investigate having the routine labs done elsewhere and the results sent in.

This. Your insurer probably has a preferred provider agreement with a lower-cost lab (think Quest, etc.), where you go to their location, wait in a huge waiting room with a hundred other people, take a number and wait for a phlebotomist who may or may not have any real medical training. You can end up paying out the wazoo for 'convenience labs,' i.e. getting them drawn in the office and sent out.

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rj
AKA
Vreemac, Moth of the Future

I'd make a call to your insurance provider and the Dr. Make sure everything was coded properly when submitted to the insurance company.

I had surgery in December and have been watching the stream of bills come in over the past 8 weeks. Monday, I got what appeared to be a "final" bill after my insurance company paid their share. Total amount was about $50,000 and my portion? $30,256. Um. No.

Called the Drs office first and then the insurance company. Looks like some things were not coded properly and were not covered at the rate they should have been. In the end, I think I'll end up owing about $2,000 on top of the $2,000 or so I've already paid. That's in line with what I expected.

DM

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rjmacs

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C(-)ris
I've just never had labs cost that much before. I may investigate having the routine labs done elsewhere and the results sent in.

This. Your insurer probably has a preferred provider agreement with a lower-cost lab (think Quest, etc.), where you go to their location, wait in a huge waiting room with a hundred other people, take a number and wait for a phlebotomist who may or may not have any real medical training. You can end up paying out the wazoo for 'convenience labs,' i.e. getting them drawn in the office and sent out.

FWIW, I find the wait time at Quest and the phlebotomists there are far better than at the hospital or my PCP.

YMMV

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Embarassing myself on the Internet since 1978.

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dmann
I'd make a call to your insurance provider and the Dr. Make sure everything was coded properly when submitted to the insurance company.

I had surgery in December and have been watching the stream of bills come in over the past 8 weeks. Monday, I got what appeared to be a "final" bill after my insurance company paid their share. Total amount was about $50,000 and my portion? $30,256. Um. No.

Called the Drs office first and then the insurance company. Looks like some things were not coded properly and were not covered at the rate they should have been. In the end, I think I'll end up owing about $2,000 on top of the $2,000 or so I've already paid. That's in line with what I expected.

DM

I wish you luck but I have recent experience with the "not coded properly" that I just couldn't get resolved and finally just effing gave up. Bounced back and forth between the provider and @#$%& Humana about 200% more than I had time for. Small amounts, fortunately.

First, take another look at your bill. It may not be the tests cost so much, but the doctor. It occasionally happens that the practice or hospital has a deal with the insurance company, but the physician you happen to see or the phlebotomist or in-house (or outside) testing company is out of network. If this is the case, you may be able to fix it in the future by simply requesting only in-network care.

As for negotiating with a clinic, dunno. Worth calling and inquiring.

Hospital billing departments will often have policies to carve up to 50% off of a bill with a cash offer for the remainder. (Contrary to what they say in self-help articles, they usually follow strict bureaucratic procedures with pre-defined tiers for these kinds of discounts and are only willing to actually negotiate when they get served with a lawsuit.)

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I have heard that some personnel within an in-network place can be out-of-network.

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Dennis S
I have heard that some personnel within an in-network place can be out-of-network.

Yup. We got nailed at an urgent care clinic last year. 5 of the 6 docs on staff were aligned with my partner's insurance co. She got the 6th.