Healthcare Tips

Hello everybody, so lets just get to it. So you go to your primary Dr. for an office visit and you hand the front desk your Ins. card and they verify coverage and ask for your $30 co-pay. You hand them your ATM card and then ask, "so, is this all I'm going to have to pay for today's visit"? The front desk clerk is finishing processing your payment, while handing you the condition of registration form to sign, smiles and says, "yes,yes no worries this is just a routine wellness check-up, please have a seat and we will call you shortly. You sign the form hand over the clipboard, done deal. Nice, quick and efficient, Sound familiar? Then they call you in for your visit and the Dr takes all your vitals while talking up a storm, how you doing? How you feeling? How's the family? Before you know it the visits over and you think its all good but you will just wait to be notified about anything. Now this next part will really sound familiar. A couple weeks pass and you receive a bill from the medical group and your like, what is this for? $327.o0!!? For what!?  Yeah...It happens like that. All day everyday. And your like, "but I paid my Ins. premium this month and my co-pay"! "Why didn't they tell me this up front"? "And I barely was in his office but 10-15 minutes if that"!  Well, let me explain. You just may have one free wellness check up a year with your Ins. plan, besides paying for your co-pay. But guess what, all that small talk when the Dr asked how you were feeling, and hows the family, became the visit, itself. Because when you said, "well doc, other than this pain in my lower back it's all good". "And the family's all good too, just a little worried about pops and his diabetes lately, Been feeling like I might have it myself at times".  All of a sudden this same wellness visit has about 4 different diagnosis on it after you got done talking and you may have even mentioned something about dandruff so you can best believe that the primary diagnosis is not a "Routine Check-up" now.  But see, you don't know that yet. Charges aren't entered on a claim till after services are rendered based on the notes from the Dr for that visit. But you still say that was just small talk for 5 min, just conversation..."Why do I owe"? Well, because you have a Deductible with your plan and it hasn't been met for the year.  "And"?? Well, now that this visit was for lower back pain, checking for diabetes, and dandruff, It's not a "free" wellness visit anymore and these charges are now subject to your deductible. "What does that mean"? That means that your Insurance carrier has contracts with your medical group and they have negotiated rates for all the many CPT (procedure codes) charges your medical group can bill for. So after all the Contractual adjustments are done on the total charges billed, any remaining balance will be patient responsibility if your deductible isn't met. Wow... But, it sure seems like the insurance didn't pay anything. How much were the total charges billed?  Well...Red pill right? LOL...OK, $220 for the office visit itself...yes, 15 minutes. This is why they go to school for 15 years to charge you $15 a minute. Then you had 7 lab tests for diabetes, dandruff and who knows what else you told this man! Those lab tests were billed on 3 different claims by the way, totaling over $500. So the total charges billed for this "free" routine wellness visit ended up totaling close to $800 dollars. But it Looks like the $30 co-pay you paid up front did take care of your office visit responsibility on the claim. Those contractual adjustments on those lab tests weren't as substantial as you would of liked though. And being that your deductible is $5000 for the year, I'm sure it isn't met...$327 dollars is definitely owed by you for this visit. "Well, i'm not paying"! "I wasn't told this up front"!.  Anything stated up front prior to services being rendered is an estimate only sir...They may know what your co-pay may be for an office visit but the front desk certainly doesn't know your particular insurance benefits and plan. That is your responsibility. We simply bill your insurance as a courtesy and they process your claim according to your benefits and plan. And your Dr. is there for your Health not as your insurance broker. The medical group also isn't responsible for knowing where you are with your deductible or whether your premium was paid for this month. Not to mention your insurance has more denial codes under the sun than your medical group has procedures to charge you with! The medical group is not responsible for payments by your insurance carrier nor can it guarantee payment. "Well I could give a sh!$ i'm still not paying!" "This is your doing for not explaining this to me"! Did you not read the C.O.R. that you signed before services were rendered sir? Huh?? Yeah, that conditions of registration you signed prior to services being rendered...Gotcha!!!  Remember people it is a business. Yes, your Dr may be friendly but he is not there to be your friend. Don't think you can go to their place of business for some free advice without getting charged for it, even when you were told there would be no charge. The Dr's don't control the billing aspect of this and they are shielded by the medical group. Everything is compartmentalized in healthcare for a reason. When you have a complaint about something that happened during your office visit you get steered to customer service. And then they have to follow protocol. If a patient feels they were coded incorrectly for an office visit for example, then the customer service rep has to submit a code review. Professional coders do the review and I can tell you that almost 99% of all charges stand after a patient requests a code review. The Dr and his or her notes from that visit dictate what a patient will be billed for. Not the patient or the insurance. Maybe the complaint was about the front desk at a Dr's office that concerns a "Quality of care" issue. The Customer service rep now transfers the patient to a patient liaison at the site wherever this took place. A mad circle. But the Dr's and their staff will rarely ever have to answer to issues that stemmed from their doing. They get to play the dumb card. And even though it may be true that it is the patients responsibility to know their own insurance benefits there are still way too many loopholes and shady business practices that medical groups take advantage of. The public remaining uneducated with how the insurance works is just one way the insurance company, as well as the medical group, benefits and profits. Read your health insurance handbook and educate yourself on Premiums, Co-pays, Co-insurance and Deductibles. Be aware of what is communicated at each and every Dr visit. Know what you are signing before you sign it. And most importantly take care of your own health so you don't have to go to the Dr's! Peace, Love and Steem.