Letters to the Editor
KitchenGirl
Published Letters: 638 Editor's Choice: 39
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Self-pay, in network, out of network -- read the fine print!
[Read the article: "Sicko"]
[Read more letters about this article: Here]Re: Billed Costs are not the same for payers
"When a self-pay patient gets a bill, they are seeing the full fee that the physician charges TO EVERYONE. What they pay themselves is another matter entirely, and most physicians and hospitals will offer steep discounts to self-pay patients roughly matching their average reimbursement for a given service."
The problem here is with the wording "most" - how can you tell in an emergency if you lucked out and found one of those.
Luck has nothing to do with it, but confidence and a little industry knowledge will go a long long way. Write them a hardship letter, complete with a proposal for a negotiated payment, after they've patched you up and you're almost 100% guaranteed to come to some kind of payment plan/payment schedule agreement. They would much rather deal with individuals who will pay them cash money than deal with the incessant, interminable red tape that the insurance companies dish out, and finally wind up "writing off" (meaning, just giving up on ever getting paid) the balances that are owed them rather than fight it out another day.
One thing is for sure - if universal coverage is adopted there will be a lot of people out of a job in this country because we will not have all these people sending out bills!
Yeah, like me. Oh well, I guess adaptability is key to the modern economy, right? Time to find something else to do...
By the way, I was paying Blue Shield $4000 every quarter to cover myself and my 2 daughters. I had lab work ordered and went to a "non-member" lab by mistake - that was a $500 error - yes it was my ignorance that I did not look at the "preferred" lab list for my so-called PPO plan so what should have cost $100 cost $600....but how can it be right for the lab to make those exorbitant charges? I'll tell you why - because WE the INSURED are still paying our own premiums plus shoring up the system in place for the uninsured...we are already paying too much for less.
The labs have their own contracts with insurance companies. As with physicians, they charge $N for a lab panel. If the lab has a contract with BS (do you live in California by any chance?) BS will pay them something like 80% of $N and you will pay %20 of $N (or whatever). If the lab doesn't have a contract with BS, BS will pay them nothing. That is why you get stuck with the entire cost. The lab isn't charging different rates, they're just not charging your insurance company because your insurance company isn't going to pay them.
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Another inside tip...
[Read the article: "Sicko"]
[Read more letters about this article: Here]This just occurred to me also, since caught my own dentist trying to do this.
The line on an EOB which your insurance company sends you (at least mine do) that says "contractual" is NOT billable to you. That is the amount that the doctor has previously agreed to "eat" as it were, and not collect from either the insurance company or the patient. Copays, co-insurance, deductibles yes, but anything that says "contractual" or "contractual adjustment" is not a billable amount.
If your doctor's office tries to tell you that you owe that money, call your insurance company immediately, raise holy hell, and make sure they get on the horn to your doc about it (and they will, believe me. They don't like it either since it violates their contracts with the providers, and nothing puts the fear of jeebus into doctors than the word "fraud".)