Is Your Doctor's Office Trying to Cheat You? Part 3

My EOB for my last doctor visit has an interesting statement on it:

"This document outlines your share of the charges for services. You should use this to determine how much you need to pay. If there is a discrepancy, use this summary to to discuss the charges with your provider."

This is a new message, and it's a perfect lead in to this last part of my little mini-series. Is your doctor's office trying to cheat you? If they are trying to bill you for more than the insurance company says you owe, then YES they are.

Parts 1 and 2 of this series outlined how all the pieces (networks, claims, and money) fit together. Here's my personal story about the weasel tactics one office tried to pull.

Two years ago, in 2009, I chose a high-deductible health plan from my options at work because it seemed like made financial sense. During that year, I needed to have a suspicious lesion removed from my leg. The nature of my coverage meant that I would be paying for the whole procedure myself, and it counted against my deductible. It wasn't that much, as medical procedures go, only about $150. On the way out of course is where you stop at the billing window. I argued with them there at the billing window for half an hour about what I should pay that day. They insisted that I needed to pay the whole amount they wanted to charge, and I insisted that we didn't actually know how their charges lined up to the insurance company agreed-on amounts.

They were impervious to that argument, and swore to me that their charges were the same as the allowed amounts.So fine, I finally gave in and paid them what they asked. About a week later, they sent me a bill for one more charge that they had missed that day, for another $6 or so.At that point, however, I wasn't paying another penny until I saw how the claim settled.

Sure enough, a few days after that the EOB arrived and showed that I had, in fact paid too much already. I really had only owed them $145. The charges that had been filed to the insurance included the extra $6 so I knew they owed me money at that point.I just figured I would get a refund the next time I went in.

I'm sure you can imagine my surprise at that next visit, when I stopped at the billing window to pay my copay for that visit and they tried to make me PAY THEM the $6 they said I still owed!! I had to make them call the central billing office. The person there not only erased (I thought) the $6 but backed off the extra $5 from what I paid that day. At that point we were even.

Six months later (Nov 2010), what do you think I got in the mail? You guessed it - a bill for the $11 plus interest. I called them and accused them of balance billing and told them I didn't owe them a penny. After more than one lengthy time on hold and a recap of the whole history, they said basically that because it was only $12 they were going to write it off. I'm thinking, damn right you are! But they did NOT admit that they were doing anything wrong.

So, fine. That was that, or so I thought. However, at the end of February 2011, once again! I received a bill for the same $11 plus interest. The bill was identical to the one I'd received last November, and basically called me a deadbeat for not paying these charges that were not covered by my insurance. So much for them writing it off.

At this point, I was seriously pissed off. But this time I was smarter. I called my insurance company and asked if they could help.Once the CSR (customer service rep) determined what was going on, he offered to conference in the billing office right on the spot and get it taken care of once and for all.And he proceeded to do just that. It's amazing how the 500-lb gorilla can whip things into shape! It was not pretty. They jerked us around, passed us to several different people, put us on hold more than once, and even disconnected the call at one point. Undeterred, my CSR in shining armor got them to finally agree, once more, to write off the bill. Interestingly, they used pretty much the exact same wording they had used in November. Without admitting that they were balance-billing, they said it had been so long and was such a small amount that they were going to just write it off. Beyond that, he extracted a commitment that they would send me a letter saying I owed them nothing. Which I received a few days later. Trust me when I tell you I have it filed away with all the other paperwork around this!

So I am quite sure that this office does this whenever they can. If I didn't know how this all worked, or didn't bother to read my EOB, or wasn't willing to fight for $11, they would have been a little bit richer. Multiply that by hundreds of patients and thousands of doctor visits, and they are raking a tidy sum via this kind of fraud.

Needless to say, I no longer go there. And I'm kind of sad about that, because I liked my doctor. But I won't do business with criminals. And I'm thinking that there's a lot of this happening these days, hence the new message on my latest EOB. In this particular instance, the insurance company is on my side, and I like that.

As a final side note, I found out who my CSR was that day and his boss's name. I sent the boss an email telling her how wonderful my CSR was, and copied him on it.

This Series:
Part 1 is a description of fee-for-service health insurance in the US, including lots of boring terminology.
Part 2 is a description of how health insurance claims work, and how to tell what you should pay the doctor.
Next: Summing Up: Don't Let them cheat you