Unreasonable medical bill - doctor's office threatening to collect

[Barwick]

(Michigan) I had a extremely minor procedure done on my big toe (I had worn speedskating boots too tight and the nail had irritated the skin, apparently allowing in a very slight infection). I went into a podiatrist to see if something should be done, and he said that it's just a minor infection in the area, and the irritation I was feeling was caused by an inflamation right next to my toenail. He said he could simply use a few drops of a solution to "freeze" the area to numb it, pop it and drain it real quick and be done with it.

I said "ok, sure that's fine", because he made it seem like it was no big deal. He came in, fixed it, gave me some topical antibiotic cream, and I went on my way.

A few months later, I get a bill in the mail from them saying I owe them $200 for my portion of the insurance deductible (I later find out the whole procedure was billed to the insurance company at something around $350). I talk to the lady and tell her that "The doctor never said it was going to cost that much money, he made it seem like he could just take care of it for me while I was there as part of the visit". She said "Our policy is the doctors here don't talk financial with the patients, they don't know what our fee schedule is, you should have asked before you went in" (even though I didn't know what he was planning on doing, I was planning on just paying for an office visit, which has a $15 co-pay). Now they're saying if it isn't paid they'll go to collections.

So basically, they either grossly overcharged for a procedure, and/or they failed to represent to me the fact that the procedure was going to cost that much. If it was going to cost that much I would have gone elsewhere or just done it all myself. Basically, I feel like I walked into a building that said "Meet a famous actor, $15", then I walk in and shake the guy's hand and he says "want an autograph?" I get his autograph and he says "Oh, that's going to be $350 for the autograph, pay on the way out".

[deadlock]

(Michigan) I had a extremely minor procedure done on my big toe (I had worn speedskating boots too tight and the nail had irritated the skin, apparently allowing in a very slight infection). I went into a podiatrist to see if something should be done, and he said that it's just a minor infection in the area, and the irritation I was feeling was caused by an inflamation right next to my toenail. He said he could simply use a few drops of a solution to "freeze" the area to numb it, pop it and drain it real quick and be done with it.

I said "ok, sure that's fine", because he made it seem like it was no big deal. He came in, fixed it, gave me some topical antibiotic cream, and I went on my way.

A few months later, I get a bill in the mail from them saying I owe them $200 for my portion of the insurance deductible (I later find out the whole procedure was billed to the insurance company at something around $350). I talk to the lady and tell her that "The doctor never said it was going to cost that much money, he made it seem like he could just take care of it for me while I was there as part of the visit". She said "Our policy is the doctors here don't talk financial with the patients, they don't know what our fee schedule is, you should have asked before you went in" (even though I didn't know what he was planning on doing, I was planning on just paying for an office visit, which has a $15 co-pay). Now they're saying if it isn't paid they'll go to collections.

So basically, they either grossly overcharged for a procedure, and/or they failed to represent to me the fact that the procedure was going to cost that much. If it was going to cost that much I would have gone elsewhere or just done it all myself. Basically, I feel like I walked into a building that said "Meet a famous actor, $15", then I walk in and shake the guy's hand and he says "want an autograph?" I get his autograph and he says "Oh, that's going to be $350 for the autograph, pay on the way out".

All medical surgical office visits are coded by a universal system. You usually see it on the slip when you check out of the doc's office. These are based on time, type, equipment and supplies used to calculate the "mean" charge for the type of service.

The insurance companies use a reimbursement schedule called usual and customary. These are statistics of charges based on geographical areas by researchers at NIH. (You can read about this on their website.)

Then the charges that are agreed upon by the providers in their contract with insurance companies is complex and very hard to understand. If you have ever seen a medicare bill it has an enormous charge then funky calculations, charges paid by additional carriers, and finally the bill to the client for an amount.

The fees are not arbibitary figures, they are calculations. And I think most Americans feel the way you described feeling. But your frustration is misdirected towards the provider. He/she has nothing to do with it now. It is a God size problem that has taken many years to create and the solutions aren't easy. Even if the doctor want to charge you nothing, he is under pressure of the group he works with or for. They are literally required to do anything pro bono, if you will, in a free clinic and they never advertise these services (malpractice insurance company, the catastrophic type (NYL) requirements.

[lealea1005]

It is your responsibility to know what is and what is not covered by your insurance policy. You should have been aware, by reading your policy, that you have a deductible. Obviously the procedure was covered by your insurance. Your insurance company discounted the $350 fee down to $200 and applied it to your deductible which due and payable BY YOU.

Your opinion of the complexity of the procedure in inconsequential. A service was rendered to you and the provider deserves payment. You owe the money. Pay the bill.

No wonder many offices require payment of all deductibles & co-insurances before rendering a service!

[deadlock]

It is your responsibility to know what is and what is not covered by your insurance policy. You should have been aware, by reading your policy, that you have a deductible. Obviously the procedure was covered by your insurance. Your insurance copany discounted the $350 fee down to $200 and applied it to your deductible which due and payable BY YOU.

Your opinion of the complexity of the procedure in inconsequential. A service was rendered to you and the provider deserves payment. You owe the money. Pay the bill.

No wonder many offices require payment of all deductibles & co-insurances before rendering a service!

In fairness to Barwick, he really didn't know what the doctor was going to do before he saw him. There are options to lancing and draining something in the office. He said that he had developed an infection resulting from an irritatation next to that site. Technically, all surgeries, even a minor surgery is supposed to be preapproved before it is done. And if not there is usually a penalty that patient is required to pay.

The doctor offices have no way of knowing what a patient deductible is going to be and Barwick really cannot expect that the clerical people have the time to go into that detail with each patient. But I have never heard of an office requiring patient's pay a deductible before they see the doctor.

[lealea1005]

In fairness to Barwick, he really didn't know what the doctor was going to do before he saw him. There are options to lancing and draining something in the office. He said that he had developed an infection resulting from an irritatation next to that site. Technically, all surgeries, even a minor surgery is supposed to be preapproved before it is done. And if not there is usually a penalty that patient is required to pay.

The doctor offices have no way of knowing what a patient deductible is going to be and Barwick really cannot expect that the clerical people have the time to go into that detail with each patient. But I have never heard of an office requiring patient's pay a deductible before they see the doctor.

Many offices in our area require that deductibles and co-insurances are paid before being seen. They're tired of not getting paid for their services. As you said, the provider has no way of knowing unless they call the insurance company before each patient's visit, and even then, the insurance company has their ever famous recorded disclaimer ("verification is not a guarantee of payment").

Incision and drainage does not require pre-approval from the insurance company. Taking into consideration the Physician's expense, the fee wasn't unreasonable at all, especially given the insurance company's "discount".

[Barwick]

It is your responsibility to know what is and what is not covered by your insurance policy. You should have been aware, by reading your policy, that you have a deductible. Obviously the procedure was covered by your insurance. Your insurance company discounted the $350 fee down to $200 and applied it to your deductible which due and payable BY YOU.

Your opinion of the complexity of the procedure in inconsequential. A service was rendered to you and the provider deserves payment. You owe the money. Pay the bill.

No wonder many offices require payment of all deductibles & co-insurances before rendering a service!

WTF are you? The prosecutor? I pointed out that I had no clue I was going to be charged for a PROCEDURE, I was simply expecting an office visit, and the doctor made it seem that way, that this was a simple, routine thing he could take care as part of an office visit.

[deadlock]

WTF are you? The prosecutor? I pointed out that I had no clue I was going to be charged for a PROCEDURE, I was simply expecting an office visit, and the doctor made it seem that way, that this was a simple, routine thing he could take care as part of an office visit.

Most plans require pre-authorization for an invasive procedure. BCBS does and does Medicare. Additionally, Podiatry is one of the areas that have been scrutinized because of what you described as a simple procedure, done quickly in the office without fully eXplaining alternatives, etc.

The reason I mentioned it to begin with is that "deductibles" usually come around first visit of the year plan. Not late in the year. Call or write your ins co. and ask for an eXplanation of the denial. The statement and/or EOB are printouts that require a claims person to "pick the best one". It may or may not be the reason for the additional cost to you.

Let us know because you can dispute the charge if indeed it was because of something the office "didn't do" or failed to eXplain to you.

[lealea1005]

Most plans require pre-authorization for an invasive procedure. BCBS does and does Medicare. Additionally, Podiatry is one of the areas that have been scrutinized because of what you described as a simple procedure, done quickly in the office without fully explaining alternatives, etc.

The reason I mentioned it to begin with is that "deductibles" usually come around first visit of the year plan. Not late in the year. Call or write your ins co. and ask for an explanation of the denial. The statement and/or EOB are printouts that require a claims person to "pick the best one". It may or may not be the reason for the additional cost to you.

Let us know because you can dispute the charge if indeed it was because of something the office "didn't do" or failed to explain to you.

Just FYI....deductibles can come any time of the year. Some plans have separate deductibles for diagnostic labs and "surgical" procedures. Although OP's office visit may have seemed simple to him, the CPT coding may have been interpreted by the insurance company as a "surgical procedure" and, therefore, applied to a separate deductible. Sooooo, you're medical office visit deductible may be taken care of early in the year, but in November you may have a "simple" procedure like I&D of an infected toe, and that gets applied to your surgical deductible.

To OP: Next time, even it you are told it's a simple office visit, ask about the possibility of a "procedure" and then call your insurance company and ask whether there is a separate deductible.