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  1. #1
    Join Date
    Sep 2013
    Posts
    2

    Default Can My Doctor Charge More Than Agreed to

    State : Kansas
    City : Wichita

    Problem
    I discussed all of the pros and cons regarding what my healthcare coverage
    benefits were. We discussed co-pays, coinsurance and Deductibles. I told
    them that the only reason for choosing their office was there "in networks"
    status. They confirmed the insurance company's approval for the procedure.
    I asked "does that mean they agreed to cover the procedure at the 80% / 20%".
    They answered yes but reminded me that some things are not covered by insurance.

    We agreed that the items "not covered" by insurance would be billed to me.
    We also agreed that I would be responsible for the remaining 20% of the covered procedure.

    The actual Dollar amount was not set but the percentages of the cost were.
    After we discussed all of the insurance and billing questions, the appointment
    was set. In good faith I trusted the information they gave me after getting the
    procedure approved with my insurance company. I completely expected to
    be billed for item not covered and 20% of those that were. I told them I wanted to
    be notified before the procedure if there would be any further cost beyond what we
    had already discussed. They told me that the only additional cost would be if
    complications required additional services to complete the procedure.

    I am being sued by the doctor for 100% of the bill after the insurance company
    approved the procedure and later passed it all off to deductible when the doctor
    billed the insurance company after the procedure. I asked them to confirm that the
    cost would be covered and not subject to the deductible. They told me the
    procedure was approved. If I had known I would bare the entire cost, I would not
    have used them. Paying 100%, I could have negotiated for a better price and
    filed a claim for reimbursement myself.

    Did they provide good service, for the procedure Yes.
    But in regards to billing, I feel completely mislead.

    Their attorney is also the debt collector.

    Any advice would be appreciated and should I hire an attorney?

  2. #2
    Join Date
    Jun 2006
    Location
    Massachusetts
    Posts
    24,521

    Default Re: Can My Doctor Charge More Than Agreed to

    At what point did you contact the insurance company to confirm what would be paid? Did you read the policy to learn that when a procedure is approved for coverage that is NOT a guarantee of payment? Because I promise you that is included in the policy.

    Bottom line is that it is your responsibility, not that of the doctor's office, to determine what is coverable under your specific plan.

  3. #3
    Join Date
    Sep 2011
    Location
    OH10
    Posts
    17,019

    Default Re: Can My Doctor Charge More Than Agreed to

    That is the purpose of a deductible. I am sorry you did not look to determine how your particular situation played out in advance. It can be confusing. I had a situation recently where a doctor was in network, yet his clinic was out of network. He of course insisted I have lab work redone at his lab so he could make sure he was satisfied with the conditions of the testing. Further he noted he could not see me as a patient if I did not. I dumped him after determining the tests he wanted to run over would have cost me about $3k, been redundant and not gotten me any further. The lesson is you need to investigate the situation more in depth so you understand what is happening. I'm sorry, you owe the money.

  4. #4
    Join Date
    Sep 2011
    Location
    OH10
    Posts
    17,019

    Default Re: Can My Doctor Charge More Than Agreed to

    One thing I will note that is ambiguous. Your insurance company has an in network rate. The doctors usually bill above that rate. Even if you owed the co-pay you should only be responsible for the contractual rate agreed between the doctor and insurance. Your EOB will give you this amount as the amount you owe provider.

  5. #5
    Join Date
    Jun 2006
    Location
    Massachusetts
    Posts
    24,521

    Default Re: Can My Doctor Charge More Than Agreed to

    While I do not disagree with anything in the above post, I will point out that IF the entire charge was applied to the deductible, then you do owe that. I will also point out that Disagreeable's post is correct for doctors that are in the network, but not for doctors that are out of network.

  6. #6
    Join Date
    Sep 2013
    Posts
    2

    Default Re: Can My Doctor Charge More Than Agreed to

    Thanks for the replies everyone.

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