General Question

TILA_ABs_NoMore's avatar

Am I liable for these medical fees?

Asked by TILA_ABs_NoMore (895points) March 4th, 2010

Last year I went to a podiatrist because of severe pain near my heel. After having an x-ray he found that I had a tendon that was tearing from the bone and gave me a steroid injection as well as some kind of vibrating thing he put on my foot after the injection. Also a splint. I went in a week later and he asked if I still had any pain and I told him that I still had a little. Another injection with the stimulation. I then receive a bill from my doctors office for the amounts that my insurance did not pay, totaling over $500!! Had I known the insurance was not going to cover I would have lived with the pain!! I know that I should have been more familiar with my insurance and what they pay, but am I wrong to feel that the Dr.s office is also partly to blame for not informing me? Surely they’re more familiar with insurances companies than most of the patients…right?!?

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26 Answers

Rarebear's avatar

The doctor should be paid for his services. You should have known what was covered and what was not.

janbb's avatar

Some doctors will find out exactly what you are responsible for beforehand; some will just submit and bill you for the difference. You don’t say whether it was an in-network doctor in an HMO or traditional coverage. In any case, yes, you are liable for the bill. However, it’s quite possible that if you talk to them and explain your difficulty, they may be willling to reduce the amount you have to pay. I have heard of cases where this has happened.

aeschylus's avatar

It’s called a deductible. It’s probably described in a contract that you signed. Read the fine print or don’t risk the commitment. Welcome to the real world.

TILA_ABs_NoMore's avatar

@aeschylus Do you always answer so rudely? Im very familiar with the “real world” jerk thanks

Likeradar's avatar

It’s not the doctor’s job to know the ins-and-outs of your insurance.

I’ve been billed unexpectedly too, but it’s my fault (and yours) for not taking responsibility.

melissamiranda's avatar

It’s always good to ask ahead of time how much everything will cost. I have a high deductible plan so I always ask the approx. cost when I book the appointment, or the doctor just before I get the procedure. As a rule, anything a doctor does other than just talk to you and examine whatever it bother you will cost extra. $500 is a lot, but it could have been worse (over $1000).

TILA_ABs_NoMore's avatar

@melissamiranda Good advise :-) Thanks!!!

funkdaddy's avatar

A doctor’s office sees people with a wide range of insurance coverage. A wide range in this case being dozens or hundreds of policies, each that changes at least each year. There isn’t a unified list of covered and uncovered procedures so they simply have no way of telling you for sure if it would be covered or not, at what percentage your insurance will pay out, how that affects your deductible, etc.

They may not know for sure, but most are happy to discuss expected costs and will give you whatever information they can about whether or not something is generally covered. I generally ask about costs after the exam while they’re describing what treatment we’re going to be doing. Just like when you take your car to a mechanic, ask questions and then make a decision about treatment based on whether it’s worth it to you or not. They won’t be able to give you an exact amount, and they may be way off, but you’re also welcome to make a call to your insurance provider either from the office, or to come back for treatment another day. Just remember you’re in control when you go in.

I’m sorry about the bill, but it generally comes with a explanation of benefits from your insurance provider as well. There’s quite a bit of information there, and calling your insurance company can get you even more if you need anything explained.

lilikoi's avatar

This happened to me once and I wrote a letter to the doctor. His office had claimed that his fees were reduced since it was found, after the fact, that my insurance would not cover it. I was peeved that his fees were inflated in the first place simply because insurance would pay (no wonder medical is so expensive in this country), and because he was still billing himself out to me at something like $1k an hour. I let him have it in that letter, told him I’d like to discuss his fees further, but enclosed a check for the material costs to be fair. I never heard from him again, probably because other clients are willing to pay $2k an hour for his time via insurance companies.

marinelife's avatar

I think it would not hurt to write a letter claiming hardship, but if they insist then you do owe the money.

Arisztid's avatar

Yes you are. I wish I could tell you otherwise but, no matter if the doctor was milking you, incompetent, a liar, etc., you have to pay.

One would think doctor’s offices would be more knowledgeable than the patient, however, there are so many insurance companies out there and often the doctor’s office just does not care as long as they get paid. They do not care who pays them.

I do not have insurance but, when I did, I learned exactly what was covered and what was not, refusing treatment for what was not covered. I have had experiences and others have had experiences with doctors who just do not care if something is covered.

Since I have no medical insurance, I have lists of various formularies that I can afford (wallmart has one) and a general knowledge of prices. If a doctor, for example, prescribes “x” antibiotic for bronchitis, if it is an expensive one, I tell them that I cannot afford it and give them a list of antibiotics I can afford.

It is always best to keep yourself as knowledgeable as possible before going into a doctor’s appointment. If a doctor wants to run tests which you do not know if they are covered or not, find out before having the test

When my wife had medical insurance, she hit her insurer’s cap and nobody told her. She did not learn this until she got a bill for thousands.

I would talk to your doctor’s office and explain the situation. They probably will, at least, allow you to make payments. Good luck to you.

semblance's avatar

I am an attorney. Do not take this as creating an attorney-client relationship. You may, however, find it helpful.

As a legal matter, you made a contract to pay the doctor for his services. In all likelihood you signed paperwork that says in it somewhere that although insurance may be billed, you are responsible for payment. So, assuming that the charges were reasonable, meaning at the going rate so to speak, you are liable for the full amount. Sorry.

Also, in the USA there are a bewildering number of insurance companies, all with different coverages and rules. The doctor and his staff are probably not as knowledgeable about what is and is not covered as you think.

Having said that, many doctors will at times compromise bills if payment is not received from the insurance company. You might write a letter, pleading that you have been surprised at the lack of coverage and cannot pay the full amount and offer to pay a lesser amount. Good luck.

mrrich724's avatar

If the doctor is going to give you a service, and you just agree to it without asking the specifics, including cost (which I don’t see why you would do), I think it would be safe for him to assume that you are agreeing to pay whatever the cost may be, unless it’s completely outrageous. So I think you are in debt to the doctor. You received the service. . .

It’s like at a bar/restaurant, if you walk up and say, “Hey, can I have a beer” you have to pay the cost for that beer, and unless it’s a “special” $50 beer, I think the bartender is safe to assume you know what you are asking for.

A $500 bill at the doctor’s office is not outrageous at all.

But if you think it is, I wouldn’t hesitate to ask for a breakdown of what the bill total was, what your insurance paid, etc. And then you can call your insurance company and verify that nothing sounds fishy. B/C a doctor can easily be in the position to rip someone off, since the cost for services isn’t “common knowledge.”

cak's avatar

Unfortunately, you might be out of luck. More than likely, you signed saying you would accept responsibility for anything not covered by your insurance company. Call them, see if they will negotiate at all, or at least make pay arrangements.

In the future, as for cost up front; also, as if you pay for something – completely up front (say a low cost injection – something like that) if they discount. A lot of medical offices will work with patients, as long as there is a level of communication.

When it comes to health care, you are your best advocate, inform yourself of cost and need before you make a decision that maybe you can’t afford – and maybe there are other solutions. With that said, don’t skimp on things that you really need!

Good luck to you.

marinelife's avatar

@cak It is so good to see you posting! Your wisdom and compassion still shine through.

cak's avatar

@marinelife I take that as a high compliment coming from you! It’s good to be here. :)

jca's avatar

my dermatologist takes my insurance as “payment in full.” therefore, when i get a bill for something that results from his services, his office will recode it to something that the insurance will accept. for example, if he cut off a mole or something, the insurance company may consider that cosmetic. he will recode the bill so that it shows the that it was not cosmetic, it was itchy, or needed biopsy or something like that. you should speak to the billing dept and tell them to resubmit to your insurance company. frankly, they will probably be willing because they know it will be easier to get it from the insurance company than to get it from you.

thriftymaid's avatar

This is your responsibility. It is up to you to know your own insurance coverage and to ask pertinent questions when acquiring services. Yes, you are responsible for all charges.

PandoraBoxx's avatar

I would also look at your EOB and call your insurance company. Very often, claims are not paid because the doctor’s office codes the services incorrectly.

Darwin's avatar

For future reference, certain fields of medicine are more problematic than others in terms of insurance being willing to pay.

Foot care of various sorts is a mine field, with orthotics and often splints not being covered. Over the past few years I had four necessary foot surgeries and laid out about $500 each time to cover such things.

Physical therapy is another risky field. I discovered to my dismay that the cost of every pillow I used for comfort during treatment was mine to pay for as they were “not essential to my recovery.”

Psychiatric and psychological services are yet a third area of surprise expenses. We were denied payment for one of my son’s hospitalizations because we had made “insufficient use of community resources,” which translates to we hadn’t had him arrested and sent to Juvie.

And then there are the things that the insurance company says are “experimental treatments,” such as a bone marrow transplant for a friend of mine with Stage VI lymphoma, or growth hormone injections for a child who wasn’t making any.

The secret to all of this is know what your insurance covers and what it doesn’t. Be prepared to ask questions when you don’t understand their decisions. Talk to your doctor’s office about whether things should be coded differently. Be persistent but calm and business-like in following up the steps to appeal a decision. And by all means speak (politely) to your doctor about it if the fees are a true financial burden.

And I fear that it is correct to welcome you to the real world. You apparently haven’t realized that this is how medical care works these days in America. This is why some folks are trying to change things.

BTW if the diagnosis was accurate you should not have ignored the pain. Once the tendon has torn completely away from the bone you would end up with a lot more medical bills than a measly $500.

thriftymaid's avatar

@PandoraBoxx Some insurance plans do not cover podiatrist services.

lillycoyote's avatar

Yes. You should make yourself familiar with your insurance plan. Then, if it looks like the claims should have been paid under your plan then you are going to be spending a lot of time on the phone with your insurance company. And yes, if services were rendered to you that your insurance doesn’t cover, the you have to pay for the services rendered by the doctor. It’s not the responsibility of his office to tell what your insurance will and will not pay. That responsibility is yours.

lilikoi's avatar

@mrrich724 The difference between buying a beer, or a dress, or a massage, or just about anything and medical services is that the price is always given to you up front on all those things whereas when you are in a doctor’s office, the prices are not. Even when you ask how much it will cost, many times they will skirt the answer or simply tell you they don’t know – good luck finding out how much your visit will cost before you get there. No, you can’t make a phone call and ask them to read you the menu. When the bill comes back to be $500 or $1k or more, especially if it was for something simple and/or unnecessary and/or that only took 10 minutes, I don’t see how anyone would expect you to be anything but shocked. Doctors are often greedy bastards out of touch with reality – I often question why they became doctors in the first place. Was it really to help people? Was it? Really?

PandoraBoxx's avatar

@thriftymaid, yes that’s true, too. Mine does not cover orthotics for flat feet, but does cover them for bone spurs.

jca's avatar

Doctors will often accept whatever the insurance company pays them. when i go to my doctor, my insurance pays him $27 for a visit. if i had to pay him cash, he would probably charge $100 or more. i’m sure the advantage of him accepting my insurance that pays him $27 is that he gets a large quantity of patients coming in.

a friend of mine has given birth to two babies at the same hospital, under two different insurance companies. the first childbirth price was vastly different from the second. they were both caesarians. she called the hospital and asked them why, and they said they bill the maximum of whatever the insurance company will pay. so if the first child was born under Insurance Company A, which paid say $10,000, and the second childbirth was under Insurance Company B, and paid $20,000, they got the two different amounts and it was acceptable and legal.

YARNLADY's avatar

I’ve been reading about some legislation that would end the practice of doctors billing for the difference between what the insurance pays and what the doctor charges, but I think it is confined to hospital charges, and not personal patient care.

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