Can someone please explain to me why

[bumbershoot]

Is it common now for Dr's in network to charge more then the insurance will pay?

It might be common, but if they are truly in network as a preferred sort of provider, they probably aren't supposed to.

If they have contracted rates and are in network then that difference is a write off for them, call the insurance they can send out a balance bill letter.

Definitely.

I once saw a general MD who wanted me to pay the amount insurance said was not allowed...since I knew she was a preferred provider, and was likely under contract to NOT charge that, I called the insurance company immediately. They were VERY happy to hear about it, put me on hold, called the MD's office, and it was taken care of inside of 5 minutes (minus initial hold time).


OP, call your insurance, see if the pod is in network and preferred, see if they are allowed to charge the "not allowed" amount. Try to see if something was billed funny. Then call the MD's office.



Another problem we're experiencing is that the billing offices of these places is completely behind. We have a couple providers right now using the SAME billing place, and they are months behind. Also, we get our EOBs online (Aetna) almost immediately (under a week from the service), but the offices don't get the info and/or the money for more than a month. I just want to pay our portion, but I have to wait and wait for their bill!

 

[Stitchfans]

We just recently paid off the hospital bill from my last stay there. Our balance came to a little over $2,200.00. Now we also have other bills from all the different doctors they had popping in on me just to say hi and ask me how I was doing. None of them actually touched me since the nurse's did all the work. But still they had to get their several thousands and whatever I owe them.
Which we we pay whenever we can.
But my question is: how does it work with medial supplies? A woman from the wound center had a big box shipped to our home with medical supplies for me to use on the wounds on my legs.gauze strip rolls, tape, special medicated squares to put on the wounds. All this came to supposedly a little over $3,000.00 and now our balance is suppose to be a little over $500.00. The woman went overboard and I have tons of it left over and my wounds are just about totally healed. I will have a lot left over and will have no use for it.

My first reaction is that seems like too much for what I got, and now I still owe over $500.00 out of pocket. And as said with a lot of supplies I will never use. What are my options if any besides just hand over all that money?

This is going to end up costing us at least $4,500.00 or $5,000.00 out of our pocket which really stings considering DH pays for the insurance monthly from his pay check from the company group insurance. Hope I made sense and didn't confuse you all.

 

[Eeyores Butterfly]

We had an issue with a medical equipment company. I was givn a machine to use after my knee surgery and the insurance agreed to it. Almost a full year after the surgery I received a bill from the company who makes the device for the rental fee. Our insurance was livid because the company was specifically told not to contact us and the bill had already been paid. Thank God my dad told me that or I would have paid it and been none the wiser.

 

[Piecey]

I get irritated with this, too.

I got my bill for my csection. Well over $10k, as expected. The hospital had computed *my* portion owed and had a "Pay By" date on it of next week (my c-section was 6-3!)...

I have two insurance companies. They'd billed secondary as primary, according to the letter. So I called to fix that and she asked me how I wanted to pay.
I told her I wasn't paying anything until it went through both insurance companies (my secondary insurance company covers maternity/delivery and my inpatient maternity care at 100% so I should owe NOTHING) and the lady gave me serious attitude because what they computed will go to collections if I don't pay.

....I was always under the impression that anything I pay I am "accepting responsibility" for so I wait until both of my forms of insurance have had their say and THEN I pay.

 

[Stitchfans]

We had an issue with a medical equipment company. I was givn a machine to use after my knee surgery and the insurance agreed to it. Almost a full year after the surgery I received a bill from the company who makes the device for the rental fee. Our insurance was livid because the company was specifically told not to contact us and the bill had already been paid. Thank God my dad told me that or I would have paid it and been none the wiser.

Funny you said cause the woman told me that the insurance agreed to the medical supplies too. Maybe I should contact the insurance and question them about this bill.

As a matter of fact I will question them about the remaining bills also if it is true that the doctors normally are suppose to write off the remainder after being paid. Like I said owing them kind of stings considering they didn't do squat.

 

[minnieandmickeymouse]

Before I had my colonoscopy I called my insurance up to ask how much it was going to cost me. They told me 130. for outpatient. Well months after I was getting bills from a doc. in my neighboring state wanting 500 for lab. work (that was the biop. taking during my colonoscopy) plus some other payments from the hospital, that was more then 130. So I called my insurance Co. up and they said I owed that other doc. nothing! They just want a piece of you so to speak. They straighten it out, and I never got another bill. Also the extr $$$ the hospital was asking for was fixed too, and I only sent the 130. in.

Every time I go to this hospital to get lab work done, they send me a bill saying something like: 150 for service. Insurance covered 120 and you owe 30.00. Well I don't owe $30. because lab is SUPPOSE to be 100% covered. So I call the insurance Co. up and they say they allowed 150. and you owe nothing. They always straighten it up for me. I just don't get it? If my insurance Co. says they paid the full 150, then why do I get the hospital saying they only paid 120??

I guess I didn't explain that I wasn't getting a FULL bill in the mail. I am always getting "this remaining amount is your responsibility", when my insurance Co. covers these services 100%.