Ok, anyone been to a dr. that charges $450?

[luvwinnie]

I have to know. The new rheum. I'm going to charges that. My cardiologist goes to him and insisted I see ONLY him (he's not on my ins plan). For that amount , I know I will finally be ASSERTIVE with a dr. though.

 

[Pin Wizard]

Wow! I would definitely find someone on my insurance plan!!

 

[Cindy B]

You need to find one on your insurance plan, and tell your doctor that... be firm and tell him that his charge is too expensive.

 

[fkj2]

I would check your insurance plan; they usually allow "some" percentage toward the bill. As an example, in plans may cover 80% while out of plan providers may only receive 70% coverage. You need to thoroughly check the plan.

 

[jsmith]

I believe this in the ball park of the amount my SIL pays her rheum-and because she has a chronic illness she sees her about once every 3 months.

 

[SilverLily]

Also, if you do decide to go to this doctor and your insurance doesn't cover any of it, you need to ask for a reduced rate. With most insurance companies, the provider (doctor) has negotiated a cheaper rate to be part of their plan. If you paid the $450, you would be paying the "rack rate". Many times, if you explain the situation, they will give you the reduced rate that they normally accept from the insurance company. (At least, this is what my friend who works for an insurance company told me!)

 

[luvwinnie]

a $500 deductible, then I get 80% back. I've been to 2 dr's in network who were useless and I've left their office so discouraged I was in tears. I'll see about the reduced rate though! Thanks.

 

[PamOKW]

It certainly won't hurt to ask if they have a reduced rate. However, there is a move in the NY metro area for some doctors to not even take insurance and to set their own rates. They are moving more toward being boutique doctors for the wealthy. They claim they will provide better service. (Could be a topic for the debate board.)

I don't think it applies in your case, but if it were that insurance would pay less for an out-of-network doctor they also base it on "customary charges". They don't necessarily pay the percentage off of the top charging doctor's rate but of a more average charge.

 

[DocRafiki]

is that just an office visit/ doctor's fee, or does it include a test?

 

[CyranoJones]

If you are a first time patient this fee could very well fall under an initial consultation code. That fee, depending on the area, is not terribly unusual.

 

[Krisu]

Don't know what insurance you have but could you check the Provider book and show your Doctor who is in it? Maybe there might be another one he might consider. Spending $450.00 out of pocket is a bit much. They also might pay for an out-of-network Dr. but usually that is only if there is no one in your area, or if there is a valid reason your Dr. recommends him. Good luck and keep us posted.

 

[Pumbaa_]

As someone who works for a managed care organization, the odds are EXTREMELY low that this OON provider would ever be considered inplan. There are providers in her area that are participating. AND her plan covers providers out of network. There is just higher cost sharing. (We have plans that have up to a $1500 deductible before anything is covered ouch!)

You can check with your carrier before the visit to see if the whole anount will be applied to your deductible. If the cahrge is higher that the Reasonable & Customary (R&C) charge for your area, anything above that amount will not be applied to the deductible. The doctor may consider accepting that fee, but he is not required to.

I am sorry that you are having this problem finding a doctor to help you. If this doctor can, then it sounds like it would be worth the money. And once the deductible is satisfied, then the next visit would be less. You can also try to time your visits to get the most out of the year before you have to pay the deductible again.

Good luck!!

 

[CarolA]

Well, I have gone to Out of Network physicians and would do it again in a heartbeat. I had chronic hives and the only doc who has ever been able to help me was not on my plan. However, it was well worth the cost!

 

[browneyes]

I'd be looking for a doc in my insurance coverage too! How many times do you think you'll have to go see him?

 

[ckr]

(Not directed at the original poster, but rather as a look at our society in general....)

Why is $450 for a Dr who comes highly recommended and could possibly change her quality of life such a shock to us all? How many pay that EACH MONTH just to drive a fancy SUV?? Or spend that PER NIGHT on a room at WDW?? Do we have our priorities mixed up?

If she only goes to this doctor every 3 months or so, wouldn't $150 per month be money well spent if he can help her feel better? Sometimes you DO get what you pay for.

When my toddler was very sick and we couldn't find out what was wrong, I came to the realization that money did not matter. I wanted the best for her. Since that time, when seeking a referral, I always preface my question with "If I were paying cash up front for the services, who would you recommend? Is this who you would send your husband/wife/child to see?" I don't want to be referred to Dr. Average simply because he's the best one in my insurance group, but rather to Dr. Amazing because my family's health and well-being is no longer something I take for granted.

Just another perspective....

 

[luvwinnie]

You are so right. This dr. is the one my own dr. goes to so I trust he is one of the best. He is "nationally known" for research in autoimmunity.