What to do? Being charged by eye clinic WAY over my insurance co-pay

[nbodyhome]

Okay - last year, I went to a large, Orlando area eye clinic for an eye exam. They are on my insurance, so I expected a $20 co-pay. Had I known how much this COULD cost me, I'd never have gone. I hate clinics now anyway, since you never know who you will see.

As I said - I was expecting $20.00. Then, after being dialated, the guy who was doing my eyes said "oh, and it will cost you $50.00 today). I was stunned, but what was I going to do for the next hour with dialated eyes? I guess, next time I'd leave.

At the front desk, they only charged $20 - and I didn't say anything, because I didn't feel I should owe more as it wasn't agreed on in advance. I really only wanted to be fitted for glasses, I could have gone to BJ's or Sams for that (and should have). But the real kicker was that eventually I got a bill for $245.00 for what our insurance didn't pay! I think they had a doctor look at me who wasn't on the plan.

This eye clinic knew my insurance before I got there. It wasn't an emergency, I wouldn't have seen someone if they weren't on my insurance had I known. I sent them a letter, along with Cigna, a few months back - they never called me, just sent me the bill over and over again.

What would you do? I understand that in hospitals, sometimes you end up with a doctor who isn't on plan. In an emergency, I understand (though I'd hate being billed a lot when not expecting it). But this wasn't an emregency at all - I just wanted glasses and I went thinking I'd pay less than Sams Club or BJ's to get my eyes checked!

Thanks everyone! The bill is about to be sent to collections, and I am not sure if it would effect credit a lot - but I just don't feel I owe it. It's like I have a very expensive ($4000!!!) dental bill coming up - if they said it was $7000 after the fact, that wouldn't be okay with me either.

 

[tracys2cents]

Call the place as if you are a possible new patient. Ask them about their services and the charges and if they take your insurance. Ask them what your payment would be if you had such-and-such done. See what their explanation is. If they say $20 copayment is all you'd owe, then something is fishy. You could report them to the BBB or something. Usually a phone call from the BBB, stating that they're about to be written up, will get them to re-think the charges.

However, if they end up telling you that the service will be $245 because your insurance doesn't cover everything....then it was really up to you to know this from the beginning and you might as well pay it because collections can be bad news.

It seems to me that when they charged you $20 on the way out, they were pretty much telling you that's that. The $245 bill after the fact should have been mentioned at that time.

 

[disneysteve]

It seems to me that when they charged you $20 on the way out, they were pretty much telling you that's that. The $245 bill after the fact should have been mentioned at that time.

Sorry but it doesn't work that way. When you register at any doctor's office, you sign an agreement to pay the bill. When leaving the office, they might only collect your co-pay. Then they submit their bill to your insurance company. If, for some reason, your insurance doesn't cover the charges, the doctor can bill you for the balance.

I would suggest first looking at the EOB (explanation of benefits) that you got from your insurance company. See what was billed and how much the insurer paid. If they paid nothing, there should be a coded footnote giving a reason why the claim wasn't paid.

You mention sending a letter but didn't say anything about calling your insurance company. Call customer service and find out why you are being billed if the office was in your plan. Also, if you needed a referral, did you have one?

 

[nbodyhome]

I don't need a referral to go to a specialist, I can just go.

I'm just stunned, I've never been charged extra before. I'd never have gone if I'd thought that there would be an extra charge - it seems to me that I should know that someone is on my plan. It was very uncomfortable to begin with to be told that it would cost $50 right after my eyes were dialated. I wish I'd stopped everything right then.

 

[rob6597]

Then they submit their bill to your insurance company. If, for some reason, your insurance doesn't cover the charges, the doctor can bill you for the balance.

I would agree with that IF the provider is out-of-network. However, if the provider is in-network, I would expect that their contract (with the insurance company) would include a "hold-harmless" clause. That is, they can't balance bill you. (That's the way it works in Minnesota, anyway... maybe it's different in Florida?).

Check your EOB from the insurance company. It should say whether or not they are in-network... or a "participating" provider. (Call the insurance company if you can't tell.) If they aren't in-network, then you're out of luck, and you owe the balance. If they are in-network, then they shouldn't be balance-billing you.

 

[ceecee]

Call the insurance company and ask them. Check your explaination of benefits as well and see what it says. On our old insurance plan our MD would never take the w/o he was supposed to until we called the insurance company and they called. His wife worked the front desk and just didn't get the whole w/o thing.
As far as owing only what you were charged on the way out. Probably there was some sort of disclaimer type thing that you signed on the forms you filled out explaining that if your insurance did not pay then you are responsible. The office will estimate your part, but if you have a certain co-pay I'm not sure why it is so much more, check the EOB from the insurance and see what it says.

 

[EthansMom]

I agree with the others. I would call the insurance company and check to see how much was covered and why some part of it was not covered. It may be that your insurance doesn't cover some of the procedure or didn't cover some part of your glasses. I know many eye insurance plans don't cover the extra treatments (anti-scratch, anti-glare) to lenses and only cover a certain portion of frame costs, etc.... However, your insurance carrier should be able to answer your questions.

In fact, my experience has been that eye insurance coverage is so poor and expensive that DH and I are better off to do without eye insurance and pay for our exams and glasses ourselves. DH and I both wear glasses and get new ones every 2-3 years.

 

[tracys2cents]

I've never been to an eye doctor who didn't check with the insurance company, and then tell me on the way out just how much I owed. In fact, especially if I'm a new customer there, they demand full payment at that time or at the very least a hefty deposit on the balance due.

 

[arielsleepingbeauty]

When i call to make an appointment with any doctor, they ask me who my insurance company is. When i tell them the insurance company name they tell me right away if they accept it or not. This way i will know if it is covered or not. I never pay a copayment, i let them send me a bill for it so I can see what i am paying for. If i have any procedure done at a visit that is anything other than the norm, I always ask them to check with my insurance company first. When i receive a bil for anything more than my co payment I will call my insurance company to see why they didn't pay it. Most times it is an error on their part. I would definatley call your insurance company. Something my have slipped through the cracks. I had been sent to have an MRI done about 2 years ago. They ended up sending me the bill. I was furious because they had all my health insurance information prior to MRI. If it hadn't been approved then would expect that they should have told me before I had the pocedure. An MRI is thousands of dollars. Everyone I know doesn't have a few thousand extra to pay for out of pocket. I fought with the MRI company about it and haven't heard anythign about it since.

 

[shaylahc1]

I would think if the office did not take his insurance, they would have told him up front and not collected the copay If I was the OP, I would call the insurance company and see if they paid. I have had medical offices try and "bill twice" for services, or else they'll claim they have no record of being paid by the insurance company Usually after several phone calls everything is settled. Keep calling until you can find someone who can help you.

$265 seems high for an eye exam anyway

 

[nbodyhome]

Just to answer one post, that didn't include glasses - I never get glasses at a doctors office, I took the prescription to BJ's.

Cigna did cover part of the bill, I am just not sure how much. Plus I paid my $20.00 copay. The clinic does take Cigna, but from what I gather, the doctor who treated me for 5 minutes (and $245??) might not. I don't understand why they'd not tell me, they knew who my insurance was before I even set foot in the office. As I'd mentioned, I won't go to a place like this again - going to one doctor on a plan insures that they are on the plan. If I'd had any idea that this was going to cost extra, I'd have just gone to a warehouse store (I thought that I was going to save money by going to the eye clinic!) And it seemed really dishonest not to tell me that there was an extra charge (which was not charged to me) after I was stuck there. I don't know if this is how they normally run their clinic, but I was wanting to walk out (but couldn't!)

Thanks everyone, I'll check with the insurance on Monday.

 

[mamalle]

did they use that new machine where they can see the retina and any other issues like freckles and the vessels? mine has that machine now and it is not covered under insurance. so on top of my copay there is a charge. Its a great tool but since I have no issues like diabetes, etc Im only doing it every other year.. Mine will tell me upfront before they do it though so I can refuse..

 

[Cheshire Figment]

If this was part of a chain or a franchise I would go up the line to the main office. Be sure to document everything you do and get names. If at all possible go to where the services were provided and get the names of the person who took your money and the doctor.

 

[paladin]

Another thing that this could be from is your deductible. Does your plan have one? Had you met it? If not, that could be the reason for this charge.

For example, my husband recently had a test performed. Everyone involved was a participating provided (in-network) and insurance covered the test. However, since we had not fufilled our deductible for the year, we were responsible for 247.00 (in addition to the usual co-pay). As others have said, check with your insurance for an explanation.

 

[disneysteve]

The clinic does take Cigna, but from what I gather, the doctor who treated me for 5 minutes (and $245??) might not.

If this is the case, I don't think you should be responsible for the extra charge. They knew what your coverage was and should have assigned you to a doctor who accepted that coverage.

mine has that machine now and it is not covered under insurance. so on top of my copay there is a charge.

If they provided a service that wasn't covered by your plan, that could certainly generate an extra charge. It would have been nice for them to tell you that upfront, but they may not have known it wasn't covered until after they submitted the bill and got the denial. We don't always know upfront that a service we provide will have payment denied when we submit the bill. We deal with dozens of different insurance plans, all of which have slightly different coverage arrangements, and those arrangements frequently change. In fact, sometimes we will get a notice from an insurer that as of, say, August 1st, procedure X is no longer covered. That's nice, but sometimes that notice doesn't arrive until August 15th. Any bills we've submitted up until that time get denied.

Another thing to consider is that there was a simple billing error. A claim could have been incorrectly filed. A diagnostic code could have been left off making the claim "not medically necessary." That's why you need to call Cigna and find out why the claim got denied.

 

[nbodyhome]

did they use that new machine where they can see the retina and any other issues like freckles and the vessels? mine has that machine now and it is not covered under insurance. so on top of my copay there is a charge. Its a great tool but since I have no issues like diabetes, etc Im only doing it every other year.. Mine will tell me upfront before they do it though so I can refuse..

I didn't notice anything really different from the last time I had my eyes done (elsewhere). The ony real difference is that I had to go to like 4 different rooms to get everything done by like 4 different people. I believe the problem is that the doctor has nothing to do with Cigna, but the clinic does. That doesn't make any sense to me whatsoever. I will find out for sure on Monday, though.

As far as a deductible - we didn't have anything else done last year that wasn't covered on-plan (i.e., all tests were covered, all doctors visits were the regular co-pay).

 

[Skatermom23]

did they use that new machine where they can see the retina and any other issues like freckles and the vessels? mine has that machine now and it is not covered under insurance. so on top of my copay there is a charge. Its a great tool but since I have no issues like diabetes, etc Im only doing it every other year.. Mine will tell me upfront before they do it though so I can refuse..

They use this instead of dilating your eyes which is great but my doctor charges an extra $30 to do so. I have to sign a paper agreeing to the procedure and cost prior to doing it. I agree with everyone else, you need to call the billing office at the clinic. They may have just made an error.

DD has been seen recently for contacts and I noticed that they charged me a $10 co pay for the exam. Well it is a contact lens fitting exam (which doesn't have a copay) and not an eye exam. I called and they corrected it right away. Sometimes you just need to talk to the right people.

 

[dcfromva]

nbodyhome,
The key here is to get your Explanation of Benefits from your insurance provider without delay. If you misplaced your copy, ask your insurance company to send you another one (FAXing it to you, if that is possible).

The EOB should explain whether or not you have met your deductible (if any) and how much you are responsible to pay. If it says $20.00, fax the EOB over to the Drs. billing office. If it says more, call the ins company and tell them what happened and ask why it could be so much more. It could be a simple coding mistake or maybe you don't owe more. Hopefully, they will be able to get this resolved.

Obviously, you don't want to put this off because of the collections thing, but also if the Drs office failed to file an insurance claim in the first place (which is another possibility)--some insurance companies only give you 1 year from date of service to file a claim.

-DC

 

[rocky41102]

I'm not sure if this was mentioned before, but I have never heard of a general eye exam for glasses costing $245 let alone adding extra on for the copay you already paid and the part your insurance paid. Even when I had a specialist look at my eye for a serious problem, it didn't cost that much. Generally eye exams are no more than $100 or so. Is it possible they did some type of medical exam by mistake and not just the general exam where you look at letters on the wall and blow air in your eye? I definitely agree with everyone else about reviewing your EOB. Compare it to the billing statement you got and it should tell you exactly what the charges were for. Even if that one doctor wasn't associated with Cigna, eye exams shouldn't be that much.

 

[Dznypal]

we had something similar happend only our bill was $1000!!!!!!!

my DH dr is in our network--he sent DH to anothe dr to have some test done

the office did some tests but instead of sending DH to a covenant lab they did the lab work at the aurarua lab which was out of network.

we tried fighting it but it was "our problem".

I was so mad that I took a baggie and put $50 in singles and 0.95 in pennies (since the bill ended in 0.95) and took it to them in person and said I was paying it in protest!!!

When I called they werent very nice either.

I have had this problem of the dr not sending you to the right place--

I hate dealing with insurance!!!!!