OT- Dr. Charges | Arthritis Information

 

Opinions please-

you should pay.  I assume your husband is the primary person on your insurance, as a result his waiver signature covers all persons covered on his policy.   it is your responsibility  to know what your insurance pays not your doctors and if your son is still on your insurance policy and a dependent on your taxes then you are ultimately responsible for the charges at the doctor.   If your son is an adult he pays his own charges.   How do you know what the doctor performs as part of a physical ...you ask.  How do you know what your insurance covers as a physical..you ask. It sounds like the dr. has covered the bases on this one, so you are responsible and have learned the lesson the hard way, unfortunately.  I think they could be nice about it, instead of rude, because I'm sure other patients will have this issue going forward.

Our ped does eye and ear exams every annual checkup, and so far it has been covered.  A separate person does them, so I can see why a separate charge would come up.  Since my JRA daughter sees a ped opth every three months, I refused the eye exam last time because it seemed unnecessary and the ped agreed.  I don't know if it saved anybody any money, but it did save time.   

I hope what you have communicated with them will at least make them more careful about letting patients know certain things might be covered up front.  For example, when you make a well visit appt., they could say 'we like to do a vision and hearing screening that might not be covered, so please check with your insurer prior to the visit'.  Then you could make an informed decision.

I bet insurers don't to want to cover them, now that so many schools do annual screenings?
Suzanne2008-05-10 09:25:53Ouch. Sorry you got stuck with the bill and I understand why you don't think you should pay. However, it was a service the doctor provided and he does deserve to be reimbursed. He definitely did not have to be so rude though! You might try calling your insurance company to see if they can adjust the claim and if that doesn't work, speak with the billing department at the doctor's office to see if they can provide prompt pay discount for a balance paid in full. Actually I am the primary person on the insurance I wouldn't pay!!  I think he was trying to milk money from you.. esp if his letter was that nasty.. and legally he has to send your patient records, to other drs.. whispered I think you should pay. I've always thought that it's my responsibility to know what my insurance does and does not cover..Have you talked to the insurance company? I got charged for a lead screening at my son's 4yr old checkup. Insurance said it was not necessary. All I knew was that every 4yr old I knew had had this done so I thought it was part of the routine physical. After talking to the insurance company they said that the office had keyed it in wrong. She changed the code and then it was covered. Something like the screening alone was not necessary but in conjuction with other things it was...whatever.

If it is still say it was not needed-then you gotta pay. I hate that your son is caught up in this but I guess it is a life lesson for him as well.I agree you that you need to know what your insurance covers but how far into detail do you have to go? I researched that a physical is covered on a yearly basis. I booked a physical- part of the physical was not covered. My insurance company did not tell me parts of a physical may not be covered- the doctor did not tell me parts of the physical may not be covered. The isurance company got paid their monthly premium, now the doctor got paid for the yearly physical from the insurance and is going to get paid by me for the unnecessary procedure performed. PS wanttobe - I disagree with your statement "dr's offices know what is covered and what is not".  Everyone's insurance coverage is different.  One person with Blue Cross Blue Shield may have coverage for that test, and another does not.  It is YOUR responsibility to ask the doctors office what tests will be performed and it is YOUR responsibility to call your insurance company or look through your book or go online to see what is and what is not covered.  It's only a charge?  C'mon, pay the bill.  I wish I would have had hearing screenings when I was growing up.  Perhaps someone would have caught the hearing damage I have in my left ear - presumably from ear infections, but who knows?

It was discovered when I was 25 and went to work at Nutrasweet.  I had to have a complete physical, including hearing and vision tests before starting, and then once a year thereafter.

Also - many kids today are damaging their hearing with MP3 players.  I would much rather spend the on it now and find out if there is damage being done.
Debra Actually, it's not really the insurance company that dictates service payment. Groups/Employers who purchase insurance plans are able to select what services they want to deny/cover and at what covered cost to the patient. There are "cookie cutter" type plans that can be selected, but the majority of large groups/employers vary from the norm. (That just my experience working for an insurance company.) [QUOTE=wanttobeRAfree] JasmineRain,  [QUOTE=kweenb]JasmineRain,  also don't forget that while the insurance person may know what has been paid previously the doctor himself usually doesn't.  Thats why he has a billing clerk.   Most doctors habe no idea what kind of insurance a patient has.   And just because 2 patients each may have Blue Cross for example if they are bought through two different emploters the exact coverage may be drastically different.  The only thing that is the same for the doctor is the reimbursement amount for each procedure.  [QUOTE=JasmineRain]

Certainly this child is not having his hearing tested for the first time at the tender age of 18?
[/QUOTE]

#3 I recently read an article about how often hearing tests need to be performed and it wasn't necessary for my son to have one.

Wanttobe, Mrs. A is correct.  I work for a dr.'s office; one BCBS or Harvard Pilgrim, etc. is different depending on what the employer picks.  The doctor's office does not know what tests are covered unless they check on your individual plan.  Because it is your policy, it's up to you to know what you have.  I know that in our office, we don't have the staff to check on each individual coverage and the doctors offices I go to don't check for me because it is my responsibility. [QUOTE=kweenb][QUOTE=JasmineRain]

Certainly this child is not having his hearing tested for the first time at the tender age of 18?
[/QUOTE]

The odds that the dr himself wrote the letter to her or that he has any idea that a billing dispute is going on is pretty slim.  If you want to make sure the doctor is aware of your issue you have to talk directly to him

 

Oh yes it was directly from that S.O.B doctor and signed in his handwriting. It was a very insulting letter. However I had addressed my concern to the billing department.

 

Also- no it was not the first time my son ever had a hearing test but obviously it was either  not billed out as a separate charge by the doctor or maybe it was within the range of when a hearing test should be performed based on age.  I just know it never came up before.

 

The office staff and doctors at both my primary and RD practices are not like the offices some of you seem to be working at. They are most helpful and don't act like they are too pressed for time. Even though policies do vary for each insurance company depending on who you work for- historically they can see trends and are nice enough to give you fair warning that you may want to check if YOUR insurance covers this or that. I believe in "patient care" across the board- not just getting "treatment".

 

It's obvious that you are pissed you have to pay.  This is a no-win conversation.  Our office goes above and beyond for the patient.  As far as your "trends".....if you worked for a doctors office you would realize how ridiculous a statement that is.  moving on.............Yes I am pissed that I have to pay for an unnecessary procedure.  I'm not trying to win any conversations.  As for making a ridiculous statement... that's the explanation my doctor's office gave when informing me I may want to contact my insurance company to see if a certain procedure was covered.

 

[QUOTE=JasmineRain] [QUOTE=kweenb][QUOTE=JasmineRain]

Certainly this child is not having his hearing tested for the first time at the tender age of 18?
[/QUOTE]

 

I have no idea, but even this statement in WTB's original post would still make me question why the doc ran the test.

 

#3 I recently read an article about how often hearing tests need to be performed and it wasn't necessary for my son to have one.

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Again, I would tend to put more faith in my doctor than in an article (newspaper? Cosmopolitan? New England Journal of Medicine?) I read.
[/QUOTE]

 

I can understand why you are so passionate about this subject, really I do. 

 

I was never blessed with children.  Maybe things are different for children's physicals or maybe things have changed since I was a young adult, but I swear that hearing tests were NEVER part of my yearly physicals.

 

[QUOTE=wanttobeRAfree]Yes I am pissed that I have to pay for an unnecessary procedure.  I'm not trying to win any conversations.  As for making a ridiculous statement... that's the explanation my doctor's office gave when informing me I may want to contact my insurance company to see if a certain procedure was covered. may be a part of a well-child appointment. In most hearing tests, your child responds to how well he or she hears a series of tones or words (subjective testing). Hearing is also tested by examining your child's ears or by using an instrument to measure how the ears react to sound (objective testing). In objective testing your child is not asked to respond to sounds. The Committee of Practice and Ambulatory Medicine and the American Academy of Pediatrics have recommended that:²

• Newborns' hearing should be tested with a hearing test (objective testing).
• Children ages 1 through 12 months should be tested by asking you about your child's hearing.
• Children at 15, 18, and 24 months and 3 years should be tested subjectively.
• Children 4 years old should be tested objectively.
• Children ages 5 to 10 years old should be tested objectively at 5, 6, 8, and 10 years old.
• Children and teens ages 11 to 21 should be tested objectively at 12, 15, and 18 years old and be tested subjectively at the other yearly checkups.

Yes, you should pay.  If your son (who is 18) wasn't sure if they should be testing his hearing, why didn't he ask the dr?  Or, why didn't he call you?  Why didn't you go with him so you could question what was being done or not done.  It boils down to personal responsibility.  It is your responsibility to know what your policy pays for and if your son is still on your policy, to know what is done for him during the visits.

Pay it and move on.[QUOTE=Debrakay]  As far as your "trends".....if you worked for a doctors office you would realize how ridiculous a statement that is.  moving on.............[/QUOTE]

 

Across the board, our providers see "trends".  I've been told a lot to check and see if it was covered, or that my insurer might not cover it, or seen surprise expressed that our insurer DID cover it.....moving on.......

 

Edited to say no instructions for physicals/annual well visits.

Suzanne2008-05-10 18:23:43My two cents on this is that it is a nominal amount of money. Is this worth it?

I had a charge like this about three years ago. It was part of an approved procedure--between me and the doctor's office back and forth with the insurance company and the hospital. The hospital didn't get approval for an X-Ray during an approved  pre-surgical health screening. Must have spent untold hours of my time alone. It was the hospital's fault for not getting approval knowing full well I am on an HMO and that needs approval as a separate procedure. They knew that. The insurance company said no and I really bent over to try and get them to pay up. They didn't, so neither did I. When the collection agency called last, I told them they owed me for the hours that I did their work--even at minimum wage they needed to cut me a check. Haven't heard from them since. I think this is an important topic for all of us - it underscores the need for everyone to be in charge of their own healthcare team. For me personally, although I love the girls at the doctor's office (I've known them all my life), I know they make mistakes.  Everyone does. I double-check to make sure lab results and records are exchanged between my doctors, and that test/xray orders get to the appropriate facility before I do.  And I know I am ultimately responsible for the bill.  I've called our insurer on a number of occasions to inquire about coverage - prior to receiving the test or treatment in question.  That way there is less chance of a surprise.

OK- lots of posts since I was last on- I'll try to address them

 Yahoo Guidelines: Not sure what are objective/subjective reasons for a hearing test ( but I found the article I read. It was just written by a pediatrician ( so...maybe no expert) and they pretty much said every other year until 11- teens aren't tested unless there are specific concerns. There were none. It sounds like the two are in agreement.

 

What's really bothering me? The nasty, insulting letter the doctor wrote.  I didn't write a nasty note to the billing department. I just told them that I had contacted my insurance company to see why the hearing test was not covered and they said they do not cover this during a routine exam. Since I scheduled a routine exam I felt I should have been notified that a non-routine test would be performed. Since I wasn't- I didn't feel responsible for the charge. 

His letter was so harsh it gave me a migraine headache. So after being treated so rudely by the doctor the bill is just a sore spot. That's OK though- as some of you stated it's just not worth it- not worth stewing over or getting a bad credit report over.

I will simply send a check and a letter stating why I am having both sons records transferred and tell him I hope the and his ranting was worth losing two patients over.

Phat Girl- do you have young adult children? Why didn't he ask the doctor why he was doing a test, why didn't he call me? Please. Why didn't I go with him? I haven't even gone inside the examining room since the boys were 14 because they need privacy and to build their own patient/doctor relationships. Up until 18 the doctor will then speak to the parent about any significant problems- but not at 18.

Lastly- again -I do make it my responsibility to know what is and what isn't covered by my insurance company but how would I know that when I scheduled a routine physical (covered), that I needed to ask if non-routine tests would be performed during it?

I am going to move on at this point...because I realized that I actually have a lot to be thankful for. The rest of the practices we use are exceptional from what I read here. Who could ask for anything more? I have always thanked them and complimented them on their services. I feel that is just as important as having to make a complaint.

 

 

 

 

YOUR QUOTE:  Why didn't I go with him? I haven't even gone inside the examining room since the boys were 14 because they need privacy and to build their own patient/doctor relationships. Up until 18 the doctor will then speak to the parent about any significant problems- but not at 18.

Actually, I didn't say anything about going in the exam room with them.  But as you said, "they need to build their own patient/doctor relationships".  You 18 YR old son agreed to this test.  Get over it.  Pay the bill and move on. 

One other thing..you keep assuming that this was part of his physical.  How do you know?  Did your son complain about some type of problem while he was in the exam room BY HIMSELF?  You don't know what was said between patient and doctor because it is confidential.  Chalk it up to a lesson learned and move on. 

One more thing....if you have used this dr. for several years, why not step back and really evaluate this issue.  This *might* be simply a situation of you not getting your way and throwing a fit.  If he is a good dr, why move your children?  Besides, if they are adults, don't they get a say?

Maybe you could sit on this decision for a couple of days before you start firing off nasty notes to the dr and moving their care.

 

Geez, I can't believe half of what I've read.

 

Quoting Jonathan, WTB is not the problem here.

phat girl

 

I just added the info about the boys building their dr./patient relationship I was adressing your comment about attending the appointment with an adult child.

I did ask my son when I received the bill aboutthe circumstances...there were none. I'm not an ignorant fool.

By the way- neither of them care for this doctor - I did give them the courtesy of a choice in the matter.

Who said my letter to the doctor would be nasty? It will be factual of why we are leaving the practice.

Why are you so angry with me?

Why are people coming to this doctor's defense so strongly? None of you read the rude, insulting letter he wrote. he is an absolute pompus ass.

It never ceases to amaze me how some people are so supportive to some of the people that come to this board and so attacking to others.

I suspect people are on the doctors side because your original question was should you pay him.   And the vvast majority said yes.

 

Your real issue with the doctor is the letter not the charge...and nasty is in the eye of the beholder no one here can judge whether it was nasty or not cause we haven't seen it.  Most practices have a fairly blunt (personalized) form letter that gets sent when patients question a charge, which essentially says its your responsibilty to pay and if you don't we'll send it to collections.  If thats nasty then its nasty but most ding letters aren't high on pretty words

WTB,

 

The question in your original post was whether or not you should pay.  Later you added that this wasn't the first time your son had the hearing test and the insurance paid.  You wondered if it was submitted to the insurance company differently.

 

I would contact your insurance company and talk to them about this.  If it was paid before, it should be paid this time.  If not, find out why.  They will be able to tell you.  If the doctor submitted the claim incorrectly, they can resubmit it.

 

 

WTB,

Your question was if you should pay or not.  I answered your question.  You have spent 5 pages talking about why you should or should not be responsible for this charge.  If you spent half as much time finding out why he conducted this test or why insurance denied it, you would have your answer by now. 

I got the impression your letter would be nasty because you said you were going to send the check with a note saying that he lost two clients.  I just said that maybe a different approach would be appropriate.  It sounds like there is nothing this doctor can do to make this right in your eyes.  You have made up your mind based on what you preceive to be a nasty, hateful letter.  No one can speak on this because no one has seen the letter but you.

I am simply speaking on my experience with this issue.  I am not angry with you.  However, I think you are giving this dr a bad rap based on the information you have given.  That is all we have to go on.  None of us were there, so we have to base our responses on your post.

BTW, I never said or suggested that you were an ignorant fool.  You are entirely too defensive about this issue and growing more so each post.  This is my last post about this.  I simply stated in the post before this that perhaps a different approach might get you what you want. 

The bottom line *IMHO* is that this could have been handled very differently which would have given you a much more satisfactory outcome.

Good luck to you on resolution of this issue.

JR,,,,,

Good point, everyone makes mistakes.  Everyone, from surgeons, to clerks.  It is in our best interest to double check everything and everyone not because we are suspicious, but to help us understand what is going on. 

Exactly- I asked for people to give me their opinions as to whether or not the bill should be paid.

You answered me plus wanted to tell me a whole lot more about why my opinion is wrong- (not you alone) I did not ask anyone to judge me or for them to tell me to "get over it" or "move on".

Yes I certainly will defend myself.

There are people who simply are not reading what I have been saying. So the tone of the letter is subjective to whomever is reading it? So why am I not being given the benefit of the doubt?

 

It doesn't matter- close this thread.

 

I'm off to have a nice Mother's Day dinner with my family down the shore.

 

Hope all the mother's out there are enjoying as nice a day!

This thread is now closed!.. per want to be instructrions.

                  CLOSED THREAD

 

Wish to discuss drs', insurance companies, billling, go see New thread.

 

Gees closed allready....
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