How to reduce doctor's bill after the insurance won't pay?

Question

Hi,

I went to see an eye specialist twice for my cataract condition. He examined my eyes. Afterward, my insurance denied payments citing pre-existing condition. Then I received a $1,300 bill from the doctor.

I think the charge is excessive for two sessions of eye exams. I guess the doctor was billing me for the full price of the consultation and examinations. But I believe I should pay only what the insurance would have paid to the doctor if my insurer didn't deny payments.

How do I find out how much the insurance would have paid? Will the doctor accept that amount?

Thank you very much!!

Answer 1

Well, you can call the number on the back of your card, and just ask them what they WOULD have paid, if this hadn't been pre-existing.  If your doc is in network with the insurance company, he should accept that.

But you also have to call his office manager, and ask them to reprice the two exams, down to a cash price.  Tell them that the insurance isn't paying, and you need help with the bill.  Be sweet - you really do catch more flies with honey.

Answer 2

don't just give up fight the insurance company file a complaint with the isurance commisioner in your state

Answer 3

You can ask what the insurance would pay, but I seriously doubt the provider will accept that as payment from you. The reason being is that is a contract between the insurance and provider -NOT you and the provider or you and the insurance. You should see if you can appeal the denial by your insurance company first - if you have proof of immediate prior coverage to this policy, most plans automatically waive any pre-existing clauses.

Otherwise, your only other option is to ask the provider for a discount - it will probably not be comparable to what the insurance pays, but it should be something. (20% is generally the standard.) Then make payments.

Answer 4

Unfortunately, you as a "retail patient" don't get the group discounts that insurers prenegotiate with network providers.  You can ask the doctor for a discount but he/she is not obligated to provide it.

Answer 5

If your policy has a pre-existing condition clause, your contract does not entitle you to the contractually agreed amount.  If you can prove to your insurance company that you had pre-existing coverage with another carrier via a HIPAA certificate, you can get credit for that, and depending on the clause itself, you can use that to get the claim paid.

If you just want to know what the contractually agreed amount the insurance company would have paid, you would have to call them to ask them that question.