On principle, does this aspect of billing for medical care bother you?

Question

You have insurance. You pay for this insurance. You select a provider from your insurance company's provider directory. You go to the doctor/dentist. You fill out 20 minutes of paperwork. One of the pages says something to the effect of, "I ________________________ understand that Park East Orthopedists will bill my insurance company for charges incurred for this visit. I also understand that I am responsible for any charges incurred for which the insurance company does not pay."

True to their word; they see you, and you get a bill. Meanwhile, you probably pay more than the visit was worth in dues for one month.

Do you believe that if an insurance company makes an arrangement with a provider to pay a certain amount for a certain service, and that provider agrees to be on that plan, that you, the patient, should be guaranteed not to be billed and the provider should have to settle for the amount agreed upon with the insurance company?

Answer 1

My health insurance policy is very comprehensive, and very clear to understand.  I know what my out of pocket expenses are going to be.  I go online and find the list of doctors connected with my insurance for the service that I might need to access, say, a psychiatrist for one of my children.  My insurance tells me that I get 6 visits with no co-pay, then each additional visit will be $50.00.  I know this before I go in.



With my previous insurance, my co-pay was 30% of the negotiated rate, negotiated between the doctor and the insurance company.  It was upfront and I knew it. If I chose an "out of network" provider, my copay was 50%, which I knew upfront.  Using the network provider lowered cost for both me and the insurance company.   With my current coverage, it's much better, with no out of pocket for most services.   In either case, I've never received a "suprise" bill because the doctor didn't think they were getting their fair share.

For the record,  I'm pretty sure the line " I also understand that I am responsible for any charges incurred for which the insurance company does not pay."  is about covered services. Example, my insurance wouldn't cover laser tattoo removal, but would cover other types of laser treatment.  Therefore, I would be responsible for the charges incurred when I get the tattoo removed, but not have to pay for the other laser treatment that was covered.

Answer 2

Sort of.

It would be nice, but will never happen.

Answer 3

You are obligated to pay for services you receive.  If your insurance co. agrees to pay for a portion of the bill, that is to your benefit.  However, the doctor still needs to get paid for the remainder.  If you have a problem with that, it is between YOU and the insurance company.  The doctor has no contract with the company, but with YOU.

ETA:  Let me explain again.  The doctor is providing services.  YOU are the one receiving the services, and YOU are obligated to pay for the services.

Now, you are also opting to pay for insurance, which offers partial coverage for these services.  You are entitled to full, detailed information on EXACTLY what is covered by your insurance company, and how much.  This is all part of a THIRD-PARTY arrangement between YOU and your insurance company, and in no way releases you from your obligation to the doctor.

EDIT #2:  Wow.  You have grossly misconstrued your obligations, and those of your doctor.  Again, the doctor has agreed to accept money from the company on your behalf, but this is in NO way, in any universe, interpreted as a negotiation for a lower fee.  Their fee stays the SAME, whether or not a THIRD PARTY is offering to help you pay it.

And for the record, doctors are paid "through the nose" because of their many years of postgraduate education, their level of professional liability, and the millions of dollars they must pay in malpractice insurance.

Answer 4

Whatever the arrangement, it has to be honored.

Answer 5

blame blame blame.

you could have researched if this was the best dr. for you and if you would need to pay out of pocket before you went for services.

maybe you are not clear on what insurance is or how it works....

if you want a policy that guarantees you no matter what you will have no out of pocket expenses, you are dreaming. even if such a thing exists, it will cost more then otherwise, *and* you will not get to choose your doctor so freely.

maybe you should look into an HMO....