Jew Make the Call: Doctor's Office/Insurance Edition

Scene:

You have a non-urgent issue with unknown pain in your eye, so you schedule a visit an ophthalmologist. You have never been to this doctor before. Your eye is only in moderate pain, vision is normal, and you are not worried about any long-term damage. You just would like to see someone about it in the next week or so.

The office tells you to e-mail them your insurance info in advance, and also to fill out some paperwork, scan it, and e-mail them that as well. You are told to do this so they can "verify that your insurance is taken and the visit is covered" prior to going. Obviously this sounds like a good idea, so you do it. The office manager responds to your e-mail that they've received everything. Your appointment is in 3 days, on a Friday at 4:40pm. You did not choose this appointment time -- it's simply the only time they can see you this week.

You show up to your appointment, and after waiting for about 20 minutes, they give you the bad news.

"We can't verify your insurance," says the office manager. "Apparently they close at 4:30."

Indeed, to your surprise, your insurance's customer service department closes at 4:30pm PST -- something you didn't previously know.

Then you remember that you submitted your paperwork to this office 3 days ago, so they could verify it then! Why is this happening now? Why didn't they already verify it, and call you with any issue?

You ask the office manager this question. She sheepishly admits, "We meant to do this, but accidentally put your paperwork aside and forgot to check on your insurance. When you showed up for your appointment now, we realized we hadn't done it yet, but your insurance is closed."

You ask the office manager, "Well, okay, but shouldn't you know if you take my type of insurance?"

"Oh, we do," she says. "But we have to verify that you're still enrolled and everything is valid."

You then ask what they're asking for you to do at this point.

"We are going to have to ask you to put up $150 in advance for this visit, which is our non-insurance rate. If we can verify with your insurance on Monday that you are really enrolled, then we will refund the difference to you." (Your co-pay is $30.)

"That's the only option? You can't just assume that my insurance is good, since it was you guys who forgot to check it? I mean, here's a valid card I'm holding right here. Look at it...", you reply

"I'm sorry," she says. "You either need to pay us the $150 in advance, or we can reschedule you to next week."

"But this whole thing was due to your office forgetting to check my insurance in advance. This is only an office visit. I'm not here for any kind of expensive test or procedure. Can't you just have the doctor see me?"

"We can't do that, I'm sorry. That's policy," she coldly tells you.

"How about you take a copy of my credit card, but agree to only charge it on Monday in the case that the insurance isn't valid? I'll be glad to sign a paper authorizing that."

"We can't do that," she says. "Once again, either pay the $150 now, or you can reschedule."


What do you do? For your information, this is a small office, and the office manager is the doctor's wife. There are several other ophthalmologists in the area, all of whom are unaffiliated with this doctor.

Answer poll above.

this is an awful doctor. i've never heard of something like this. usually doctors will charge you the copay amount and then note that you're responsible in the event insurance doesn't cover it. but making you pay the whole amount up front? that's unheard of in my experience

edit to note i would have paid it only to save myself some inconvenience and it wasn't that much money

Quote:

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Originally Posted by Dan Druff

Scene:

You have a non-urgent issue with unknown pain in your eye, so you schedule a visit an ophthalmologist. You have never been to this doctor before. Your eye is only in moderate pain, vision is normal, and you are not worried about any long-term damage. You just would like to see someone about it in the next week or so.

The office tells you to e-mail them your insurance info in advance, and also to fill out some paperwork, scan it, and e-mail them that as well. You are told to do this so they can "verify that your insurance is taken and the visit is covered" prior to going. Obviously this sounds like a good idea, so you do it. The office manager responds to your e-mail that they've received everything. Your appointment is in 3 days, on a Friday at 4:40pm. You did not choose this appointment time -- it's simply the only time they can see you this week.

You show up to your appointment, and after waiting for about 20 minutes, they give you the bad news.

"We can't verify your insurance," says the office manager. "Apparently they close at 4:30."

Indeed, to your surprise, your insurance's customer service department closes at 4:30pm PST -- something you didn't previously know.

Then you remember that you submitted your paperwork to this office 3 days ago, so they could verify it then! Why is this happening now? Why didn't they already verify it, and call you with any issue?

You ask the office manager this question. She sheepishly admits, "We meant to do this, but accidentally put your paperwork aside and forgot to check on your insurance. When you showed up for your appointment now, we realized we hadn't done it yet, but your insurance is closed."

You ask the office manager, "Well, okay, but shouldn't you know if you take my type of insurance?"

"Oh, we do," she says. "But we have to verify that you're still enrolled and everything is valid."

You then ask what they're asking for you to do at this point.

"We are going to have to ask you to put up $150 in advance for this visit, which is our non-insurance rate. If we can verify with your insurance on Monday that you are really enrolled, then we will refund the difference to you." (Your co-pay is $30.)

"That's the only option? You can't just assume that my insurance is good, since it was you guys who forgot to check it? I mean, here's a valid card I'm holding right here. Look at it...", you reply

"I'm sorry," she says. "You either need to pay us the $150 in advance, or we can reschedule you to next week."

"But this whole thing was due to your office forgetting to check my insurance in advance. This is only an office visit. I'm not here for any kind of expensive test or procedure. Can't you just have the doctor see me?"

"We can't do that, I'm sorry. That's policy," she coldly tells you.

"How about you take a copy of my credit card, but agree to only charge it on Monday in the case that the insurance isn't valid? I'll be glad to sign a paper authorizing that."

"We can't do that," she says. "Once again, either pay the $150 now, or you can reschedule."


What do you do? For your information, this is a small office, and the office manager is the doctor's wife. There are several other ophthalmologists in the area, all of whom are unaffiliated with this doctor.

Answer poll above.

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Reschedule and give them an invoice for $150 for wasting your time.

This is pretty shitty service. If there are other docs in the area, I'd visit one of those and tell these guys to fuck off. If they are this incompetent from the get go, who knows what else is in store for you.

And like Blake said, the proper thing to do would be to charge the copay and let the customer know that they are responsible for the rest if it if insurance doesn't cover it.

Most insurance companies have electronic verification systems in place for providers to use. This means that they can verify insurance 24 hours a day with the swipe of card or entry of some keystrokes. Your provider should be aware of this.

There is another option: Pay via credit card and do a Credit Card dispute if they do not refund the difference.

I picked pay now and trust them.

Only because I want to see the fallout.

Tylenol and a bag of frozen vegetables used as an ice pack.

You're welcome.

Surprised you were able to go to a specialist without a referral, or is that a benefit of Obamacare?

I legit think they forgot to run your paperwork and if you would pay the $150 it would have been refunded to you the next week.

But then they have $150 of your money for a week, interest free....Hmmmmm.....where have I heard that before?

Pay to be seen, only because finding a doctor and getting an appointment could have you waiting weeks with unknown pain and it's just $150.

Out.of principle, yes fuck them but time is money.

Where's the "move to Canada" option.

Oh wait, I forgot our system is the absolute worst in the world.

Quote:

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Originally Posted by JoeD

Tylenol and a bag of frozen vegetables used as an ice pack.

You're welcome.

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The best ice pack for an eye is a full, unopened can of beer from the fridge.

This is from much experience. You're welcome.

so to be clear, you had a pain in your eyeball that was bad enough to send you to the doctor, but when told that due to an office fuckup you would have to front (not pay, front) the $150 to get it dealt with until they can validate your plan, you were like, WOW WHAT A DILEMMA WHAT SHOULD I DO OMG SO FUCKED UP

reschedule next week...its not like you have anything important to do


btw, next freeroll, let's play draw poker, One-Eyed Jacks wild

Quote:

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Originally Posted by GrenadaRoger

reschedule next week...its not like you have anything important to do


btw, next freeroll, let's play draw poker, One-Eyed Jacks wild

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id fucking love to see a draw game freeroll.

Quote:

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Originally Posted by Hockey Guy

Quote:

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Originally Posted by JoeD

Tylenol and a bag of frozen vegetables used as an ice pack.

You're welcome.

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The best ice pack for an eye is a full, unopened can of beer from the fridge.

This is from much experience. You're welcome.

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Can't argue with Cerveza Fria

Some points of clarification:

Quote:

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Originally Posted by 1marley1

Go to your primary care doctor. Get a referral. Go to specialist. Done.

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The 1990s called. They want their Managed Healthcare model back. That's not how PPOs have worked for a long time. You do not need any referral to a specialist on these plans, and haven't for like 20 years. You just figure out the specialist you need, and make an appointment with one. Saves you a needless trip and co-pay. At least that's how it works in California and Nevada. Maybe other states are different.

Tight red rep, though, as always.

Quote:

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Originally Posted by sonatine

so to be clear, you had a pain in your eyeball that was bad enough to send you to the doctor, but when told that due to an office fuckup you would have to front (not pay, front) the $150 to get it dealt with until they can validate your plan, you were like, WOW WHAT A DILEMMA WHAT SHOULD I DO OMG SO FUCKED UP

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The pain was moderate, and I was on the fence about whether I should even bother going to the doctor, or if I should just wait and see if it got better on its own. You can't run to the doctor every time something doesn't feel quite right, and in fact doing so can be harmful, as you sometimes end up treating non-problems (since most doctors want to take SOME action in order to satisfy the patient).

If I felt there was an urgency, obviously I would have paid the $150 without even debating what to do. Here there was not.

HMO's still require a referral to a specialist and prior auth.

Any provider who is in network should just see you anyways if they fucked up. Also seriously who doesn't have real time eligibility? I'd tell them to fuck off and then go straight to the internet and complain.

Quote:

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Originally Posted by Dan Druff

Some points of clarification:



The 1990s called. They want their Managed Healthcare model back. That's not how PPOs have worked for a long time. You do not need any referral to a specialist on these plans, and haven't for like 20 years. You just figure out the specialist you need, and make an appointment with one. Saves you a needless trip and co-pay. At least that's how it works in California and Nevada. Maybe other states are different.

Tight red rep, though, as always.

Quote:

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Originally Posted by sonatine

so to be clear, you had a pain in your eyeball that was bad enough to send you to the doctor, but when told that due to an office fuckup you would have to front (not pay, front) the $150 to get it dealt with until they can validate your plan, you were like, WOW WHAT A DILEMMA WHAT SHOULD I DO OMG SO FUCKED UP

---

The pain was moderate, and I was on the fence about whether I should even bother going to the doctor, or if I should just wait and see if it got better on its own. You can't run to the doctor every time something doesn't feel quite right, and in fact doing so can be harmful, as you sometimes end up treating non-problems (since most doctors want to take SOME action in order to satisfy the patient).

If I felt there was an urgency, obviously I would have paid the $150 without even debating what to do. Here there was not.

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But you did go to the doctor for this, so there was urgency. Most of us would just cough up $150 just to not have to repeat the process of carving out a window of time out of work or social obligations to knock this out.

Not a concern for you since you don't work and enjoy being in these situations, but most of us for that figure would just pay and go with it.

Also, being kind to front desk people can also be to your benefit, especially at some mom and pop operation. If your forum presence is any indicator, you probably come off as entitled and obnoxious.

Everyone wants to stick it to people like you in these spots.

Okay... now that this has been up for about 15 hours or so, time for a confession.

The story is real, and I am the patient involved in this story, as you might have guessed.

However, it did not occur in 2019. It occurred in 2010, in Las Vegas. Some of you with good memories might recall this discussion because I created a thread on Donkdown about it at the time.

The matter came to my mind again because I was discussing with a Vegas friend about a semi-similar billing/insurance related dilemma they were having, and I told them my 2010 experience.

So why did I run to PFA to post this thread, when I already posted the story to DD nine years ago?

I was curious the type of response I would get from today's PFA crowd versus the 2010 DD crowd. I also figured that few of you (if any) would remember the 2010 post, because the situation wasn't really interesting or memorable (unlike, say, tomatoes on the side or the Babies R Us bathroom).

Credit to the great minds at PFA, though. The response in this thread is much more positive than what I received on DD at the time.

A sample of responses I remember from DD (I'm paraphrasing, obv):

"You should be happy they even gave you the option to reschedule. They would have had the right to charge you for a missed appointment if you refused to pay the $150 and see the doctor, so they were actually doing you a favor!" (This guy was totally incorrect, btw.)

"Druff acting entitled again that businesses need to cater to his every whim and desire."

"What the fuck do you expect from an appointment at 4:40pm on a Friday? Of course you should pay them the $150 in advance if your insurance company has such crappy hours for authorization checks."

"What were you afraid of? That they were somehow going to steal $120 from you? Paranoid Jew..."


These responses were not from the usual trolls, but rather from people who were typically positive or neutral towards me!

In fact, I remember having a difficulty finding a single person agreeing that the office was behaving in an unreasonable on unprofessional fashion. I felt like I was in the Twilight Zone.

In the next post, I will reveal what I ended up doing, and my reasoning for doing it.

As you might have guessed, I chose to walk out and go look for a different doctor the following week.

Why?

blake's post sums it up pretty well. Their behavior was very non-standard. Most places will simply collect the co-pay, and then have you sign a form that you will pay in the event that your insurance doesn't cover the visit. While a small percentage of offices will require verification of validity of insurance in advance, this is more of the exception than the rule. Additionally, since this was just an office visit, they weren't risking very much if the worst case occurred, and my insurance wasn't actually valid. (Demanding proof of valid insurance would be more reasonable if, say, I were there for a $3000 test or procedure.)

Since their inability to check my insurance was their own fault (by their own admission), they should have just waived that requirement, because I had a valid-looking card, and it was very likely to be good anyway.

Note that I also tried to invent some workarounds which could protect both sides. I offered to let them make a copy of my credit card, and that I would sign a paper authorizing them to charge $150 on Monday in the event my insurance was found to be invalid. The office manager (doctor's wife) refused. She couldn't even explain why, other than saying, "It's not our policy to do that" over and over. It was pretty much just a power trip for her. She wasn't interested in coming up with logical solutions.

I walked out stating that I would never visit their office again, and would warn my friends about their customer-hostile practices.

I figured I would call other offices on the following Monday, and schedule an appointment. Then Monday came around and my eye felt better, so the entire thing was moot.


Now, you might be asking WHY I was so opposed to giving them the $150 in advance, especially given that I already would owe a $30 co-pay anyway if I went forward with the appointment. Did I really think that a doctor would steal a paltry amount like $120 from me?

The answer is: Yes!

Medical billing is a disaster in the US. It's actually the area which needs the most reform, yet is almost always overlooked in the endless healthcare debate nowadays. There are a ton of coding tricks where they can bill for multiple things from what appears to be a simple office visit. This isn't just the concern with the scammiest and shadiest doctors. Unfortunately, multiple-coded visits have become an industry-standard billing procedure, and even the "honest" doctors will often do it. A good example is the annual physical trick. The doctor will ask you if you "have any other concerns". If you dare answer the question, your "free" physical suddenly costs you money. If you reply, "Well, my stomach hurts sometimes", you will be billed for a GI exam. This sort of crap is incredibly common.

So back to my situation in 2010. When doctors pull this multiple-coding crap, you have the power as the consumer to refuse to pay the bill. You can call up, argue, and demand they take off the multiple codes, and return the bill to what you thought you were going in for. Your only power lies in the fact that you haven't paid yet, and they risk you giving them the middle finger and paying nothing (even the money you fairly owe them) if they won't play ball and be reasonable.

Once a doctor's office is holding excess money of yours, there becomes a HUGE temptation for them to multi-code, since they're already holding your money. It's a hell of a lot tougher to get a patient to pay a bullshit medical bill than to simply withhold his refund for supposed extra charges accrued.

Therefore, you should never, never, never, never ever pay any doctor even one penny more than what you are going to owe, or otherwise you might as well tattoo CHUMP on your forehead.