Quote:
Originally Posted by bbbbmw
An MRI is almost always pre-approved - the provider calls your insurance and figures out:
- what the procedure will cost,
- what discount has been pre-negotiated by your insurance,
- what the net balance will be that you will owe.
That's the paper you got. Yes, it's an estimate, but it needs to be within a reasonable range. They collected it up front, so you should be off the hook.
For this to happen, the provider has likely billed it incorrectly to the insurance company. Consider:
1. Call your insurance company and ask them to review the claim. If it's a coding error, they can likely spot the error right off the bat, and give you some idea of the error. You then call the provider and tell them to re-bill it correctly. The provider has usually 60-90 days to do this.
2. If it's correct, then call the provider and tell them you paid according to a reasonable estimate that you were given. You can see a 10% variance, but not 250% - tell them you will pay another $69.00 max. Do this before it gets turned to collection.
3. Call the doc directly and explain what happened. You should also get a survey, which is very important to them. There's also rating on healthgrades.com.
4. Call your insurance company if they don't resolve this, and ask them to intervene. You can also file an appeal with your insurance, to have it formally reviewed.
This is what I'd do if I were you and I'm speaking on a personal level of what I solely would do and not giving any financial/legal advice.
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What I found interesting is I noticed the paper only lists one thing although I had MRI and EKG. I signed no other paper. On the insurance side it shows both procedures, but MRI basically shows the plan discount to be the entire amount of the MRI so it shows I owe $0 for the MRI. Then on the EKG it says it was billed as $2,893.00 and the plan discount is $906.08 and I owe $1,986.92. Seems weird the MRI is basically not charged at all.
My old doctor use to do the EKG right in the office on some old machine he had. Never had any issues with it, never got some crazy bill from him for the EKG. Unfortunately he retired and new doctor doesn't have any of that stuff in the office.
I think I'm just going to pay the $150 and fight the $1200. I have never had this issue before even with my crappy individual health plan. Next time I will make damn sure I get an exact number before I let them do anything and I sure as shit will not be doing anything at that hospital again.