My Doctor’s Office Crazy Billing Experience

Doctor Billing and Insurance! Out of pocket is more than they get from the insurance companies?

Much to my chagrin, my loving wife made an appointment for me to see a skin cancer dermatologist. She was concerned about some dark spots on my neck.

I hate going to the doctor, I am not a fan of paying doctor fees and I don’t really want to deal with the fact that my skin may have gotten too much sun.

Well the doctor was nice and also a golfer so he could relate to my time in the sun.  He pointed out that my skin had plenty of sun damage (no cancer yet) and I should apply sunscreen (SPF 30 was recommended) everyday. That will minimize future damage and may even reverse the existing damage.

The interesting part came when it was time for me to pay the bill:

I have a $5,000 deductible plan with Blue Cross Blue Shield (BCBS).

When it was time to pay the bill, I asked them what I owed and the woman at the front desk didn’t know until she got the billing code from the doctor’s report.

She told me that they would be billing BCBS $229.  I asked her what it would cost me if I didn’t want to run this through my insurance.  She had to find her accounting supervisor to find out.  After some checking, the supervisor quoted me a cost of $189 if I paid them directly, without running it through BCBS.  If you wonder why I might not want to run it through BCBS, keep in my that I have a $5,000 deductible and will be paying 100% the bill without a co-pay either way.

I don’t like to run minor doctor appointments through insurance. I want to keep my annual insurance premium increases down as much as possible.  Putting this claim through my insurance might end up costing more in the long run. Increased monthly premiums than the ($189-$115) $74 I save by running it through BCBS and getting the PPO discount.

I wasn’t satisfied with my two payment choices.

I called BCBS and asked the claims department what they were going to pay the doctor if my claim was submitted.  At first, they told me they couldn’t tell me until the claim was submitted, but I wouldn’t take that for an answer.  I then provided BCBS with the Dr. ID #, the procedure code and the diagnosis codes.  Thirty seconds later, I had my answer.

BCBS would allow for a $115 payment to the network doctor for this visit.

Aha, I thought.  I informed the office accountant that they would be receiving a check for $115 from BCBS for this visit if I put it through my insurance. Based on that information, I offered to write them a check right now for $115 since that is all they would get from BCBS.

Guess what they said?  They said “no”! The Doctors office would rather have it run through insurance.  “Really”?  I couldn’t believe they wouldn’t want their money now.  Not a lot of business sense.  You would think the doctor’s office would want to minimize the use of insurance in this case, because that means more paperwork and manpower expense for their business.

I choose to roll the dice and run it through my insurance and pay the $115. When the bill comes in about 60 days, rather than pay the $185 to keep it off my record and hope that it doesn’t increase my premium.

Why bother going through this whole exercise to end up putting the claim through my insurance company in the end?

I want doctor’s to have to openly post the cost of basic services so consumers know what they charge before we agree to set an appointment.  The only way this will happen is, if people have to pay for basic medical expenses out of pocket. The way many people pay for dental expenses.

I believe insurance is for large, unpredictable and unavoidable expenses.  Having a high deductible plan has saved me about $20,000 in premiums (net of claims) over the best 5 years.  If more people had medical insurance like this, they would insist on knowing what basic, everyday medical appointments cost.

This would make for a competitive market for basic Dr. services and consumerism would rule the day.  In the end, we would all save a lot of money due to the competition that would be created.

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  2. Brad
    That was an excellent article on the doctor/insurance process. Thanks for taking the time to write it.

    Hopefully you forwarded it to Governmental leaders, and some of their constituents read and hassle them about it.

    Then again, it would be used by some to advocate for efficiency with single payer. Without a competitive insurance market and visible doctor fees there is little chance for improvement.

    Keep pushing!


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