Is it okay for doctor's office to make you pay upfront, before billing to your insurance?

Answers:3   |   LastUpdateAt:2012-07-21 20:29:02  

Question
Evelyn
Asked at 2012-06-04 23:57:22
I have 23 weeks of pregnancy and used private insurance through my employer, for the first time, covering 80/20. I started going to the doctor in September, I paid the co-payment of the first visit. I received an EOB for laboratory services and has a bill later. I went to the doctor again a month later, had an ultrasound fact, have not been billed for anything.
When I went back for a checkup early November, I asked about the allegations. I was presented with a "contract" to sign, stating that you will pay $ 640.00 (which covers all medical consultations, laboratory tests, caesarean section, and postpartum check-up). This is 20% that I am responsible for that insurance does not cover. I explained that I will not have insurance so after my job ends at the end of the year, and I will take Medicaid. The office manager said it did not matter, I still have to pay $ 640.00.

When I returned again for my next appointment at the end of the month (3 days to be exact) for a checkup and another ultra-sound, he wanted half of the payment, because apparently I have to pay in full for my 7 th month pregnancy. I told them again that I will be receiving Medicaid. And again, I said it did not matter. So I went ahead and wrote a check for half.

I called my insurance provider, and they told me the doctor's office just showed up to my September visit. Now I am approved for Medicaid and have just learned that can be used as secondary insurance but come to see my OB / GYN does not accept secondary insurance.

When I arrived at the doctor's office for more answers the billing department, both the administrator and office manager denied that I have not mentioned anything about getting Medicaid. The lady who makes his billing, he said $ 640.00 was only estimated, when they present all I have to pay more. I discussed about having Medicaid, and I told them not have to pay that amount. The lady told me that the check you gave them was not refundable and I signed the contract and that I can try to switch to another doctor, that is if they will take me because I'm more than half of my pregnancy. I said that does not mention anything about being non-refundable. She said firmly, which is not refundable, and will probably pay more when presented for the 4 visits I have been.

I asked the lady, "What if this doctor is not my baby, and does another doctor?" She told me I still have to pay the $ 640.00. So I said, "So you're telling me that if I were to have my baby while I'm out of town, and another doctor at birth, the doctor still get paid, plus they have to pay another doctor? " She said: "Yes." I'm not familiar with how insurance works, but that's just ridiculous!

I'm tired and stressed out to talk to them because I still feel it is unfair. Can I get help through my private insurance, if I bring up this issue?
Answer1FerdinanAnswered at 2012-06-08 19:50:24
It is not uncommon to have to pay upfront for medical services. I infertility services and had to pay in advance all services. This is because not covered by the latch.

It is not uncommon to have medical bills related to the birth of a child. We have insurance and still had to pay about $ 1000 for our visit to the hospital.

You are not cheating . You have to pay some medical bills. $ 640 for all medical bills related to a section C and ultrasounds , etc. really is not much.
Answer2KrystalAnswered at 2012-07-01 18:29:05
Yes, it is perfectly legal - and in fact is common, when the doctor's expected that insurance is not really going to pay for any reason
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In your case , you are telling them that they will not pay, but some insurance OTHER - Medicaid - will pay, which has not yet succeeded yet. Note, Medicaid has a maximum of 9 months to pay doctors what they should , and in some states , Medicaid payments to providers are not happening at all. When paid, is a very low rate .

It would be like if I ask you to come work for me, and when I hit the lottery in six months, I'll pay . . . but you have no idea how I'll be paying, or even if I'm going to give.

In addition , if that were not flat doctor accepts Medicaid, are not paid by Medicaid.

Normally, if a different doctor the baby is born , the doctor is paid by your doctor.

Not that I will not take Medicaid as secondary - is that you don "t have Medicaid , however,
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I think they think you are trying to scam, and are trying to cover their bases.
Answer3gorky Answered at 2012-07-21 20:29:02
You are missing the bigger problem. Not all doctors accept Medicaid. If this doctor does not have Medicaid, you will have to pay 100 % ( not only the copayment of $ 640) all safe after the end of his employer. Medicaid does not guarantee the ability to go to any doctor in the world for free . If you only have Medicaid and go to a doctor who does not have Medicaid , the physician may charge the same amount the doctor charges for patients without Medicaid.
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