VeryCoolSpouse needed an extensive set of tests. There is only one specialist in our state that does said tests and takes our insurance. VCS called to make an appointment and was told there would be an additional $8,000 in charges. To make a VERY long story short, and skip to the literal bottom line, the insurance company has a negotiated rate with the Dr.–he is obliged to do the procedure for that rate–but he can bill us for whatever he wants and if we pay it too bad for us.
VCS got the tests, we did NOT pay anything extra, the Dr. had to go home with the money the insurance paid him, and VCS is now on the proper medication.
Re: the OP “My portion after insurance was $478.00.” If you’ve paid, you’re probably stuck now, but Aetna is generally a good plan and most likely you didn’t have to pay that $478.00. I’d check into it with my insurance person next time.
One of the problems is exactly that the large insurance companies have negotiated reduced rates. So, the hospital charges (I’m making these number up) $1000 for some service, but if you have this insurance, it’s only $600, and if you have that insurance, it’s $650.
Basically, that means that you’re screwed if you don’t have insurance. The very people who SHOULD be paying less, are paying way the hell more.
When my insurance declined further physical therapy and stopped paying the bills, the PT said I could just pay the lower (insurance-negotiated) rate (about 50%)
Yes. I thought insurance would pay for it all. If the appointment would have been scheduled/conducted properly, it would have been covered as my free yearly physical.
I just recently ran into the same problem. I went in to get a Hep B shot, and my doctor ended up doing a half-assed physical and ran some blood tests. She spent five minutes trying to decide on a code, and ended up picking one that was not classed as preventative, because it wasn’t a “real physical”. So I ended up paying for a doctor visit rather than having it be a free physical.
And if you ever try to argue with how a doctor codes something, good luck.
Same situation, except my insurance would not cover removing skin tags. I asked, doctor said she’d do up to 10 tags in one visit for one price.
I negotiated a bill for my uncle down to 40%; he had no insurance and had incurred a large bill the year before he went on medicare. I noticed that medicare paid less than half, doctor’s office said they’d settle the bill for half; that dropped a $10,000 bill to $5,000.
Most dental plans have an annual $1500 cap per patient. I always ask my dentist what a procedure will cost, he’s fine discussing costs. I think that’s common in the US for dentistry.
I know. I spent months going back and forth with them. I still should get a yearly physical (since I clearly didn’t get one), but I’m sick of my doctor and her clinic and I don’t feel like finding a new one. So I can either go there and (hope) to get the treatment I need or find a new doctor and (hope) to get the treatment I need. It sucks.