As someone who works in a doctor’s office (just for the summer, thank god), and also being the poor sot who sits at the front desk and takes the brunt of the billing complaints, I can tell you this, Bill.
It’s out of our hands.
It doesn’t matter what we charge, the insurance company decides what it will pay. There are “discount” prices for some insurance companies because the doctor belongs to that company’s network as a provider. The only way (that I’m aware of) that an insurance company will pay for stuff like office visits, labwork, surgery, etc., is if those services are carried out by a doctor within that company’s network. The “discount” is not actually a discount. Rather, it is an amount of the charge that the doctor writes off (and basically takes as a loss) to ensure that the insurance will pay the rest.
MsRobyn said:
When you do that, please, PLEASE, PLEASE be patient with the receptionist/billing clerk. Our computers act up, insurance payments may be outstanding, and looking into your account/ ledger takes some time. Hospitals have entire billing departments, so this suggestion mainly applies to individual practices. For example, our office has one billing clerk working on roughly 5500-6500 accounts at a time. Believe me, it’s difficult enough finding people to fill biller’s positions without having patients calling up screaming and cursing them and the last 5 generations of their family because the insurance company applied something to the deductible.
Also, if you need help deciphering an EOB (Explanation of Benefits) that you receive from your insurance, and if you don’t want to talk to someone at your doctor’s office, don’t throw it out! Call your insurance company (EOBs usually have 1-800 customer service numbers on them, and even if they don’t, it’s on your insurance card.)
The insurance company is the entity that makes the rules, not the doctor’s office. We don’t know why they do what they do sometimes. We’ve had charges rejected for no reason at all, and Medicare charges that weren’t billed because the mail wranglers at Medicare didn’t feel like processing claims and threw them out (!!). My basic point is that if the billers at your doctor’s office can’t answer your questions, your insurance company certainly can.
Oh, yeah. If you want to know how much a procedure costs, never ask the doctor. Ask his front office staff, since we are the people coding procedures and billing the insurance. If you’re wondering about hospital charges, call the hospital’s billing department rather than asking the doctor, since the doctors themselves rarely, if ever, handle the financial side of office business.
Another thing (what the hell, might as well make this post a little longer), if you don’t know what a deductible/coinsurance/copay/other weird insurance term is, ASK ASK ASK ASK ASK!!! Please! And believe the office staff when we tell you! We don’t lie when it comes to money matters! Honest! Don’t just assume it’s unimportant.
And once more, in case it didn’t register before, if we at your doctor’s office can’t answer your insurance questions (Like WHY there is such a thing as a deductible. I haven’t the slightest idea), your insurance company can. Don’t hesitate to call their customer support line (Wait times are NOT that long. I know), and while their operators are hardly the friendliest, they will explain everything to you.
This post is long enough, methinks. Can’t you tell it’s been a fun summer? 
