I went to Urgent Care recently with a bad rash on my face. All they did was take my blood pressure and temperature, and then the doctor looked at me for a couple minutes and told me to go to the Emergency Room. I was not told I was going to be billed for the visit, but I must have given them a card when I checked in, because I was charged this week for an absolutely insane amount for the amount of work that they did. I presumably authorized the transaction when I signed the paperwork checking in, but this is a bit absurd. Are merchants allowed to charge people without them approving the amount? I thought the card on file was just making it easier to pay when I needed to. I would have been outraged to get a bill from them for the amount they charged me, and I’m even more outraged that I was charged without notification. But this is a company that at very least licenses a name of a major hospital in the area, one that I trust for all my medical care; I don’t think they are directly affiliated given a conversation I overheard while there about someone’s insurance apparently not being taken there despite being taken at the hospital.
Should I dispute the charge? What should my strategy be if I do dispute it? This isn’t exactly a fly-by-night operator able to pull up roots and move elsewhere quickly that’s trying to make a quick buck by overcharging me illegally. It seems like there must be some sort of policy that allows it, but it still offends me that I was charged without being told the amount, irrespective of the fact that I’m outraged at what they charged.
The people present giving you care probably didn’t know the amount you were going to be billed. As a nurse I never did beyond a very general idea. Most likely a medical billing clerk, perhaps even in a different city coded your visit and billed you. In my area at an urgent care if a doctor even looks at you from the doorway it can be $300. You can try to dispute but it is unlikely to do you any good unless you were billed for treatments you did not receive like oxygen or an IV.
I don’t mind paying for some service that I used, but I feel as though I should be given a bill first. Even if it said “Hammer $100 Knowing where to swing the hammer $9900”.
In my experience, you should not pay the first bill they send you. I’ve seen ludicrous swings as the provider and my insurance company duke it out.
You undoubtedly signed something that said you were responsible for all charges not paid by your insurance. Nevertheless, it wouldn’t hurt to call and question the amount of the bill. Last fall, for complicated reasons, my family went together to get flu shots from the urgent care affiliated with the hospital system we use. Some time later, we received bills for $300 per person! When I called to find out how that could be, given that we each could have received free or very cheap shots through work, pediatrician, etc., they quickly acknowledged it was coded wrong. I’m not sure we ended up paying anything, but certainly not more than twenty or thirty bucks.
Three years ago, I was referred to a podiatrist. It took almost three months to get an appointment, November to February. By the time I saw the doctor she had apparently dropped out of my insurance network.
I saw the podiatrist for less than 30 seconds. She did not see me at all. She looked down at her tablet, pronounced a diagnosis based on my PCP’s notes and my intake questionnaire. She then directed me to pick up “care instructions” from the reception. They handed me 40 pages of instructions I could have downloaded from a dozen websites.
I got a bill for $700+. And based on the boilerplate I signed at check in, I had to pay. My insurance was no help. They had taken my insurance information at the reception, but said they were under no obligation to tell me that they were no longer in-network.
The OP is why I do not seek medical care without a huge chip on my shoulder, questioning each thing that is done and declining anything where coverage is questionable. I’m sure doctors hate me, but I’ve averted some close calls.
If we’re going to make people pay for their own medical care, providers should be required to provide an estimate ahead of time, based on parts and labor.
Several years ago, I’d had ongoing sinus issues for several years. My ENT recommended balloon sinuplasty[*]. Because it’s elective, he said they had a policy of always determining and informing the patient of the cost well in advance. When his admin called, she said that, after consulting with my insurance, my share was going to be twenty grand. I gagged, but agreed, as I’d been miserable for years.
After all was done and I received my bill, my insurance had “disallowed” most of it. I think the total was a couple thousand and my share was well under a grand. When I next saw the ENT, I made clear that I was happy with the direction of the error, but that I didn’t understand why it was so far off. He didn’t either, but said it was really common and really frustrating for them. They tried hard not to surprise their patients, and they just couldn’t get decent estimates from insurance.
FWIW, this was a couple of years after ACA went into effect, because we also talked about the fact that a few years earlier, he’d have been willing to charge uninsured patients twenty grand when he was otherwise happy taking pennies on the dollar. He didn’t have a good answer for that, but at least wasn’t one of those doctors who opposed the ACA (I’ve had plenty of those).
[*] The most horrific thing that’s ever been done to me, and I’ve been hit by a semi and resuscitated from cardiac arrest.
“Disallowed” like they told the provider they weren’t allowed to charge it… and the provider agreed… which begs the question wtf did they bill it in the first place?
[A: because they get off on destroying those least able to pay]
Are you asking why they sent the bill to the insurance company? The ‘disallowed’ part may have been from when they tried to pre-authorize it before hand or maybe they sent the actual charge through to see what would happen, that’s not un-common. Every time I have an eye or dentist appointment, I tell them I don’t have vision/dental insurance, but more often than not, they try anyways.
Provider: we want a bazillion dollars
Insurer: you can have a hundred dollars; you should get twenty of it from the patient
Provider: Oh, OK
Sometimes this goes through multiple iterations before it settles out. It’s asinine.
Disallowing coverage is a whole other hell that I don’t often encounter, because I pay a lot upfront for a PPO. Coverage isn’t always great, but I can see anybody I want without referral, and most providers I’ve encountered are in plan.
That’s how that works. They have negotiated a price with all the insurance companies whose networks they’re in. Yours will pay them $2000, someone else’s might give them $1500, mine might give them $3000. So they bill high and take what they get. It’s probably easier to just bill a flat $XX,XXX for the procedure than to figure out how much to charge for every plan from every carrier they work with.
Also, in all these cases when I say ‘pay’, I mean, ‘allow to bill’. Since in some cases the insurance company will pay all, or a major chunk of the bill and in other cases (ie high deductible) the patient is going to be paying all or most of it.
In any case, many offices have a ‘cash price’ for those without insurance. I’m guessing that’s what happened.
Yeah, I get that. If this was just a fictitious price that nobody actually pays, I’d chalk it up to “dumb things accountants do”. But the fact is that real people do pay this inflated cost and they are frequently the people least able to afford it.
But how would you have known which instructions to follow without the podiatrist’s guidance? Presumably you couldn’t self-diagnose from any of these websites, or you wouldn’t be going to the doctor. I have no problem paying experts for things when they have much greater knowledge about the topic than me. But when the expert charges your credit card before even giving you a bill, something seems sketchy.
Based on feedback here and on Facebook it sounds like the best plan is to at some point mosey back down to the urgent care and ask for a detailed bill to make sure that they correctly asked my insurance what they were allowed to bill as well as make sure they only billed for things that actually happened. I assume they did correspond with my insurance, because I got the hospital bill this same week, so I assume it took that long to fight things out with insurance. The hospital bill was not quite an order of magnitude bigger, but I had no problem paying it because they actually gave me a bill first, showed how much being on insurance saved me, and actually performed very well at diagnosing me and curing me, something I can’t say so much for urgent care, since you can tell anyone you see to go to the emergency room and not be "wrong’,