What to do about my health insurance? They are refusing to cooperate with the doctors office…?
My son had surgery back in February, I received a estimation of benefits once for the surgery. According to the eob we were only suppose to pay 315.90 for the copay and 2.15 for the coinsurance or something like that and we were suppose to be billed for the 317.00 which was the two previous numbers added together. We kept receiving a bill from the doctors office for 501.91 which was basically the total for the entire services minus 18.00 which the insurance paid. Well, I called and talked with the anaestsia office and they told me that my insurance (anthem) wasn’t paying enough that’s why I received the bill for 501.91. So I talked to anthem and they said I was only responsible for the 317.00 so I sent that and it came out of my bank account. Even after both the doctors office and anthem telling me I paid what I was suppose to, I received an updated eob showing that I still owed money. They even changed around the copay and coinsurance amount to make me look responsible help???
Here’s the big question that you need to ask your insurance company and/or the doctor/hospital: Does the anesthesiologist have a contract with Anthem agreeing to accept their discounted rates?
If a provider doesn’t have a contract with your insurance company, they can bill you all the way up to the amount that they charged – they aren’t obligated to accept a discount.
Based on the fact that you received a second Explanation of Benefits from Anthem with the discount removed, it sounds to me like the following happened:
Your son’s anesthesiologist is not contracted with Anthem. Anthem processed the claim showing their discount. The anesthesiologist protested and argued that they aren’t obligated to accept the discount, since they didn’t sign a contract agreeing to it. Anthem re-issued a 2nd EOB to you, because they can’t stop the anesthesiologist from billing you for the whole amount.
(The above paragraph is my gut feeling based on what you typed above – you’ll need to confirm with Anthem and the doctor’s office that its what actually happened in your case.)
If you confirm that’s what happened, here are your options:
1) You can try appealing with Anthem to consider the full billed charge on the claim, rather than their discounted rate.
(note – was the surgery done in a hospital? If so, use the term “hospital based physician” in your appeal letter to the insurance company. In some states – Ohio for example – the insurer will have to consider the hospital based physician’s charges in full if they aren’t contracted. If the surgery was in an office or surgery center, that term won’t apply of course.)
2) Contact the hospital where the surgery was done and let them know that you are being balance billed by the anesthesiologist. Some (not all) hospitals require that the anesthesiologists who perform services in their hospital work with patients on the discounted rate. I can’t guarantee that this will work for you, but the hospital should at least be aware that you’re being balance billed by the anesthesiologist. (After all, they are the ones who assigned a non-contracted anesthesiologist to your son’s surgery in the first place. Doesn’t make the hospital financially liable, but they should be aware that their action lead to greater expense for you.)
3) Try to work out a deal with the anesthesiologist’s office. Let them know that you’re filing an appeal with Anthem for additional payment. First of all, if they know you’re appealing the claim, they’re not likely to send you to collections for your outstanding balance. Second of all, their billing person might have additional info/suggestions on what to put in the appeal. Finally, if they know you’ve exhausted every avenue possible to appeal the claim with Anthem, they might be willing to work out a discount. Doesn’t necessarily mean that they’ll reduce your bill back to the $317, but they might meet you somewhere in the middle of the $317 and the $501.
Good luck!
Office Labs: Future of personal health concept
|
|
Brita Water Pitcher Replacement Filter $62.50 Brita® Pitcher Replacement Filters… |
|
|
Thermos Stainless Steel Travel Tumbler – 14 oz / 0.4 L TherMax double wall vacuum insulation locks in temperature to preserve flavor and freshness…. |
|
|
Presto 6-Quart Aluminum Pressure Cooker $25.50 National Presto Industries 01264 Cooker & Steamer 01264 Rice Cookers & Steamers… |
|
|
Lil Drug Store 00032 Carmex Cherry Click Stick Lip Balm $31.54 It soothes, it heals, it protects. Long lasting relief for dry, chapped lips. Moisturizing lip balm. Display contains 24 each .15 oz. click sticks. Cherry. SPF 15…. |
|
|
Paradise In The Dental Office $13.99 Guided Imagery CD to enhance relaxation, decrease fears about dental care. Encourage good oral health and habits. Allows you to relax during dental appointments and also reduce tooth grinding…. |
|
|
Whales – Zen Serenity CD This relaxation CD, takes you to the soothing sounds of the Pacific ocean, as a pod of whales pass the California coast. You will love this relaxation CD. Use it at home, in the car for those horrible commutes, or even at the office. This CD is strictly sound of the ocean, there is no musical instrumentation. Even your gold fish will enjoy this CD, when you are away…. |
|
|
Bernie Siegel: How to Live Between Office Visits (Inspirational) [VHS] $29.97 … |
|
|
Handle Life with Care [VHS] … |
|
|
How to Live in Between Office Visits [VHS] $29.98 … |
|
|
Howard Leight MAX1 Earplugs Uncorded NRR33 Box/200 Count $17.99 Howard Leight Max pre-shaped foam earplugs feature a smooth outer skin for maximum user comfort. The smooth, soil resistant skin helps prevent dirt from penetrating the surface prior to insertion.These ear plugs have a 33 Noise Reduction Rating (NRR 33), the highest certified protection rating measured and are available in both corded and non-corded styles. … |
|
|
From Patient to Payment (Mixed media product) $89.62 From Patient to Payment: Insurance Procedures for the Medical Office, provides a practical, focused overview of medical insurance and billing. Each chapter is structured to give students a hands-on, practical approach to understanding and working with … |
|
|
Back Booster Portable Lumbar Support $14.88 Use in the car, on the plane, at the office, in a wheel chair, at the ball game, on the couchLightweight, portable, customizable levels of support, strong and durable construction |
|
|
Cando Ball Office Chair $118 Office chair combines the benefits of ball therapy with the convenience of a chair baseCando ball chair is made of durable metalErgonomic chair is held securely in place by the base design |
|
|
Cando Ball Office Chair $118 Office chair combines the benefits of ball therapy with the convenience of a chair baseCando ball chair is made of durable metal, with no armsErgonomic chair is held securely in place by the base design |
|
|
Top Screwups Doctors Make and How to Avoid Them (Hardcover) $16.13 Looks at the most common, preventable–and sometimes fatal–mistakes that hospitals, doctors offices and pharmacies make and helps readers learn how to take action. |
|
|
Stretching (Paperback) $11.94 A revised edition of a popular fitness reference features two-color inks to better define targeted muscle groups, 10 new stretching routines, routine abbreviations for busy practitioners and a variety of tips on office ergonomics and preventing repetit… |
|
|
Johnson & Johnson 50-person First Aid Kit $66.44 Industrial First Aid Kit is supplied for up to 50 peopleFirs Aid Kit has products you can trust in the workplaceMedical emergency kit is ideal for use in offices, restaurants and more |
|
|
Galaxy Disposable Latex Exam Gloves (Case of 100) $17.03 Powdered latex exam gloves offer a skintight elastic fitGloves provide excellent dexterity for medical, dental and lab applicationsMedical grade gloves meet FDA 510K requirements |
|
|
Medical Billing and Coding for Dummies (Paperback) $15.8 The easy way to start a career in medical billing and codingWith healthcare providers moving to electronic record systems, data accuracy and efficient data processing is more important than ever. Medical offices need professionally trained bi… |
|
|
Medical Office Procedures With Medical Pegboard (Paperback) $150.52 Medical Office Procedures with Medical Pegboard, 4E is highly successful simulation of activities and events that occur in physician`s office. Since the first edition of Medical Pegboard Procedures was published, new forms, procedures codes, and diagn… |
|
|
EasyEye Oval-shaped Desk Lamp $52.79 Brighten your home decor with EasyEye desk lampLighting creates a flicker-free, bright, white light that duplicates natural lightingTable lamp provides a soothing light that contributes to an overall sense of health and well-being |
|
|
EasyEye Oval-shaped Desk Lamp $59.99 Brighten your home decor with EasyEye desk lampLighting creates a flicker-free, bright, white light that duplicates natural lightingTable lamp provides a soothing light that contributes to an overall sense of health and well-being |
|
|
Merriam-Webster`s Medical Office Handbook $25.74 A single volume handbook that provides fast, reliable answers in running an efficient and effective medical office by addressing all aspects of office management, medical writing and managed care issues. This invaluable health resource was written by a… |
|
|
Premium Portable Ultrasound Therapy Machine $71.99 This portable ultrasound machine is great for a second office unit, mobile therapy, start up clinic, or for sporting events. An unanticipated benefit during portable scanning is the ability to move from patient to patient. |
|
|
ANSI-compliant First Aid Kit with 16 Units $42.08 First aid kit is ANSI-compliant with 16 unitsHealthcare supply meets ANSI Z308.1-2003 standard only when the required minimum fill is maintained with first aid products marked ‘ANSI Z-308.1-2003′First aid kit meets federal OSHA requirements |
|
|
Conair BE117 Double-Sided 10x-1x Variable Lighting Mirror $37.99 Four settings make for great viewing for evening, home, office and day environments in this double-sided mirror from Conair. This mirror has a polished chrome finish and magnifications of 1x and 10x. |
|
|
Medium Kleenguard G60 Nitrile Cut-resistant Gloves $15.83 Kleenguard G60 Nitrile cut-resistant gloves offer great hand protectionGloves made for industrial employeesExam gloves are ambidextrous and breathable with flexible dotted palm and purple nitrile fingertips |
|
|
Detecto 6127 Waist-high Physician Scale $369.9 Detecto’s ProMed 6127 medical scale is the right choice for home, health and clinical office weighingWeight scale is designed for years of dependable and accurate weighingVersatile scale meets all clinical health requirements |
|
|
Case Studies for Use With Computers in the Medical Office (Paperback) $53.48 This capstone simulation using Medisoft Patient Billing Software, Version 16, gives students enhanced training that fosters superior qualifications for a variety of medical office jobs. Extensive hands-on practice with realistic source documents teache… |
|
|
Oregon Scientific Jumbo Blood Pressure Meter (Refurb) $28.49 Take control of your health with this 2-pack of blood pressure metersBlood pressure monitor helps you keep your blood pressure in checkKeeps track of your last 30 readings without ever having to leave your home or office |
|
|
Medline Hospital Quality Women’s Two Pocket Scrub Top Ciel Blue $8.99 Great for any medical office or just for lounging around the house, this scrub top features a two-pocket design. |
|
|
Mahogany Candle Globe Candle $18.8 Fresh mysteria creates a lovely fragranceGlobe is polished and internally painted with waxCandle for home or office provides approximately 50 hours of burn time |
|
|
Total Resources International 25-person 170-pc First Aid Kit $30.49 Stay safe and protected by being smart and prepared with the 25-person first aid kit for the home, office and daycare by Total Resources International. This kit contains 170 pieces of quality name brand first aid supplies within a wall mountable case. |
|
|
Medline Women’s Navy Elastic Waist Scrub Pant $11.49 Great for any medical office or just for lounging around the house, this scrub pant features a soft cotton blend for the ultimat |
|
|
Sarah Peyton 5-piece Earth Tone Candle Tray Set $20.99 Experience tranquil candlelight safely with the Sarah Peyton 5-piece LED tray set. This classic tealight set will create a vivid display of beautiful lighting and is ideal for adding a touch of radiance and sophistication for your home or office. |
|
|
Medline Ladies Two Pocket Scrub Top, Navy $8.99 Great for any medical office or just for lounging around the house, this scrub top features a two-pocket design. |
|
|
MABIS DuroMed 25-person Metal First Aid Kit $43.99 This white metal 25-person first aid kit is great for smaller office or warehouse settings. For convenience this kit mounts to walls for quick access. |
|
|
Azzaro ‘Azzaro Pour Homme’ Men’s 13.6-oz Eau de Toilette Splash $71.99 Launched by the design house of Loris Azzaro in 1978, Azzaro Pour Homme is classified as a refreshing, spicy, lavender, amber fragrance. This masculine scent possesses a blend of wood, musk, lavender, basil, and sandalwood and recommended for office wear. |
|
|
The Healthy Woman (Paperback) $18.77 Description not available. |
|
|
The Heart of Power (Paperback) $12.19 Even the most powerful men in the world are human–they get sick, take dubious drugs, drink too much, contemplate suicide, fret about ailing parents, and bury people they love. Young Richard Nixon watched two brothers die of tuberculosis, even while do… |
|
|
Elizabeth Arden ‘True Love’ Women’s 3.3 oz EDT Spray $19.49 Introduced by Elizabeth Arden in 1994, ‘True Love’ is classified as a refreshing, gentle floral fragrance with a blend of lotus, iris, and jasmine. This women’s eau de toilette is recommended for office wear. |
|
|
Dial Antibacterial Foaming Hand Wash (Pack of  $26.65 Stock your office or home bathrooms with foaming hand washHospital strength antibacterial soap is ten times more effective at killing germs than ordinary liquid soapsRestroom supply has Activ-foam system that provides instant lather |
|
|
Cando Ball Chair $74.25 Exercise ball chair holds a 50cm ball Chair holds a therapeutic ball securely in place Office chair features locking casters |
|
|
Jaguar Plastics Red 33-inch x 39-inch Health Care Bio-hazard Printed Trash Liners (Case of 150) $47.05 Health Care Bio-hazard Printed Liners, 1.3 millimeter, 33 inches x 39 inches, red, 150 per carton.High-visibility red medical waste bags hold toxic materials and liners. |
|
|
Virtual Medical Office for Clinical Procedures for Medical Assistants (Paperback) $51.48 Gain realistic experience in a physician`s office without leaving the classroom! By using Elsevier`s Virtual Medical Office learning system – an Elsevier textbook, a study guide, and interactive software – students develop critical thinking and decisio… |
|
|
Massage Table Cart $56.49 Use this table cart to transport your massage table easily and safely to your clients, your office or home. This easy-to-use cart just needs to be unpacked, placed on level ground, the handle unfolded and it is ready for your massage table. |
|
|
ComfortEase Midnight Blue Scrub Pants (Small) $15.86 Extremely practical, scrubs from ComfortEase are ideal for workUnisex medical uniform is designed for comfort and durability Soil-release finish keeps clothing clean longer |
|
|
Total Resources International Emergency Preparedness 42-pc Kit $28.49 Stay safe and protected with the emergency preparedness kit for the home, office and school by Total Resources International that is US Coast Guard approved. This kit contains 42 pieces of quality first aid supplies, food and water. |
|
|
Nine Stars 8.7-gallon Medical Motion Sensor Trashcan $38.99 This stainless steel 8.7-gallon motion sensor trash can is a clean addition to your office or room. The hands-free trash can is ideal for offices, labs or restrooms. |
|
|
Medline Hospital Quality Women’s Scrub Pant Ciel Blue $11.49 Great for any medical office or just for lounging around the house, this scrub pant features a soft cotton blend for the ultimat |
|
|
||
Manna Pro Animal Health Aids Nurseall 3.5# |
Mada Equipment Company Gauge Protective Covers - Model 92016 - Each |
||
| click for price Sears.com | click for price Sears.com | ||
|
|
