Health insurance and doctors sneaky tricks?!!!!

[puppypal]

Have any of you with health insurance noticed lately that doctors etc except your insurance payment but then sends you a bill for the rest?
Lately expecially Dental,
Example: Your plan says you get two teeth cleanings a year and of course the oucy bitewing x-rays.
Then the Denist office files your insurance and sends you a bill for what insurance didn't pay.
I have had that also happen with the eye doctor and my pain management doctor is now charging me my co-pay and like 13.00 etc per visit. What is up with that?

[poundwise]

Is it possible that your insurance uses a network and you are using docs outside of that network?

I ask because by the terms of most network agreements, the docs agree to accept the network pricing. That's the point of the network. I know that since I've had insurance, even when I've had to pay (I have a high-deductible plan), the price is less than if I wasn't insured/part of the network.

[fairy74]

I haven't noticed this too often, however a few times it has come up, some doctors' office do not understand if they are a contracted provider and agree to accept the contracted amount, they cannot balance bill you for the difference (excepting copays, non-covered services and deductibles). When I come up against this, I usually send a letter to my insurance company stating so and so doctor is balance billing and send a copy to the doctor's office (that is if the doctor's office is not willing to take the charge off). This usually motivates the doctor's office to remove the charge asap as they probably have other subscribers from your insurance who they have balance billed as well...

[puppypal]

Even the last time I went to the gyno (semi yearly pap thing free) put visit down as a cost pap down as a cost and urine thing as a cost. Making me have to pay the last couple. Isn't a yearly just that? See, my insurance pays up to 100.00 for a yearly type gyno visit. So 1st line he charged 125.00 insurance knocked it down to 100.00
Then listed everything that was supposed to be included separate with a separate charge!
GGGGGGGRRRRRRRRRRR

[Fern]

It means either one of 2 things:

Either your insurance company is getting even more tight-fisted with coverage and no longer covers as much of your expenses as they used to, or
The doctor raised his fees in excess of what the insurance provider has always covered.

[poundwise]

But those factors would be irrelevant if you are in PPO Network.

The doctor agrees to accept the set amount established by the network. If this is the case, the doctor cannot collect additional money from you. They may try but I would not pay.

There are, however, a multiplicity of arrangements and insurance terms. Whatever the case, you definitely have to watch them.