Cancellation Fee for appt

[Scanner]

LivingLarge,

BTW, as I stated a month or two back, I am with you on this cancellation charge. A nominal fee is normal, but not $350.

I was just speaking to the credit, balance, adjustment issue.

I don't like the fact we have to get preapproval by insurance for everything or else we run the risk of paying completely out of pocket 100% of the costs when the insurance suddenly claims to not cover the expense. Or am I wrong?

What I am talking about is simply the issue of taking assignment or not taking assignment of benefits.

If your plan has the rule of "precertification", then yes, you would have to arrange all pre-certs and go through what any dental, medical or chiro office goes through on a daily basis trying to get things approved.

Actually, being the policy holder, I betcha things would change a lot faster and all of the sudden, the precert nonsense would dry up for the most part.

But what is the point of having insurance if you constantly have to be sure to be within the boundaries of coverage?

To prevent you from catastrophic loss.

Scanner your way would mostly work if we just didn't have insurance and paid out of pocket. If we had to submit all expenses, the insurance companies would royally screw us and say we're not covered. Wanna bet on that? They do it now even with direct billing, how much worse would it be when the consumer would have to do it themselves?

Actually, as I said above, I think it would improve. Because you are paying the premium along with your employer, you have much more pull than any provider has when treating you.

Again, I know it's a foreign concept but I can remember going to the family doctor when I was a kid (I'm 38 - we didn't do pediatricians back then) and we paid him, we submitted it into our insurance and then 30-45 days later, my parents had a check back.

But as I can tell from your tone, and I don't mean anything snide by it, the concept has just become foreign.

[LivingAlmostLarge]

Scanner, both my parents are in the medical field, and I am too. But would I believe in that system of submitting? No way, I see way to many loopholes for doctor's offices to do procedures not covered by insurance companies and then balking at paying.

It's happened way too many times to count to me personally. I've had "school health insurance" where you can only go to a doctor if you are more than 50 miles from the school then they reimburse you. Well I've done that multiple times and getting reimburst has been such a hassle. I have to constantly follow up, and turn in a reimbursement form at least minimum of 3x before it is reimbursed. So it usually takes about 6 months to get the money back.

Sadly I doubt this is atypical. More likely insurance companies would prefer you forget to mail back your rebate or get fed up with the hassle they make you deal with rather than submitting a claim.

[Exile]

I've heard of painless dentistry, but this is shameless dentistry.

[Scanner]

Scanner, both my parents are in the medical field, and I am too. But would I believe in that system of submitting? No way, I see way to many loopholes for doctor's offices to do procedures not covered by insurance companies and then balking at paying.

LivingLarge,

Actually, the theory is, and I believe the theory, if the consumer had to pay first and then be reimbursed later, many unnecessary tests and procedures wouldn't be ordered and performed.

Too many times, the doctor orders a test knowing the ins. co. is "footing the bill." Of course, that's an illusion - the insurance co. isn't really footing the bill. The employer and employee are footing the bill.

The ins. co. is just a middle man.

I can give an example of a case where I resolved a case of uncomplicated mechanical low back pain in about 5 visits over 3 weeks.

The family doc (sorry DisneySteve - I'm sure there are examples the other way around) wanted to order an MRI, just to be sure even though there were no red flags or even any symptoms left. Essentially, she bent over and sprained her back. . .no leg pain or anything.

The patient said, "Well. . .why not? I ain't paying. . ." It infuriated me on one hand but I have learned over the years to not even argue. She was sold on getting this expensive procedure.

It was kind of a "treat" for her.

But. . .I bet if she had to shell out $1000 first for the MRI and then be reimbursed later, she had thought twice about the necessity.

This is major problem in the healthcare field - the disconnnect of the consumer from consumption.

It's happened way too many times to count to me personally. I've had "school health insurance" where you can only go to a doctor if you are more than 50 miles from the school then they reimburse you. Well I've done that multiple times and getting reimburst has been such a hassle.

Yeah, well, welcome to my world.

You'd rather put it on the healthcare office. I guess that's natural but I'd bet politicians would respond better if every consumer had the problem.

I have to constantly follow up, and turn in a reimbursement form at least minimum of 3x before it is reimbursed. So it usually takes about 6 months to get the money back.

Again, welcome to my world.

Sadly I doubt this is atypical. More likely insurance companies would prefer you forget to mail back your rebate or get fed up with the hassle they make you deal with rather than submitting a claim.

There is the insurance commissioner but I do sympathasize.

Really, think about what I said - just turning the problem over to the doctor's office has made healthcare professionals start to lash out. And really, the policy isn't ours. Sometimes, unfortunately, it's right back at the very people they are trying to serve.

I'm still on your side on this whole issue - just giving you food for thought. I forget how we got off on this tangent - I follow healthcare politics very closely.

Slowly, I am trying to exit the "taking assignment" madness.

My field is a little weird anyway. I always tell my staff to think of us like prostitutes.

Get as much money upfront as possible because when the "care" is over and they're better, the patients will look at you as if they did YOU a favor by coming in (typical John psychology, not that I have been one ). So, you delivered the care and gotten nothing sometimes, or a small co-pay.

Prostitutes are smart and get their money up front. In fact, less money up front (time of service discount) is much better than taking that insurance card for money later.

Just my perspective and experience. . .yours in the medical field may vary.

[cicy33]

okay then here is my question. I go to the doctor. I pay my copay. the doctor sends the bill (do not pay bill it always says!) to me that shows the real amount of the visit and then the amount the insurance company bargains with them that they will actually pay. I have been advised that this a normal practice and if people don't have insurance they pay the bigger amount. Now, wouldn't people be more willing to pay upfront if the charges weren't so inflated?

[LivingAlmostLarge]

It depends, also people probably for the most part to behonest don't have money to pay up front. LOL. It's ridiculous because we're a nation of debt so no way a pay as you go healthcare will work. Sigh.

[terri77]

Originally Posted by LivingAlmostLarge

Scanner, both my parents are in the medical field, and I am too. But would I believe in that system of submitting? No way, I see way to many loopholes for doctor's offices to do procedures not covered by insurance companies and then balking at paying.

I work in health care as well and no way would I go about paying this way either. I wouldn't trust the insurance companies to not refuse valid procedures with some strange loophole.