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Medical billing question

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posted on Jun, 12 2016 @ 08:04 AM
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Hello everyone,
This is my first topic and I am not really sure which forum this belongs in, Mods feel free to move it if necessary.
Anyway, on to my question.
I recently had knee surgery and as my insurance is pretty bad, nothing was covered and I had to pay out of pocket. I contacted all involved and got the cash prices for all the procedures and was prepared to pay that amount.
Surgery day comes, I pay the amounts quoted and everything was good.
Until I got a bill a week later for more money. I called the surgery center to inquire about this and was told that since the doctor's practice took madicaid/medicare, they couldn't charge me less than they would charge the government. I was surprised by this and when I asked a few other medical professionals, they were surprised also.
My question is this...is it true that if your doctor takes medicare/medicaid they cannot charge less that they would bill.
I live in Tennessee btw.
Thanks for any answers.




posted on Jun, 12 2016 @ 08:08 AM
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a reply to: BadgerJoe

I've never heard of that either.

Most Dr.s locally that I know are more than happy to cut you a reduced rate as a cash customer.

It sounds sort of fishy to me...

Maybe just his way of justifying overinflated rates?

Sometimes the anesthesiologist, radiologist etc will bill you separately.

Perhaps that's what's happened also?



posted on Jun, 12 2016 @ 08:12 AM
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a reply to: TNMockingbird
I did get a reduced rate for cash, which I paid at the time of surgery. I received a bill for an additional amount a week later.
Let me add, when I did receive the bill, they had listed what they would have charged an insurance company, which was five times the amount they charged me. I am told that insurance companies will bargain that down though.
edit on 12-6-2016 by BadgerJoe because: (no reason given)



posted on Jun, 12 2016 @ 08:17 AM
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a reply to: BadgerJoe


Until I got a bill a week later for more money. I called the surgery center to inquire about this and was told that since the doctor's practice took madicaid/medicare, they couldn't charge me less than they would charge the government.

Did you record that, or get the persons name that said it?

They can charge more for unforeseen complications , ask to see the itemized list of cost for the procedure, if they tack on charges that weren't included in the original 'estimate', which you probably didn't get in writing… (?)

Hospitals charge exorbitant fees because insurance often times refuse to pay them. You have no such luxury or lawyers.

Theres a department in there somewhere you can appeal to.



posted on Jun, 12 2016 @ 08:26 AM
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a reply to: intrptr

I do have voice quoting the prices, but I do not have any documentation regarding the reason given for the additional charge.



posted on Jun, 12 2016 @ 08:38 AM
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a reply to: BadgerJoe

Oh sorry, forgot the link…

Additional charges…


After you get treatment, you should ask for an itemized bill and look for procedures that you didn’t actually receive. Since these bills are often tough to decipher, call the hospital. You can also turn to a patient advocate or claims consultant for help, though they will likely charge you for the advice. Among the options are the nonprofit Patient Advocate Foundation. Other organizations and companies can be found at the end of this article.

What the hospital charges insurance companies has no bearing on your bill.



posted on Jun, 12 2016 @ 08:39 AM
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a reply to: intrptr

Oh, I understand that what they bill insurance companies has no bearing on what they charged me, I just found the difference interesting.
Thanks for the link
edit on 12-6-2016 by BadgerJoe because: Added thanks

edit on 12-6-2016 by BadgerJoe because: (no reason given)



posted on Jun, 12 2016 @ 08:46 AM
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a reply to: TNMockingbird

This this the problem, if the Doctor is a Medicare provider they have to charge the same fee as Medicare would pay. Because Medicare would turn around and say why are you charging him this price but we have a fixed price based on coding.

They should have been more upfront with you.



posted on Jun, 12 2016 @ 08:48 AM
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a reply to: Quantum12

So this is true then? They cannot charge me less than they would charge medicare/medicaid?



posted on Jun, 12 2016 @ 08:50 AM
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a reply to: Quantum12

Yeah, I don't think I grasped the question initially.

Too early!

You are correct believe.

TENNCARE is goofy so, there's no telling!



posted on Jun, 12 2016 @ 08:51 AM
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a reply to: BadgerJoe

No they can't. I know because my brother in law is a Doctor and he accepts Medicare and cannot give a discount for cash doing the same procedure. It's really sad that this happens.



posted on Jun, 12 2016 @ 08:57 AM
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a reply to: Quantum12

Thank you for the information.
I have been waiting for more information before deciding what to do next.



posted on Jun, 12 2016 @ 09:02 AM
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Do you have a receipt from your payment? That should be all you need. Paid in full is paid in full.

RE: what you were told....with medicare, no. With insurance? Yes. If UHC found that you were charged less than they pay, they will expect the doctor to lower his rates with them going forward. The assumption is: they want their buying power to give them the best positioning for negotiation. If you got a better position with your relatively small buying power, that irks the insurance giants.



posted on Jun, 12 2016 @ 09:09 AM
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a reply to: bigfatfurrytexan

I do have a receipt, but it has a disclaimer stating that this amount is an estimate and there might be additional charges if the procedure was changed.
I did ask several times if I needed to pay more and was told several times there would be no further charges. Unfortunately, I did not get that in writing.



posted on Jun, 12 2016 @ 09:24 AM
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originally posted by: BadgerJoe
a reply to: bigfatfurrytexan

I do have a receipt, but it has a disclaimer stating that this amount is an estimate and there might be additional charges if the procedure was changed.
I did ask several times if I needed to pay more and was told several times there would be no further charges. Unfortunately, I did not get that in writing.


Right, if the procedure changes.

Since it did not, i'd put their feet tot he fire over it. A bill of sale is a bill of sale. While i may be wrong, that is the position I would take.



posted on Jun, 12 2016 @ 09:30 AM
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a reply to: bigfatfurrytexan

I am leaning in that direction. I made several attempts to insure that the price quoted was correct it was confirmed as being correct.
It isn't a matter of the money at this point for me, it is a matter of principle. I did as was agreed and they did not.



posted on Jun, 12 2016 @ 09:33 AM
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a reply to: BadgerJoe

You know we should treat these medical companies like contractors. Because that is what they are. I own rental properties and can do some repairs but others I contact out to independent contractors. If I need a furnace the contractor quotes a cost and I pay. If they want more money I want a reason, and a valid one.

So if you got a quote (in writing) for a new knee, pay that amount. If they want additional money, they sure the %$#@ better have a good reason, traditional medicare charges be damned, not your problem. No reason, no more money. And if they want to send this to collections I would consider small claims court to force a settled bill.



posted on Jun, 12 2016 @ 09:41 AM
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a reply to: BadgerJoe

Go file charges of fraud with the local PD. Insist the surgery center become the target of a RICO investigation.

Whatever you do, don't roll over and just say, "Eff it. They can't get anything from me."

If they've got a lawyer on retainer ... and I'm sure they do ... you could lose your shirt.

Fight back!! And, fight dirty.



posted on Jun, 12 2016 @ 09:53 AM
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a reply to: Snarl

I am going to fight it. It is not a large amount, less than $400.00. At this point, it is a matter of principle.



posted on Jun, 12 2016 @ 10:26 AM
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a reply to: BadgerJoe

You may still lose out....but don't go quietly into that dark night.

If you know an attorney (hey, some folks have lawyer friends), a legally drafted letter might help nudge decision making in the appropriate direction.



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