health insurance question

[Smallpotatoes]

This year I have a different health insurance plan because my employer no longer offers the plan that I had for the last three years.
Recently, I saw a specialist about a knee problem. The co-pay for seeing a specialist under the new plan is $50. I saw him twice.
In the past, under my old plan, the only out-of-pocket payments I've had to make were the co-pays.
Today, I received a bill from the doctor for $104. Is it fairly common these days to have to pay an additional fee, other than the co-pay that the insurance doesn't cover and how is this possible?

 

[RickStain]

This year I have a different health insurance plan because my employer no longer offers the plan that I had for the last three years.
Recently, I saw a specialist about a knee problem. The co-pay for seeing a specialist under the new plan is $50. I saw him twice.
In the past, under my old plan, the only out-of-pocket payments I've had to make were the co-pays.
Today, I received a bill from the doctor for $104. Is it fairly common these days to have to pay an additional fee, other than the co-pay that the insurance doesn't cover and how is this possible?

Sometimes, insurance plans only cover a percentage of what's beyond the co-pay.

Sometimes, doctor's just bill you to see if you'll pay.

Either way, I'd start reading some fine print.

 

[spnited]

Call the insurance carrier and ask them. All plans are different.

 

[shockey]

could there be a deductible you must clear first? ??? ??? ???

 

[bagelchick]

My specialist co-pay is $45.00 which I think is ridiculous, a $500 in-network deductible and a $1,000 out of network deductible. And I have a stack of medical bills above and beyond what insurance covers, so not surprised to hear you are in the same situation. To top it off, the insurance company doesn't have an agreement with the largest medical provider in the state, so I had to change all of my doctors and/or oftentimes wait longer than most because they are only doing procedures for those who aren't covered by that plan on certain days.

It really sucks. I can't even begin to imagine what life is like without insurance, but the bills I have and the costs are out of control.

 

[Sam Mills 51]

This year I have a different health insurance plan because my employer no longer offers the plan that I had for the last three years.
Recently, I saw a specialist about a knee problem. The co-pay for seeing a specialist under the new plan is $50. I saw him twice.
In the past, under my old plan, the only out-of-pocket payments I've had to make were the co-pays.
Today, I received a bill from the doctor for $104. Is it fairly common these days to have to pay an additional fee, other than the co-pay that the insurance doesn't cover and how is this possible?

Did you have this appointment at the physician's private practice or at the hospital?
If the latter, you can get both a bill from the facility as well as the specialist.

Was there an MRI involved?
If yes, it will be extra.

Too many variables for us to be of much help, not to mention more and more health-care providers seem to be increasing their list of excuses (pre-existing condition, out-of-network facilities and/or physicians, medical necessity, etc.) not to pay their portion of a bill.

Call your health-care provider. Go from there.

 

[WriteThinking]

I can't even begin to imagine what life is like without insurance, but the bills I have and the costs are out of control.

I can answer that: People without insurance don't go to doctors, or dentists, for anything other than urgent/emergency care...

 

[RickStain]

I can't even begin to imagine what life is like without insurance, but the bills I have and the costs are out of control.

I can answer that: People without insurance don't go to doctors, or dentists, for anything other than urgent/emergency care...

You wait till the last possible minute and gamble that whatever aches and pains you are having are nothing serious. If you gamble wrong, you die.

 

[bagelchick]

I can't even begin to imagine what life is like without insurance, but the bills I have and the costs are out of control.

I can answer that: People without insurance don't go to doctors, or dentists, for anything other than urgent/emergency care...

You wait till the last possible minute and gamble that whatever aches and pains you are having are nothing serious. If you gamble wrong, you die.

And that is just wrong. I am hopeful that something can be done by this Administration about health care costs. We'll see.

 

[I Digress]

Definitely check the paperwork from your insurance co.. in fact, you should have already gotten it before the dr. billed.. .it will lay out what you owe.. the thing (or one of the things) that you need to be aware of is that if a doctor is contracted with an insurance company (which they have to be to accept it) they have to accept the terms.. that means if they go over the allowed charge by the insurance company, you don't have to pay it. Make sure they're not trying to bill you for that.

 

[Madhavok]

It really sucks. I can't even begin to imagine what life is like without insurance, but the bills I have and the costs are out of control.

I can answer that as well: You just wait it out. I haven't had health insurance since January of 2007 and in this time I've dinged up my knee, torn my rotator cuff, broken a rib, and did something to my left hip flexor. The last two happened at the same time. All of these in the winter, however, not on the job. I'll most likely have insurance for this winter as I hope to compete a bit more.

 

[PeteyPirate]

Call the insurance carrier and ask them. All plans are different.

Yes, do that. Let us know if you ever get through and we'll throw a party.

 

[Armchair_QB]

I can't even begin to imagine what life is like without insurance, but the bills I have and the costs are out of control.

I can answer that: People without insurance don't go to doctors, or dentists, for anything other than urgent/emergency care...

You wait till the last possible minute and gamble that whatever aches and pains you are having are nothing serious. If you gamble wrong, you die.

And that is just wrong. I am hopeful that something can be done by this Administration about health care costs. We'll see.

The only thing our government, regardless of the administration, is going to do about health care costs is increase them.

 

[Freelance Hack]

Was the provider in the network? If not, you may have out-of-pocket costs beyond the co-pay.

Even if it's an in-network provider there may be some items they won't cover. If it's a service your provider felt was necessary, then find out what your insurers appeals process entails.

Also, you should receive an EOB from your insurer. That should explain what was covered, at how much, and what (if any) you may owe. They're confusing as hell to me sometimes and I work for an insurer.