WWYD re: Ultrasound bill

[CookAMH]

Had 20 week ultrasound back in November. We have high deductible insurance so we were interested in paying up front in cash. They said no, we have a contract with your ins. company, have to go through them. Talked to three people leading up to u/s to ask about being able to have a shortened scan to cost less, they said to ask tech.  Asked for a limited u/s, not full fetal scan.  Tech said Dr. said no, but she can discount it 40%. Had the full scan. Needed vaginal u/s also because they observed a short cervix.  Another doctor comes in at end to talk about scan and also say, "Sorry, the other doctor was wrong, we cannot discount ultrasound costs".

I was not happy and talked to the billing person and couldn't get anywhere, she said ins. will have to be billed and take it from there.

I got the bill today, $800. That was the reduced rate b/c of how insurance has part written off. I am not willing to pay $800 especially because I feel like I got the run around and was led to believe, going into the scan, that it would be discounted.

What would you do to dispute it?

[MissMommyNiceNice]

Just keep calling.  That seems very expensive to me.  I had an unplanned u/s at like 30 weeks at an out of network provider b/c no one on network would see me b/c I was not a regular patient (in other words sorry homebirthing weirdo). 

I had to go to the next county over to see the service that comes up from baltimore to service the Amish at a small clinic once a week.  We had a full scan for possible twins (costs more) and it was still only $200 full price. 

I would certianly keep calling and calling and asking for  a supervisor until you get someone who can settle it for you in an acceptable manner. Also use your pcp and have them call & talk to the other doctor.  For the longest time I had a problem with my doc submitting my wbv as something differnt and my HSA was denying the claim all because the numerical code was not correct.   If it comes to it, get your insurance HR person involved.  We had to do that with a claim that was 100% medically necessary but they kept giving me the run around from dental to medical & back again until the HR person called and settled it for me, after the ins co convenientally "lost" the paper work the second time after 6 mos of arguing with them. 

If you pay them, you'll never see any money back.  If anything, set up very small $5 monthly payments just to show credit wise that you were making payments and you won't pay too much before a settlement is reached.  But I wouldn't even worry about that before 6 mos has passed.  For my situation, I sent one $25 payment during the 7 mo dispute and that was satisfactory, about the amount of my deductible. 

Good luck! 

[cristeen]

I would definitely dispute it.  You agreed to the service at a particular rate.  They cannot come in after the fact and jack up the rate.  You would never agree to that if a restaurant did that - you order your food based on the menu prices, and when it arrives your bill is double what it should be - "so sorry, the prices changed between the time you ordered and now".  You wouldn't pay the increased bill, nor should you be expected to. 

I would put it in writing.  You're not going to get anywhere with phone calls, and it's way too much of a hassle with a little one.  Put in writing the circumstances that occurred, what you agreed to prior to the scan and tell them you will agree to pay $X amount based upon that agreement.  But do not pay them that amount until you have in writing that they will accept it as paid in full. 

[CookAMH]

Thanks for the tips. The bill came from a billing agency in MO (I'm in WA). Should I write to them and cc the WA ultrasound office, attn: billing lady?

[mattemma04]

I would dispute it and try to get it discounted a bit more.Ask over at the Clark howard show.He always has good advice when it comes to money issues.

http://www.clarkhoward.com/ 

When I have had to pay bills that where disputed I sent a very low amount,because as long as I sent something they were not able to send ME to collections. One doctor I paid $5 a month.Usually though I would set up a payment plan with a minumum of $25 required even though I often paid more.

[crazyms]

That sounds really high to me. We don't have insurance and I've been paying cash to the doctor for any services I had done. The regular cost for a full anatomy scan is $250. I just don't see paying $800. I'd also ask for a detailed bill to see if that is the cost of the ultrasound or if they are charging for anything else also.

[pjs]

The problem is here is that you do have insurance, though it is a high deductible. Because of this, the u/s provider is in contract with your ins company and HAS to charge you based on their contract. Most insurers usually negotiate a lower fee, so even if you had gone in as a cash client ( no insurance ) this rate is probably less than what the cash rate is as insurance is usually able to negotiate a better fee than individual uninsured folks can. If the provider gave you a lower rate than the $800, your insurance company would be demanding that it get that lower fee for all its insured.

As for a limited scan vs a full scan, it sucks but given that it appears to have been medically necessary, would you have opted not to have it done? Was an u/ s medically indicated to begin with or was this just the standard 20 week which you could have chosen to decline?

I'm not sure of the ethics of going for an u/s and saying you don't have insurance when you actually do, but that would have possibly been an option and you could have been considered a cash client in which case you would have had more room to negotiate a fee, but again, insurance companies usually get the better fee structures.

A former medical office I worked in charged cash clients $3000 for a fee while some insurance companies only paid $1950- the facility had to try and recoup some of the deep discounts the insurers were getting ironically enough on the backs of the uninsured.

[crunchy_mommy]

Originally Posted by pjs 

The problem is here is that you do have insurance, though it is a high deductible. Because of this, the u/s provider is in contract with your ins company and HAS to charge you based on their contract. Most insurers usually negotiate a lower fee, so even if you had gone in as a cash client ( no insurance ) this rate is probably less than what the cash rate is as insurance is usually able to negotiate a better fee than individual uninsured folks can. If the provider gave you a lower rate than the $800, your insurance company would be demanding that it get that lower fee for all its insured.

As for a limited scan vs a full scan, it sucks but given that it appears to have been medically necessary, would you have opted not to have it done? Was an u/ s medically indicated to begin with or was this just the standard 20 week which you could have chosen to decline?

I'm not sure of the ethics of going for an u/s and saying you don't have insurance when you actually do, but that would have possibly been an option and you could have been considered a cash client in which case you would have had more room to negotiate a fee, but again, insurance companies usually get the better fee structures.

A former medical office I worked in charged cash clients $3000 for a fee while some insurance companies only paid $1950- the facility had to try and recoup some of the deep discounts the insurers were getting ironically enough on the backs of the uninsured.

Ditto this -- I had an echocardiogram (so basically an ultrasound also, just for my heart not my baby!) and because I had insurance, I had no room to negotiate. I ended up having to pay the whole thing (which ironically, amounted to just over $800!) and I was NOT happy... But the worst part is, while I was disputing it, it was sent to collections. Ended up not being an issue (wasn't reported to the credit bureaus) but was still very stressful when I got the collections letter! So pay small amounts each month so they don't do that to you... and you can try to negotiate but I don't think you will have much luck, given the contract they are under with your ins. company. IME medical billing is much harder to dispute than, say, your restaurant order or a clothing purchase... even if they misled you as to how much you'd have to pay.

[VisionaryMom]

You may be able to work out something with billing because they'd rather do that than for you to let it go to collections. I agree with the previous 2 posters, though, that they're doing what is required of them from your insurance company. I've had a couple of u/s visits that were that much, and yeah, it sucks. That's the best I can say; we had $6,000 in after-insurance medical bills from last year.

[CookAMH]

A couple clarifying things. The regular scan was the routine fetal scan, completely voluntary on our part (midwife didn't require it).  The additional trans vag scan was after the tech observed a short cervix but before finishing the reg scan, she went on to do numerous other measurements of the baby that could have easily been skipped.

The full charge to the insurance company was over $500 for the trans vag scan and something like $1100 for the fetal scan.  Obviously it was adjusted down a lot, but I also don't know what I would have been charged to pay up front. Their billing paperwork that they gave me at registration even said that some people prefer to pay up front and they do that.

Just to be clear, I didn't lead them to believe I didn't have insurance; I'm not comfortable with that.

I feel jipped because I requested a shorter scan, and it was my prerogative as customer to have that and I regret not addressing that more fully with the doc when the tech initially came back and said, doc said no. I should have said, I'd like to speak to the doc, etc and if it wasn't done to my satisfaction, I could have easily walked out and gotten a short scan elsewhere for a lot cheaper. I went in though thinking there would be some flexibility, and wouldn't have consented to the scan at this place if I was going to get a bill for $800. DH and I discussed that in advance of going after I called and asked them about doing a short scan for that very reason.

[VisionaryMom]

In my experience (both working in medical billing & as a patient), doctors really aren't that informed and/or concerned about the billing side of the practice. In fact, in most places the u/s department isn't associated with the doctors' office for billing, even if they are in the same physical office. We now have a wonderful family practice where the doctors and one of the PAs are great about considering the cost. The other PA is still learning, but she's only been working for a year. Most doctors just do what they think they should medically, which in general is good practice. If the money is an issue for you, then it's important to get whatever agreement you'd like to make in writing from the billing department. I completely understand how this happened from both sides. There were too many people who don't have the final say involved. For procedures like this, I've learned to talk to billing before I go if I have any concerns about the final cost.  

[crunchy_mommy]

Originally Posted by CookAMH 

I feel jipped because I requested a shorter scan, and it was my prerogative as customer to have that and I regret not addressing that more fully with the doc when the tech initially came back and said, doc said no. I should have said, I'd like to speak to the doc, etc and if it wasn't done to my satisfaction, I could have easily walked out and gotten a short scan elsewhere for a lot cheaper. I went in though thinking there would be some flexibility, and wouldn't have consented to the scan at this place if I was going to get a bill for $800. DH and I discussed that in advance of going after I called and asked them about doing a short scan for that very reason.

I wonder, though, if they are even allowed to do a 'shortened scan'??? I've never heard of anyone doing that, though maybe I've missed it... I would imagine there would be liability with that because most doctors assume an ultrasound to include certain measurements etc. so they would never know if something was wrong, and you could theoretically blame them for not being thorough enough. Not sure I'm explaining this clearly but I guess what I mean is, I always thought the u/s was an all-or-nothing kind of thing, not "just measure the head & tell me the sex" or whatever. I also think they bill 'per scan/procedure' not 'per hour' so they would likely have billed you just as much for a shorter one as a longer one -- i.e. if the baby is in a weird position, they don't charge you more because it takes longer (unless they have to switch to transvag or something).

Anyway, I totally understand why you are annoyed & feel you got ripped off, but I guess I don't see you having much leverage here to dispute it. Maybe you will have better luck than I do with these kinds of things! One thing you could do is call (anonymously) and ask how much the u/s would be if you are a patient without insurance.