Question
Hello, and thanks for taking my question. In May I went to a dermatologist who determined I needed a biopsy. It was done professionally and all was well. Turns out, my health care lapsed that month. Resigned to this fact, I showed up politely requesting their out-of-pocket discount I received in the past. The receptionist described new policies that exclude such "administrative favors". We set up a monthly payment plan for the $1000 bill and I paid the first $100.
Thank goodness, United Healthcare looked at the evidence I gave them that I should be covered in May, and agreed to cover the procedure. My provider charged United Healthcare only half the amount I was charged, having previously billed me the full amount.
So a third party, a large corporation, enjoyed the "administrative favors" outlawed by the new policies decribed to me when I asked for a similar discount. I think the discount offered to this third party should have been better allocated to a long-time a loyal customer. I have sent two certified letters since the 1st of June. The first was answered with a hasty phone call from another receptionist trying to persuade me I was not defrauded.
When I showed up another month later to retrieve my original $100 payment, I politely asked about this billing situation, and was told she wouldn't know about it. My second certified letter simply stated that I appreciate my hometown my not house their central billing office, but where would I address a question about their billing practices? I have received no reply since the first of July when this query was sent, again via certified letter.
Should I be okay that I was charged $1000 for a procedure they were happy to accept $500 for? Should I stand up for the plight of future customers? Or do I have no case?
Thanks again. I'm fervently looking forward to your reply. :-)
Jim
Answer
Hi Jim!
Provider and Dr's are able to do a "private pay" discount when a patient has no insurance but your policy must be everyone at the same rate.........it is a gray area but accepted however due to circumstances as yours it can get a provider/Dr into an issue as yours so many do not even do any type of private pay discount rates anymore.
If a provider/Dr has a contract with an insurance company then they are required to accept their terms and payment. If the insurance company billed does not have a contract than the patient would be billed the difference between their payment and the billed amount.
There is not much you can do but to recover your $100 payment which you did. Just be glad that your insurance company paid the bill.
You really have no leg to stand on since the Dr billed you according to their no private pay rate and accepted the insurance company as paid in full per contractual rates.
Tricia
