Kidney Doctor Scams - Grab Full Price Because You Haven't Met Your Deductible

Kidney Doctor Scams - Grab Full Price Because You Haven't Met Your Deductible

prominent kidney doctor scams: how kidney and other doctors easily take advantage of you once a year because of health insuranceHere is perhaps the biggest scam a Kidney or other doctor pulls off, yet mostly goes unreported. If you have a big annual deductible, as most of us do then you know this scam. I hate the word scam, yet it is the only way to describe what I just went through ... again!

As a little background information, I am the son of a surgeon and as such has been around the "inside" of the medical world. Make no mistake about it, dr's are in business to Make Money Period. Never buy into what some project as an "I got into medicine to help people" statement or ideology as fact. They ALL do it for the money first. Nothing wrong with loving what you do ... yet becoming a Dr. is difficult and expensive, yet you can make pretty big bucks doing it if you are a hard worker, yet I digress.

When a Dr. pulls up your insurance and sees you haven't met your deductible, they are about to get their "undiscounted" full rate card price for your visit. IN same cases it may simply end up being a free loan, in others, you have to chase the DR. down to get a refund.

Here's the scam. Most Drs are pretty slow to file insurance claims, especially when they just made you pay you "office co-pay" and that co-pay is over say $300. You see Dr's don't get reimbursed 100% for the invoices they send an insurance company. They have a contract with the insurance company, that pays the X for service Y, and it's far discounted from what you would pay if you paid in cash.

So when you suddenly are struck with the big deductible co-pay, and pay it, you are paying the Dr at their "Full Retail Price". Accordingly, they have no motivation to file your insurance claim because what will transpire is that the insurance company will only authorize a smaller percentage of the charge, say 25%, and the DR. is supposed to write the rest off (i.e. refund your money). Some medical establishments, mainly hospitals have the accounting staff to do this, or catch the reality down the road, but it takes several months to get your refund. Smaller Dr practices are not so well staffed, and many of them file their insurance claims monthly.

So remember, they ONLY get their full price from you when you haven’t met your deductible. If you don't have much going on, this is not a problem, as it on average gets posted before you need to go to another Dr. In the situation I am currently in, I had an accident (a neck injury), so I suddenly had to go see several Dr's, get an MRI, etc. So 3 months after writing my first deductible $100 co-pay payment of about $400, that Dr STILL has not filed an insurance claim. So at this point in time I have written checks for $3,000 against a $1,000 deductible.

I spoke with the insurance company yesterday, and they explained what is happening and that it always does. Now I have to go back to those DR'.s get a copy of the "billing statement" and a copy of my cancelled check and send all of that to the Insurance company so they will show I have met my deductible. Then I will be chasing down 3 different medical organizations to recover my $2,000. I’m getting a queasy feeling though, that I’m not going to see it all back because the Dr's are now trying to hit me for the full charge plus, post office visit.

Now I admit not all doctors operate in the less than ethical way, yet most I have encountered do, and the hospitals are the worst.

Moral of the story ... be sure when you know you haven't met your deductible, starting with the first time you get medical care after your annual deductible re-sets on January 1, be sure to get not only a receipt for the check you wrote, but also a copy of the billing form (and that's available immediately after the visit as the Dr. fills out what he did right after your visit). Same with hospitals. You then send these documents immediately to your insurance provider to give them a heads up that you have made a payment toward your annual deductible. This is the only way to be certain that it all gets posted in a timely manner.

It's a loophole in the billing system, which is a 1 of a kind. What else do you buy where there is a 3rd party (insurance company) who is going to pay something, and you owe the difference. I can’t think of anything else, and if you are injured and suddenly have to get a lot of medical attention, this is a real problem.

What insurance company do I have you might ask? The new Obama care/government payer policy for people with pre-existing conditions, PCIP.

As the financial representative who "Had To" collect another $1,000 from me Friday for an MRI because the system shows I haven't paid anything toward my deductible, said ... it's a scam! And yes, that was right from the financial manager of the hospital's mouth.

I hope my experience helps someone out there to avoid the same added stress when you are sick/hurt, and they essentially hold your feet to the fire to pay up front as a "co-pay", and then never bill your insurance company. Why would they ... after all once they do, they are going to owe you money back.

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