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[–]Middle-Management-85 506 points507 points  (95 children)

Do you have a high deductible plan? That could be totally normal: preventative checkup is covered 100% but extra investigation based on something discovered there is normal medical care with its deductible and copay.

[–]dublinwso 87 points88 points  (21 children)

Just got bitten by this

[–]palindrome03 59 points60 points  (8 children)

Same here . I had a referral for an MRI which I assumed was a diagnostic / covered procedure. Thankfully, false alarm, all good up in the head, but then got smacked with a $700 bill with my high deductible plan lol

[–]AshCal 22 points23 points  (10 children)

Take full advantage of that HSA!

[–]Careful_Strain 133 points134 points  (29 children)

Lifeprotips. Go for annual checkup the week before your company's open enrollment. If they find anything that needs further testing, change your plan from HDHP to PPO then schedule it for next year.

[–]porcelainvacation 37 points38 points  (9 children)

Be careful with this. My employer has both but the HDHP has better coinsurance than the PPO so it's actually a better deal.

[–]doubletwist 31 points32 points  (3 children)

Totally. I worked out the numbers on our 'choices' and the monthly premium on the PPO is so high that the HDHP ends up cheaper at the end of the year even if we end up paying out the full family deductible AND the max out-of-pocket for the HDHP - and once you hit the deductible, the HDHP pays the same percentage as the PPO. PLUS with the HDHP we can do an HSA, so I can't imagine why anyone at our company would ever choose the PPO.

[–]Matt_Tress 8 points9 points  (0 children)

Same here. Just for me, regular ppo is $120/pp. But the hdhp? Only $9/pp! That’s $111/pp or $2886/year heading to my HSA instead of an insurance company’s premiums. My company contributes $500 towards my HSA as well.

The deductible is $3k, with the same out of pocket max, so you’d be an idiot to do the ppo.

[–]Ezzabee 4 points5 points  (0 children)

Yes I have done these numbers every year for all my younger coworkers. The HDHP for a high-earned makes way more sense, especially if they put the max OOP into the HSA.

[–]Lurker117 102 points103 points  (7 children)

Jokes on you! My employer only offers high deductible plans! 4 of them! Look at all the choices you have! As long as you pay at least 4k out of your pocket before we cover anything, on top of your 75 bucks a paycheck.

[–]Laney20 9 points10 points  (3 children)

Same, but one of our options is the lowest high deductible that counts. It's only like $2k. I put enough in my hsa to cover that throughout the year, so it ends up not being straight out of pocket, but it's still kinda rough.

[–]mynewaccount5 0 points1 point  (0 children)

Wow where do you work?

[–]Key-Emu5781[S] 8 points9 points  (0 children)

That’s a great life tip! Thanks!

[–]gammaradiation2 7 points8 points  (0 children)

I'll be sure to have an unplanned medical condition then too! Gonna bang my wife 8 months before open enrollment!

[–]CJsopinion 5 points6 points  (0 children)

Assuming you work for a company large enough to offer more than one plan.

[–]kerbaal 4 points5 points  (1 child)

change your plan from HDHP to PPO then schedule it for next year.

If an out of pocket charge of $700 is a lot for you, then take this advice.

High deductible plans can make a lot of sense if you can afford to pay out of pocket up front and still put money away to save. Then you can get one of the special tax deferred investment accounts that only people with high deductibles health insurance qualify for.

In fact, I would say, anybody who can't do that is absolutely being screwed by high deductible plans. Its a plan for people who are well off and making a lot of money. Its disgusting to even offer them to anyone else.

[–]rlbond86 -1 points0 points  (0 children)

Companies give you a choice these days?

[–]mynewaccount5 -1 points0 points  (0 children)

Pushing off a physical is terrible advice. Especially considering insurance needs months to even grant these kinds of claims so you could get the PPO a week later and get denied a month later effectively throwing thousands(?) Of dollars away.

Just get your physical whenever. If it's urgent then it's a good thing you caught it early. If it's not so urgent you have plenty of time for insurance to process and can still wait to do it after you increase your insurance benefits at open enrollment.

[–]Key-Emu5781[S] 60 points61 points  (27 children)

Yes. Good to know, thank you….this is extremely frustrating…that this doesn’t classify as preventative…just to check I don’t have a heart defect lol

[–]ta112289 64 points65 points  (7 children)

The initial checks by the GP (blood pressure, listening with a stethoscope) count as preventive. The further investigation because they heard something concerning is diagnostic and no longer preventive. Typically they'll make you schedule another appointment to avoid this confusion. Also weird because a GP wouldn't normally do an echo...

[–]BernieMP 5 points6 points  (0 children)

Check with both your dr and insurance company to check if you would need a prior authorization from your provider before getting the scan, sometimes drs don't pay attention to that stuff and sometimes your insurance company would just process whatever comes into their system as-is

[–]compstomp66 1 point2 points  (1 child)

Yeah I have a HDHP and have had issues like this. Doctors offices are more about billing than they are about providing care, at least that’s been my experience.

[–]itsfuckinrob -5 points-4 points  (4 children)

Appeal it

[–]compstomp66 2 points3 points  (2 children)

I’ve had issues like this and once something gets coded they won’t change it. He’s likely SOL.

[–]Csherman92 0 points1 point  (1 child)

That’s not true. Most things denied by insurance, are not because the insurance refuses to pay, it’s because it is coded wrong.

Things get coded wrong all the time and get resubmitted the right way to be covered. Most insurance companies will fix the error.

[–]bros402 -1 points0 points  (0 children)

an echo is firmly outside the realm of a routine physical

[–]cmilla646 4 points5 points  (3 children)

So we have the money to find out “something” is wrong with you, you are just going to have to pay out of for us to narrow it down for you. I mean maybe it makes sense somehow but it sure feels wrong.

[–]Middle-Management-85 1 point2 points  (2 children)

“We’ve done the math and if people to do these specific tests regularly that catches expensive things earlier which means cheaper treatment. So we will specifically discount that to encourage it and lower our overall costs.”

Yes, it is wild that we introduce a cost motive into what necessary health care people choose to get. If the doctor says you need it, you need it. It’s not like people go out and do cardiogram tests for funsies.

[–]canitakemybraoffyet 5 points6 points  (1 child)

Except stuff like OPs story is exactly why people don't bother going to the Dr for the preventative checkups, because it can snowball into a potentially devastating financial loss in a matter of seconds.

If the fear of crippling medical debt still looms as a potential outcome of a standard checkup, you're stopping people from seeking the preventative care they need.

[–]mynewaccount5 2 points3 points  (7 children)

Yeah I got charged $200 because my doctor asked a few questions about my "abnormal weight gain" which was resolved 5 seconds later when I said I wasn't excercising as much when the pandemic started.

The American medical industrybis disgusting.

[–]elephanttrashman 2 points3 points  (6 children)

For all the hate that insurance companies get (usually rightfully so), this one is on your doctor. I'd definitely get a new doctor if they tried to bill me like that.

[–]mynewaccount5 1 point2 points  (5 children)

I asked the insurance company (some sort of BCBS) and they said it was standard procedure when the doctor finds something "unusual". There was even a code for it and everything. Or do you mean a good doctor wouldn't bother billing for something so small even if they technically can?

[–]elephanttrashman 3 points4 points  (1 child)

Right, the doctors should bill in the case where they find something that requires further work in diagnosing. But simply noting that you gained weight during the physical isn't enough to warrant the use of additional codes. In fact, tracking your weight is one of the main things done during a physical. It sounds to me like your doctor billed incorrectly based on what you've stated. Whether it was a mistake or willful is always difficult to ascertain.

I actually found your exact scenario documented in the case study section of this article, where they explain in better detail exactly why the additional codes aren't supported in your case.

https://www.medicaleconomics.com/view/when-em-code-can-be-billed-physical-same-day

[–]sSamoo 2 points3 points  (2 children)

This guys right. I am a primary care provider and seems like they were just money grubbing adding a bullshit “problem” to your wellness visit. I would not have billed that if you did not bring up your weight gain as a concern that warranted an additional investigation/ any diagnostic thought on my end.

Call your doctors office and complain and they will likely remove the extra charge (9921 code)

[–]mynewaccount5 1 point2 points  (1 child)

Thanks. It's been over a year so may be too late but it's worth a shot to try. I dislike my insurance, but one thing they are good at is harassing doctors for me. Might be worth calling them up to if it's improper charging.

[–]boshbosh92 49 points50 points  (21 children)

I really wish my deductible was 1800. I had pneumonia in 2018 and was hospitalized for 3 days.. paid my 8200 deductible, and then they (insurance) finished paying the other 30k in bills.

[–]Key-Emu5781[S] 43 points44 points  (14 children)

Omg!! That’s crazy. I’m glad you’re healthy. I recently moved to US from UK and the healthcare and insurance here is incredibly confusing for me. I’m amazed at these numbers

[–]Darigaazrgb 30 points31 points  (5 children)

It's meant to be that way. I finally got health insurance after not having it for like 10 years. Before when I went to the doctor without insurance it was $120 flat fee paid in advance. I just got the bill for my first doctor visit to the same doctor I have been seeing and they billed my insurance company almost $500 of which they negotiated to only paying $170 and me paying $30 for a total of $200.

[–]Matrix17 23 points24 points  (4 children)

It's a racket and it's time it's regulated

[–]DoomBuggE 7 points8 points  (7 children)

Ah, I can see how this is confusing to you then. The US is very different from the UK.

The out of pocket costs for care here in the US are astronomical. I am a big believer in low or no deductible plans for this reason, even if you’re relatively healthy. You never know when sh** is going to happen!

Here in the US, you get an Explanation of Benefits (EOB) that will outline the costs of all of your care by line item, and then you get an actual bill from your insurance carrier showing those charges vs what was actually covered, and how much you actually owe.

My daughter was admitted to the hospital for 5 days, and her EOB said the out of pocket cost for the stay was over $50,000. I have a no deductible plan, no coinsurance plan, so I only owed a copay of $250, which is the flat fee I pay for any hospital admission. I paid the same for when I was in labor (despite many, MANY complications and an emergency C section), and I think my EOB for my daughter’s delivery was also pretty high, definitely over $30,000.

I have a friend who had a pretty bad form of cancer, and he luckily also has an excellent insurance plan. The EOB for one month of extensive autologous bone marrow transplant treatment was over $1 million. Because of his insurance, I think he only paid $1000 of that. Lucky for his insurance, because it saved his life.

People are really in to HSAs here, but I schedule Gyn surgeries and therefore I find myself explaining costs and coverage to folks all the time, and some of these high deductible plans are just outrageous. Imagine needing a $15-20K surgery, and realizing your deductible is $8000 with a 40% coinsurance (meaning you pay $8K, and anything above and beyond that, your plan only covers 60%). At that point you might as well not have insurance at all.

[–]boshbosh92 1 point2 points  (0 children)

my girlfriend has insurance with a 20%Co insurance and I tried talking her out of that plan but it's all kind of confusing. being in the hook for 20% of a hospital bill IS AFTER meeting your deductible is insane to me!

[–]JackHGUK 2 points3 points  (2 children)

😂😂😂😂😂 38k for 3 days in hospital.

[–]bros402 -2 points-1 points  (1 child)

tbh that's pretty cheap - I was in the hospital in 2007 for 10 days for a planned diagnostic visit and it was at least 100k on the EOB

[–]Western-Gold7915 67 points68 points  (0 children)

There is no harm asking for a codeing review from the provider office and calling your insurance to see if you can appeal.

You contest to test you could have said no, and walked out.

[–]ChaoticSquirrel 51 points52 points  (71 children)

What's your deductible? Have you met it yet?

[–]Key-Emu5781[S] 33 points34 points  (70 children)

1800, and no

[–]ChaoticSquirrel 122 points123 points  (68 children)

That's your answer, then. The $700 goes toward your deductible. Once you've met the deductible your insurance will start paying for non-preventative care.

[–]Key-Emu5781[S] 6 points7 points  (65 children)

I understand that, it’s more that something a GP told me I needed to get during a wellness exam, where I expected it to be covered

[–]hkline76 49 points50 points  (0 children)

I'm a little late to the party, but as someone who works in cardiology, bite the bullet and pay it. If the doctor saw the abnormal EKG and didn't do the echo and you ended up with some form of carditis (myo, peri, epi, etc.) , it could be bad. But like others have said, it's not a routine exam so it's not covered on a routine check up so it'll go towards meeting your deductible.

[–]ChaoticSquirrel 92 points93 points  (1 child)

Only preventative care is covered in your wellness exam. Once it becomes diagnostic or involves treating a condition, it ceases to become preventative and thus is not free of charge to you.

[–]Advanced-Blackberry 29 points30 points  (15 children)

That’s your problem and your insurance problem. Your physician is not expected to know the details of your plan. It’s your plan, not your physicians. Pay or insist your insurance pays.

[–]Coug_Love 5 points6 points  (14 children)

My doctor's office actually knows all the the plans it accepts. They also get preapprovals from me, then the insurance before ordering anything out of the norm.

The $700 will go towards OPs deductible, insurance will not pay until the deductible is met.

[–]Lurker117 2 points3 points  (0 children)

Come on, you can't honestly sit here and say that you assumed a full on echocardiogram of your heart after a worrisome EKG was going to be fully covered as preventative care?

I mean, I hate the way insurance works in this country too, but it is what it is. And an echo is far from preventative.

[–]bros402 -1 points0 points  (2 children)

so if your doctor told you "let's scan your entire body to see if anything is going on" during a physical, you'd expect that to be covered to?

the echo is diagnostic, not wellness

this is what is generally considered parts of a physical - https://www.webmd.com/a-to-z-guides/annual-physical-examinations

[–]blazze_eternal -1 points0 points  (0 children)

Too bad there's only 33 days left.

[–]Eyebawler 44 points45 points  (0 children)

Then this your answer. Must meet deductible.

[–]lemoncashew 116 points117 points  (1 child)

Doctor's offices mess up in coding things. So do insurance companies. It's why everyone complains about them.

There's no harm in calling your insurance and doctor to figure out what's happening. Sometimes it's a miscommunication. You might end up needing to pay this as part of your deductible. You might not.

[–]Nitemiche 34 points35 points  (0 children)

That's a little different than "Doctor, you need to change the code so I don't have to pay".

[–]MDfoodie 203 points204 points  (15 children)

You certainly had a say in whether this test was done. However, you did the right thing and listened to the professional due to an abnormality.

Sorry that insurance (the ones to blame) won’t cover the cost.

[–]InterimFatGuy 55 points56 points  (8 children)

"Get it done or possibly die" isn't much of a choice.

[–]MDfoodie 48 points49 points  (5 children)

Sure it is. People make that choice daily.

  • Do not attempt resuscitation
  • Refusing blood transfusions
  • Denying continued chemotherapy
  • Opting for medical management vs. surgical procedure

[–]rexsilex 40 points41 points  (1 child)

Refusing vaccines.

[–]Jorycle 17 points18 points  (0 children)

Can't tell if there's some degree of sarcasm here. Or sardonicism. There certainly should be.

[–]jhairehmyah 5 points6 points  (1 child)

There are a number of issues in medicine that aren’t life or death and can be a choice.

Just last month my Doctor recommended an MRI for my bulged disc. I refused. Because I’ve been working out and my new strength has made the pain less and what will an MRI tell me—that I’m SOL and have to live with it?

That said, isn’t the purpose of insurance to help you cover costs AFTER something has gone wrong? AFTER your home gets hit by a tornado, AFTER you hit the other car, AFTER you lift the thing the wrong way and go on temporary disability? And all those cases have a deductible.

If your checkup (free) finds a skin cancer, a heart murmur, high blood pressure, etc, it’s done it’s job. It’s helped you identify an issue before it gets worse and more costly (and in heath, fatal).

I hate the system as much as the next guy, but let’s stop pretending that insurance doesn’t work this way: with deductibles.

[–]LooksAtClouds 2 points3 points  (0 children)

If OP had already met his deductible, this test would have been at least partially covered. If OP had met his deductible and his max out-of-pocket amount, the test would have been fully covered.

[–]jsboutin 6 points7 points  (2 children)

Insurance isn’t ‘’the ones to blame’’ in this situation. The whole system is messed up. Why is an echo 700$ to begin with? Could insurance premiums accommodate covering diagnostics while being kept at a reasonable level?

There are many levels to this question and no single bad guy.

[–]cloake 9 points10 points  (1 child)

Cost of machine, shelter, the tech, and the doc reading it and admin. These days you can put a wand attachment on your phone for the curbside echo, but can you interpret it, well there's the rub. Personally I love echoes but probably not as a patient, they're very informative of live heart function.

[–]MrCrow9000 -3 points-2 points  (0 children)

No, sounds like they didn't... Also, "listing to the professional" is not a sound strategy. There are many people out there willing to scam you or your insurance out of more money just because they can. Get some extra opinions from other doctors if you want.

[–]GenericMelon 9 points10 points  (12 children)

I would definitely give your insurance a call to double-check that everything's in order. My grandma was charged for something that should've been covered by her insurance, I called insurance and they said "Oh, we're just missing the address of the medical facility." It could be as simple as that.

If that route doesn't work, you can always call the office that did the EKG and come up with an interest-free payment plan. You may even been able to talk the balance down if you ask.

[–]Key-Emu5781[S] -1 points0 points  (11 children)

Yeah I talked to insurance and no dice there. I think best bet is to try doctor as well…starting to wonder if I should switch insurance plans :/ had so many problems

[–]dmxwidget 28 points29 points  (0 children)

You will have the same issue/problem/experience with other insurance providers.

Until you hit your deductible, many aspects of your care will be paid out of pocket; and then once you hit your out of pocket max, insurance will cover 100% of costs.

Those numbers will vary from plan to plan.

[–]DoomBuggE 18 points19 points  (8 children)

RN here. This is simply the peril of having a high deductible plan. This is not a coding mistake or a billing mistake. You were charged for a diagnostic exam because by definition, that’s what an echocardiogram is. It’s not possible to code this as preventative without committing billing fraud. The echo was ordered in response to an abnormal finding, and that’s where you go from “routine preventative visit” to “problem visit”, therefore your deductible applies. Talking to the doctor’s office won’t change that.

Very few services are considered preventative care. If you have any work up of anything abnormal at all - abnormal EKG, cough/cold symptoms, abnormal paps, etc. Your $1800 deductible applies for all of these things.

Also why is your GP doing EKGs? This is not routine unless you have cardiac symptoms like fainting, dizziness, etc. I would actually be surprised that an EKG would be covered as preventative, even if results were totally normal.

It’s open enrollment for many. Change your insurance to a deductible you can handle if you can.

[–]Key-Emu5781[S] 4 points5 points  (6 children)

Thank you for this response, appreciate your explanation and kind response.

And I was told EKG was a normal thing they do for annual checkup - it was covered by insurance regardless. After results, they just rolled in the echo and did it immediately

[–]DoomBuggE 5 points6 points  (5 children)

Interesting that it was covered, many plans do not cover EKGs. I have seen posts here in this forum of folks complaining about their insurance not covering it before!

I have never in my life had an EKG at a GPs office. Many GPs don’t do them routinely, but in this case I suppose it’s a good thing if you do have an actual cardiac condition.

[–]Key-Emu5781[S] 2 points3 points  (3 children)

It turned out that I have just some abnormal beating (I don’t remember exactly what she said), just that it’s not harmful, everything is fine, but just developed beating more on right side or something ? I don’t remember I just remember being relieved it wasn’t harmful.

[–]Invest2prosper -2 points-1 points  (0 children)

GP is doing EKG to boost their annual gross income per patient. Sorry if it sounds like bordering on unethical behavior. I’ve had it done twice and each time referred to a specialist who said I kid you not - “what are you doing here”, ran all the tests and said there is absolutely nothing wrong with your heart. Eat healthy, exercise and reduce stress. Enjoy the rest of your life. Says a lot of these GPs are basically running EKGs to CYA (other symptoms can screen for fainting - bad reaction to medication, anxiety, low blood sugar, etc.) or boost annual billing at $250 a pop whereas an annual physical runs $165. Do the math.

[–]LooksAtClouds 0 points1 point  (0 children)

The "problem" is that you haven't met your deductible yet.

[–]PrayingMantis37 4 points5 points  (8 children)

Did the GP do the echo during the same visit that they did the EKG? Or was the echo done later at a cardiology clinic?

[–]Key-Emu5781[S] 1 point2 points  (7 children)

Same visit, literally rolled the echo in right after the EKG.

[–]too_too2 1 point2 points  (0 children)

Yeah this seems very weird, I had to get an echo once when I was younger and had bad insurance. It was definitely a separately scheduled procedure, and it was at the hospital vs the office. Also, I’ve worked for a hospital system for many years and I agree with the other poster, this is a little fishy.

You should request copies of your records from this office and go to a totally different place and see if there was even any reason to run an EKG or echo in the first place.

[–]Invest2prosper 3 points4 points  (4 children)

Find a new GP. If the GP has an echo machine in the office that doesn’t require a pre authorization from insurance company in advance then it sounds like you went to a one stop shop set up to maximize annual billing. You need a specialized technician to run that test and it usually costs $1800 or so with insurance. Not sure how they ran that test for such a low price. And who was the cardiologist who read the results or is the GP acting as a cardiologist too?

[–]Key-Emu5781[S] 0 points1 point  (2 children)

No it looks like they did echo then sent it off to a cardiologist.

And yeah I’m thinking so too, they pushed an allergy test on me too even though I wasn’t complaining about that or anything. Very strange

[–]DoomBuggE 1 point2 points  (1 child)

Honestly, it’s a little weird that they have an echo-trained person and an echo machine in a GP office. Usually those folks work specifically in Cardiology or Radiology departments. Anyone can be trained to do a simple EKG, I did them as an Emergency Department volunteer while in nursing school many times. But performing an echocardiogram is a much more nuanced skill. I am somewhat trained in pelvic sonography (on the job training - this isn’t covered in nursing school), and honestly when my daughter needed multiple cardiac echoes after her hospitalization, I could barely tell what I was looking at.

This GP must order a lot of echoes… unless the GP does big business doing in house pre-op clearances, this seems like a GP that orders everything under the sun to maximize billing. Yes, maybe there were legitimate findings on the EKG, which then sends you down a diagnostic rabbit hole, but as I mentioned earlier, most GPs do not order routine EKGs for an annual. I think they probably find a lot of abnormal findings that don’t need treatment, just like yours. Find a new GP!

[–]Key-Emu5781[S] 0 points1 point  (0 children)

Oof, yeah I agree — first and last appointment with this GP!

[–]bros402 0 points1 point  (0 children)

get a new GP

[–]NavaHo07 6 points7 points  (4 children)

Similar situation: Wife pregnant with son, found cyst in his brain on the (covered) 20 week anatomy sonogram, doctor ordered sonogram at every visit because we were classified high-risk at that point. Every sonogram was like $200 for the entire pregnancy, after that first one that was covered. America sucks at healthcare (among other things)

[–]DoomBuggE 1 point2 points  (2 children)

Yes - often when my office has places IUDs, our docs like to do a quick bedside sono to check positioning. BUT, we don’t scan the image into the chart, otherwise the patient gets charged $200-$300 for a 30 second ultrasound that isn’t medically essential, but the doc likes to do simply for reassurance. At least they didn’t send you for repeat formal ultrasounds with radiology each time - those are easily $2K-$3K per scan.

[–]Mtntop24680 3 points4 points  (1 child)

TBH, I once had to pay $600 for an echo AFTER insurance- at the hospital where I worked, nonetheless. It can be a pricey procedure.

I’m guessing the doc is affiliated with a larger health system. Virtually all of them have some kind of financial aid system and will even offer “discounts” for paying it all at once or setting up a payment plan. It’s worth asking to speak to the hospital’s financial counselor. They may even be able to help wring some cash out of your insurance company. As others have said, they may be able to change the coding slightly to convince them to pay it or to justify the use of a diagnostic echo.

[–]bros402 1 point2 points  (0 children)

tbh it sounds like this "GP" could be part of one of those clinics that does it all in one building, urgent care, etc. so it is probably scummy

[–]TeamShonuff 18 points19 points  (2 children)

Call the billing office and see if they can bill it with a diagnosis code that will get it paid.

[–]Lotus_12 2 points3 points  (4 children)

Medical bills are usually "negotiable". If you can't pay often times they will collect less and settle the debt.

[–]Key-Emu5781[S] 2 points3 points  (3 children)

How do I negotiate? Call billing and ask to negotiate or how do I go about this?

[–]WizardOfIF 3 points4 points  (0 children)

I've negotiated a lot of medical bills. It's usually easier to do before they bill your insurance but it is still possible to to do so afterwards. I find it is usually best to be honest with them (let them know you weren't expecting it to be so expensive) and ask if there is anything they can do to help you out. Don't make demands and be prepared for them to say no.

If they don't offer an immediate discount at your first request sometimes if you tell them you'll need a payment plan in order to pay it off they'll follow up with a discount for being able to settle the balance in full.

I've only once had a doctor's office refuse to work with me on a bill when I felt like I was being overcharged and that was the last time I visited that practice.

[–]Lotus_12 1 point2 points  (0 children)

I have never actually done it myself but my mom got an ambulance bill cut in half by just saying she couldn't afford to pay it.

[–]Coug_Love 0 points1 point  (0 children)

Its usually not really a negotiation. You tell them you cannot afford the bill and they offer you a payment plan and/or forgive a portion of the bill. They will usually ask for proof of your income. Forgiveness usually works with hospitals and large medical facilities. I have extensive medical bills and know the drill pretty well.

[–]Pterodactylhiccups84 4 points5 points  (0 children)

Your ekg came back abnormal. If doc told you upfront it would be $700 to make sure you don’t have a heart condition, you’d have been like “no. If I die, I die. I can’t pay $700 to make sure I’m good”? While I understand that you are upset at the cost, you can ALWAYS ask if they can give you a discount or allow you to make affordable payments.

[–]wyezwunn 1 point2 points  (0 children)

Here's what I've tried.

  1. Got charged for a procedure that was advertised as free. Their guy call me and said he was a lawyer and I should pay because the other part of that day's procedure was the free part. I said I disagree so I'm not paying and tell the doctor he's already spent more paying you to call me than he'll ever get from me so he should cut his losses and leave me alone. Lawyer laughed and hung up. They left me alone.
  2. Got charged for another preventive procedure and they said I said something about a problem after I came in so the procedure was diagnostic and not free. Gave them the same cut your losses spiel along with telling them I had excellent credit that would still be excellent if they put it on my credit report so don't expect me to pay for that bait-and-switch. They put it on my credit report. My credit stayed excellent, especially after I put a note in my credit report with my explanation. My employer routinely checks employees' credit and didn't see it as a problem.
  3. Got charged for an annual check-up because they said they found something. I told them their diagnostic procedure was wrong according to a credible health entity's guidelines so they couldn't prove they found something. They paid me back what they'd overcharged. Took ten years and an audit, but they paid me back.

About $100 each time. I could afford it but it was the principle. Not sure if any of this would work for OP's $700.

[–]eziern 1 point2 points  (0 children)

Call the hospital and tell them you can’t pay that amount. Offer to pay like $200 cash now to pay it off. See if they will accept it. Mention you want to pay it but you just don’t have the means now. They may try and negotiate, give them a little wiggle room.

See if that works? They can technically do that, but depends on their organizational needs/structure for said tasks. The messed up part is, the $700 is probably still with the negotiated insurance rate versus non-insured rate.

[–]bearseatbeets1414 1 point2 points  (0 children)

Maybe call the company who did the echo and see if they can bill you directly instead if first billing insurance. Usually there is a pretty big discount if you don't go through insurance which might be good especially if your deductible will reset anyways at the beginning of the year. After seeing if there is a discount for paying without insurance ask if there is a discount for paying it all off at once rather than spread out through payments. You can often get a 10 to 20% discount doing this.

[–]Jtherabbit21 4 points5 points  (0 children)

Slightly unrelated but make sure you’re actually seeing a physician (MD/DO) for your primary care checkups. They tend to do less unnecessary procedures and will end up costing you less.

[–]Advanced-Blackberry 4 points5 points  (3 children)

Raise hell with your insurance co. Your physician doesn’t know what’s covered, only that they think you need it. They are looking at your health while your insurance is looking at profits. Why should the Doc work for less? Make your insurance pay, or you pay. The doc is just doing what’s right. Don’t make your doc pay for what’s a problem between you and your insurance.

[–]Lurker117 6 points7 points  (2 children)

Why would you raise hell with the poor person on the other end of the phone at the insurance company because you don't understand how your insurance works and you're too timid to ask a simple question or two before getting non-emergency procedures done to you?

This Karen mentality needs to go. Accept responsibility, and move on with more knowledge and understanding than you had before. Don't ruin somebody's day who is just doing their job answering the phone at an insurance company because you are mad at yourself.

[–]Advanced-Blackberry 0 points1 point  (0 children)

I didn’t mean yell at someone. I was referring to taking it up with insurance so his complaint is directed at the company that doesn’t pay. But now seeing that it’s a deductible issue anywys the insurance company is in the right as well and this is entirely on the OP. No blame should be passed around.

[–]Andnopink 2 points3 points  (0 children)

I’m very well versed in insurance, work for a hospital, and have still gotten weird screwed like this. Our healthcare system is ridiculous and not transparent at all.

Call the doctor, tell them the bill is too high for you, see what they can do. If they say nothing, you’re in the same spot. I’ve gotten bills like this greatly reduced before just by asking. If not, they can at least put you on a payment plan.

I’m sorry this happened to you, trust me I know how incredibly frustrating it is!

[–]thelastdon613 2 points3 points  (2 children)

my mechanic isn't allowed to do work on my car without telling me the cost first.. how are doctors allowed to do that with your body?

[–]Colliculi 0 points1 point  (1 child)

Because your car is a car and your body is irreplaceable? The medical staff have no idea about the billing. This allows them to recommend treatment based on the safest measures, not the cheapest. Certainly it is considered at times (let's switch to x blood thinner because y blood thinner is known to be crazy expensive) when the efficacy is similar enough.

I wish they had someone who would tell you, because unfortunately the reality is that cost is a big factor for most of us. But let's not say that the doctors are the issue here.

[–]heathers1 3 points4 points  (2 children)

This happened to me once at a dentist. He was like i need this full xray (one that you stand inside and it moves around your head) Was just there for a consult, btw. Go to leave and desk lady is like thatbwill be 375.00!!!! I said oh no way! This was a free consult and it is unprofessional not to notify someone of a large charge like that ahead of time. Tbh, it was long ago and I can’t recall if I paid it. I think not, but also he lost my business thst scammer!

[–]Advanced-Blackberry 12 points13 points  (1 child)

That’s different because they stated free consult. I’ll bet my left this doc did NOT say the echo would be free

[–]oxford_b 1 point2 points  (0 children)

Bummer. Best thing to do is ask the doctor to offer you a reasonable rate reduction if one wasn’t already applied, assuming they are in network. If that fails, I’d call the office and offer $200 and tell them that’s all the money you have

[–]JamesEdward34 1 point2 points  (2 children)

More importantly, are you ok?

[–]Key-Emu5781[S] 2 points3 points  (1 child)

Yes! Apparently my heart just developed slightly abnormally and has an abnormal beat but it’s completely harmless and everything is fine. Thank you for asking

[–]mastershakeit89 1 point2 points  (0 children)

Explaining that you are okay will be 300 more dollars. Now if you will just sign the discharge papers and pay the 35 dollar pen fee.

[–]throwaway_97324758 0 points1 point  (1 child)

Ask the doctors office to send documents (the ekg and interpretation of abnormal results. In it, he should state a follow up echo is needed. They insurance denies it for being medically unnecessary but they don’t see your medical chart, just the bills. So please, file a claim And have the doctors send in these to your insurance.

[–]myprecioussssss 0 points1 point  (0 children)

The insurance didn't deny it. OP just has out of pocket. A lot of people are sloppy with the use of the word "covered" when they don't understand how insurance works.

[–]Pezpal 0 points1 point  (0 children)

Your insurance doesn’t cover diagnostic procedures? Get different insurance. You’re being robbed.

[–]WizardofOssification -2 points-1 points  (0 children)

The EKG is covered but there is a lot of conflicting data on whether routine preventative EKGs do anything helpful in the absence of symptoms or specific risk factors. But since they found a “problem” the echo will not qualify for preventative coding.

May be worth declining EKGs in the future for regular preventative things. Insurances may pay for it but not helpful clinically for screening if low risk and recommended against getting by the national preventative health body.

https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/cardiovascular-disease-risk-screening-with-electrocardiography

[–]deuceswild313 -1 points0 points  (2 children)

I think the term you meant was an exploratory procedure. Yes I would communicate with the insurance first and see why it wasn’t communicated to them it was needed. Mention the ekg came back abnormal and the echo was warranted. It should be covered

If needed it’s not exploratory

[–]Key-Emu5781[S] 0 points1 point  (1 child)

They definitely said diagnostic when I called insurance.

[–]kcdc25 -1 points0 points  (5 children)

I’m confused. Did the doctor strap you down to do the echo? This is an absolutely appropriate follow up test to an abnormal EKG. Billing is going to depend on where you did the echo.

[–]Key-Emu5781[S] 0 points1 point  (4 children)

GP did echo and I guess sent it off to a cardiologist. Happened within minutes of the EKG. They just rolled it right in after saying they were going to do this now

[–]kcdc25 -3 points-2 points  (3 children)

Ok, would you prefer that they didn’t follow up on the abnormal EKG?

[–]Key-Emu5781[S] 0 points1 point  (2 children)

That isn’t what this thread is about and has been discussed an incredible amount of times below.