$2000 bill in the mail

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F0nzie

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So I just opened up my mail and got a $2000 bill from my son's developmental pediatrician. I see a bunch of numbers adding up to $2000 and none of them mean anything to me. I'm like wtf?

On the initial visit we paid a $60 copay, the rest would be billed to our insurance (which is a platinum plan from United we obtained through the exchange), spent around 45 min with the doc and received some initial impressions. No additional work up or testing.

I'm thinking **** my wife is a child psychiatrist and charges $450 in cash for initial evals... Chump change in comparison.

In retrospect I should have asked how much the total out of pocket initial evaluation would be but I figured it was somewhere in the $300-$500 range... Not in the thousands....

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So I just opened up my mail and got a $2000 bill from my son's developmental pediatrician. I see a bunch of numbers adding up to $2000 and none of them mean anything to me. I'm like wtf?

On the initial visit we paid a $60 copay, the rest would be billed to our insurance (which is a platinum plan from United we obtained through the exchange), spent around 45 min with the doc and received some initial impressions. No additional work up or testing.

I'm thinking **** my wife is a child psychiatrist and charges $450 in cash for initial evals... Chump change in comparison.

In retrospect I should have asked how much the total out of pocket initial evaluation would be but I figured it was somewhere in the $300-$500 range... Not in the thousands....

Did he write a report or talk to teachers, schools etc? What was all the work involved? Follow up appts set up? Did you look up what the numbers mean? Google? Let us know the numbers and codes.
There is one in our area that charges similar. Includes a report and 1.5 hours facetime.
 
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Melmed Clinic?
Their billing sheet is really clear about this...
You get a report in 4-6 weeks...
Their rules are super strict....
Interesting..
http://www.melmedcenter.com/patient-forms.html

Im sure it includes the cost of reviewing the myriad forms and interpreting the testing..
Almost 30 pages in the initial paperwork for a child..
Discussion with pcp, etc..


It pans out with paying it...From the info online...
You are responsible for knowing what your insurance benefits are, including what your insurance will and will not pay for; and how to access your benefits, including obtaining referrals, etc. If you are unsure, please contact your insurance carrier. This office assumes no responsibility for your lack of knowledge regarding your insurance benefits. You are responsible for any remaining unpaid charge(s) as determined by your insurance company regardless of cause. This agreement is necessary in order to accept your insurance without having to bill you upfront. An account past due 60 days or more and payment plans that are not kept current, may be subject to collection and associated fees.
 
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Did he write a report or talk to teachers, schools etc? What was all the work involved? Follow up appts set up? Did you look up what the numbers mean? Google? Let us know the numbers and codes.
There is one in our area that charges similar. Includes a report and 1.5 hours facetime.


Not that I am aware of.

No codes. No descriptions. Just a money being added in a column lol!
 
So I just opened up my mail and got a $2000 bill from my son's developmental pediatrician. I see a bunch of numbers adding up to $2000 and none of them mean anything to me. I'm like wtf?

On the initial visit we paid a $60 copay, the rest would be billed to our insurance (which is a platinum plan from United we obtained through the exchange), spent around 45 min with the doc and received some initial impressions. No additional work up or testing.

I'm thinking **** my wife is a child psychiatrist and charges $450 in cash for initial evals... Chump change in comparison.

In retrospect I should have asked how much the total out of pocket initial evaluation would be but I figured it was somewhere in the $300-$500 range... Not in the thousands....

This seems ridiculous! For $2000 you can get a full developmental eval with ADOS/WISC/Vineland/Speech and language eval. Bizarre!
 
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Not sure. All I know is every time I see a doctor I get a huge ass bill in the mail with a ton of charges.

Yeah. I think you mentioned some other test recently too.
I guess this shows us how patients feel...
You're right, many of them can't afford it.
 
Shouldn't there be a really simple explanation with specific billing codes supporting what was billed? Has your insurance actually been billed yet? Is the doctor in network? What's your deductible?

It seems strange they would send you a bill directly without submitting to insurance first, but perhaps it's just an atypical billing system. I would call your insurance company, explain what you received, and see what they say to do.
 
I believe you are likely paying a "summer home fee" as well as a "kids' college tuition fee," "new car fee," and "**** you I charge what I want fee."

That's what it feels like lol. I wonder if there is a way in psychiatry to accept insurance, charge $60 for an initial eval, then send a 2k bill to the patient/insurance.
 
I got a similar story.

My wife, before I was an attending got billed $600 for being injected with a vaccine. Turned out the doctor's office billed her just for the act of being vaccinated. Wasn't covered by insurance. We couldn't fight the bill cause it was one of those things where they do it, they bill for it, and the patient doesn't know about it until the act is done.

Total rip-off. Heck if I made $600 for injecting someone I'd freaking do all my own Haldol injections myself. When I was in the forensic unit I worked in I would've banked about $5000/day just from that. (IT was filled with antisocial psychotic people many who did felony level violence such as rape and murder).

The same idiot office recommended she get some labs done and told her to use the lab in the same building--the one that didn't accept her insurance when she could've gone to one that did accept her insurance so she had to pay a few hundred there that should've been paid by insurance. Since they told her to do it she thought it was kosher.
 
That's what it feels like lol. I wonder if there is a way in psychiatry to accept insurance, charge $60 for an initial eval, then send a 2k bill to the patient/insurance.

What? This is pretty typical, you can do the same thing in psychiatry too...just be an out of network provider, get paid their out of network copay, submit anything you want to their insurance for billing and then when insurance doesn't cover it turn around and send the bill to the patient. Or they get hit with it to begin with if it's all within their deductible. This isn't some new or surprising thing and if you're so shocked and appalled by this developmental pediatrician (who probably makes less than you do) doing this kind of billing, you'll have a heart attack when you see how some of fun billing tricks surgery centers and anesthesiologist groups use.

You seem to have a really bad understanding of how insurance and billing works outside of your cash practice.
 
I got a similar story.

My wife, before I was an attending got billed $600 for being injected with a vaccine. Turned out the doctor's office billed her just for the act of being vaccinated. Wasn't covered by insurance. We couldn't fight the bill cause it was one of those things where they do it, they bill for it, and the patient doesn't know about it until the act is done.

Total rip-off. Heck if I made $600 for injecting someone I'd freaking do all my own Haldol injections myself. When I was in the forensic unit I worked in I would've banked about $5000/day just from that. (IT was filled with antisocial psychotic people many who did felony level violence such as rape and murder).

The same idiot office recommended she get some labs done and told her to use the lab in the same building--the one that didn't accept her insurance when she could've gone to one that did accept her insurance so she had to pay a few hundred there that should've been paid by insurance. Since they told her to do it she thought it was kosher.

Again, there's nothing actually preventing you from doing this and there are tons of offices that do this stuff. It doesn't mean it's right but it's fairly common. What's surprising is that you're all shocked about this...
 
You mentioned a copay. If they accept insurance how can they still charge cash in addition? I thought that was not allowed by insurance paneling agreements.
 
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You mentioned a copay. If they accept insurance how can they still charge cash in addition? I thought that was not allowed by insurance paneling agreements.
Maybe deductible not met yet? This is a bit of an odd situation
 
I'm still stuck on the fact that your wife can charge $450 for a child psyc eval. WTF do they get for that price?
 
I'm still stuck on the fact that your wife can charge $450 for a child psyc eval. WTF do they get for that price?
Diagnostic opinion, reassurance, possible medication treatment, possible suggestions on future direction of treatment.
 
I'm still stuck on the fact that your wife can charge $450 for a child psyc eval. WTF do they get for that price?

It's on the bottom end of what the Child Psychiatrists out here charge for an initial eval. She spends 90-120 minutes of face-to-face time plus and additional 30 min for documentation. She also gives her cell phone and email address for parents who have inquiries and updates between sessions. She recently stopped accepting new child patients because she is booked and current parents on her caseload can be quite time intensive and needy. While the upfront cost seem high there is a lot of work that happens behind the scenes...especially in Child Psych.
 
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Wow, 120 minutes and I can understand. What part of the country (I need to move)?
 
You mentioned a copay. If they accept insurance how can they still charge cash in addition? I thought that was not allowed by insurance paneling agreements.

This isn't true if they've already sent a bill to the insurance company which they've then decided to not reimburse. Again, happens all the time with "out of network" providers who have no agreement with the insurance company for allowed charges. They're allowed to bill whatever they want and you signed a piece of paper saying you'll be responsible for any charges not covered by your insurance company. Fairly straightforward.

Or as stated above if the deductible wasn't met yet...you're on the hook for anything up to the deductible.
 
This isn't true if they've already sent a bill to the insurance company which they've then decided to not reimburse. Again, happens all the time with "out of network" providers who have no agreement with the insurance company for allowed charges. They're allowed to bill whatever they want and you signed a piece of paper saying you'll be responsible for any charges not covered by your insurance company. Fairly straightforward.

Or as stated above if the deductible wasn't met yet...you're on the hook for anything up to the deductible.

I understand out of network providers that bill insurance as a courtesy, but I thought copays were specific to in network providers
 
I understand out of network providers that bill insurance as a courtesy, but I thought copays were specific to in network providers

Depends on what insurance you have. Some have copays, some pay a certain percentage of your initial office visit, some won't pay anything upfront at all. For example, if your insurance covered 50% of out of network office payments, if his office fee was $120 then you'd be paying a $60 "copay".
 
It's on the bottom end of what the Child Psychiatrists out here charge for an initial eval. She spends 90-120 minutes of face-to-face time plus and additional 30 min for documentation. She also gives her cell phone and email address for parents who have inquiries and updates between sessions. She recently stopped accepting new child patients because she is booked and current parents on her caseload can be quite time intensive and needy. While the upfront cost seem high there is a lot of work that happens behind the scenes...especially in Child Psych.

450 for 2 hours? Thats practically medicare rates, without the extras. Around here the cash child guys charge 4-800 per hour (bay area).
 
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