Insured - still had to pay everything up front

[songsmith 334]

I blamed my surgeon for this at first, but now I think it might be hospital policy. My insurance covers 80% of my surgery minus deductible. I was told by both the doctor's office and the hospital that I would need to pay everything up front (the deductible plus that 20% not covered) by day of surgery. To make matters worse, they don't accept Care Credit (which has always offered 0% financing for 24 mos. when I've used it in the past).

No one mentioned this at the seminar or at all except when I was called about my endoscopy. Later when the hospital phoned to preregister me, I was given an additional sum I would still owe or they would not do the surgery.

It all sounds so strange to me. When I've had surgery before, I pay my copay, the insurance is billed and then I'm billed for anything left over. I wondered if this was standard procedure?

(I should mention that the doctor did say that if you were self-pay the entire cost would need to be received ahead of time. He did not say that about insured patients.)

[Careysgirl 20]

Is the hospital a private one? Why are they not billing? I live in NJ have been in hospitals and surgery centers for procedures they never took money up front I just find it strange.

[jess9395 5,449]

I had to pay my share of costs up front. Actually wound up overpaying by $100 and got a check in the mail months later.

[Sharon1964 2,530]

This is the new standard. So many people end up not paying their hospital bill that now the hospital wants what they expect your portion to be, up front.

When I saw the title, I thought you meant you had to pay 100% up front, not your portion. I was all ready to tell you how to file a complaint about that. But paying your portion up front is to be expected these days.

The lab I go to now has the same policy. They told me when I went in yesterday that they expected my portion of the bill to be $19, and they took my credit card info. In their case, it's not charged until after insurance processes.

[Careysgirl 20]

Well I guess this is news to me I better save my FSA money for my surgery date.

[Daisee68 2,493]

Yes. Same here. For any procedure I have had at least the last 6 years. It is quite daunting given moat of us have huge deductibles now.

[OutsideMatchInside 10,166]

I get billed for everything. Never charged up front. Insurance is so complicated they can't charge you up front. They have no way of knowing if you met your out of pocket and are covered at 100%. When i had surgery i had already maxed out for the year doing pre-op.

[Sharon1964 2,530]

I get billed for everything. Never charged up front. Insurance is so complicated they can't charge you up front. They have no way of knowing if you met your out of pocket and are covered at 100%. When i had surgery i had already maxed out for the year doing pre-op.

Actually, real-time eligibility, benefits, and deductible status will tell them that. A few weeks before surgery, my hospital called me and said, as of now, it looks like the remainder of your out-of-pocket will be around $3,300. I said, that's correct, all the other bills have been processed (I looked it up myself). And I said, I don't think there will be much, if anything else, before surgery. I offered to pay $3,000 up front, and they ended up billing me for a hundred dollars or so (can't remember the exact amount).

They would much rather try to collect $100 instead of $3100.

[OutsideMatchInside 10,166]

i dealt with 3 different hospital systems in in 2 different states to have my surgery completed last year. None of them collected more than co-pays up front. My PCP office doesn't even take copays for visits, they use a central billing department that mails out bills.

My list of states and metro areas to never live in keeps getting longer every year.

Also real time billing would tell nothing since some days i had multiple appointments and the morning test might have met my out of pocket before the afternoon test. Billing isnt that fast.

Im self employed and buy my own policy, if there was ever a patient to try and collect on up front, it would be me. It just doesnt work like that around here. And time value of money, I am unwilling to take a chance on overpaying.

[jess9395 5,449]

I get billed for everything. Never charged up front. Insurance is so complicated they can't charge you up front. They have no way of knowing if you met your out of pocket and are covered at 100%. When i had surgery i had already maxed out for the year doing pre-op.

My orthopedist contacts the insurance to find out exactly where you are and how much you will owe. They can find out if they want to.

[jess9395 5,449]

Also real time billing would tell nothing since some days i had multiple appointments and the morning test might have met my out of pocket before the afternoon test. Billing isnt that fast..

Actually mine is that fast! My Ortho contacted them one afternoon and they already had my blood tests and MRIs in there from earlier in the day. They don't care if you actually paid those appointments they are the ones you owe for if they finish up your deductible or out of pocket... Because they were earlier you owe for those not the later appointment.

[OutsideMatchInside 10,166]

They can but for a big hospital system/doctor network it isn't worth their time. The only place I see calling all the time to check benefits is my dentist office, but they are not the most high tech system, and they are just a single private office.

The whole reason Drs and Hospitals go to groups is to save money on administrative costs, thus centralized billing.

[jess9395 5,449]

They can but for a big hospital system/doctor network it isn't worth their time. The only place I see calling all the time to check benefits is my dentist office, but they are not the most high tech system, and they are just a single private office.

The whole reason Drs and Hospitals go to groups is to save money on administrative costs, thus centralized billing.

Our hospital system is connected by computer to the insurance system for real time updates. No need to call.

It's the wave of the future, especially the pay your portion up front and we are NOT in a metropolitan area, far from it! We are considered rural by all the medical reimbursement rates.

[OutsideMatchInside 10,166]

Also real time billing would tell nothing since some days i had multiple appointments and the morning test might have met my out of pocket before the afternoon test. Billing isnt that fast..

Actually mine is that fast! My Ortho contacted them one afternoon and they already had my blood tests and MRIs in there from earlier in the day. They don't care if you actually paid those appointments they are the ones you owe for if they finish up your deductible or out of pocket... Because they were earlier you owe for those not the later appointment.

Maybe within the same system, but some of the time I go to the Catholic hospital system and sometimes I go to Barnes Jewish. It depends on my mood. They don't have the same billing system and BCBS is not processing claims in real rime, it takes 24 to 48 hours.

The healthcare system in America really varies and there are different laws and regulations in different states. It is not all the same. No, collecting everything up front is not standard practice everywhere, just like being billed isn't standard practice everywhere, it varies. This is the first PCP that i have ever had that doesnt collect co-pays at the time of service which I find annoying, especially since they send paper bills in the mail and dont have an online electronic billing system.

[jess9395 5,449]

Also real time billing would tell nothing since some days i had multiple appointments and the morning test might have met my out of pocket before the afternoon test. Billing isnt that fast..

Actually mine is that fast! My Ortho contacted them one afternoon and they already had my blood tests and MRIs in there from earlier in the day. They don't care if you actually paid those appointments they are the ones you owe for if they finish up your deductible or out of pocket... Because they were earlier you owe for those not the later appointment.

Maybe within the same system, but some of the time I go to the Catholic hospital system and sometimes I go to Barnes Jewish. It depends on my mood. They don't have the same billing system and BCBS is not processing claims in real rime, it takes 24 to 48 hours.

The healthcare system in America really varies and there are different laws and regulations in different states. It is not all the same. No, collecting everything up front is not standard practice everywhere, just like being billed isn't standard practice everywhere, it varies. This is the first PCP that i have ever had that doesnt collect co-pays at the time of service which I find annoying, especially since they send paper bills in the mail and dont have an online electronic billing system.

It definitely must vary because I have blue cross anthem and the hospital, lab and MRI were not part of the same system, all independent because line j said I live in a rural area and we don't have a lot of big systems and groups, yet blue cross had my info and what I paid and owed in real time. I'm sure they hadn't paid the claims yet, but the info was there!