billed you for more than your OON deductible and coinsurance, you’re probably caught in a scam. Here is what to do about it:
Check your EOB. Did insurance pay the provider? If your insurance did pay the provider, and the provider has billed you personally for more than your OON deductible and coinsurance, then they are defnitely scamming you.
The reason providers always bill insurance, even if they are OON, is because some people have great OON coverage that pays 90% to 100% of full charges. Comparatively, this can be two or three times as much money as the provider receives for a normal patient. However, most people do not have great OON coverage. Providers “play the lottery” and still see OON patients because if one in ten OON claims does pay at this high rate, they pay so well that it more than makes up for the others.
This is often illegal and always wrong. Providers cannot “balance bill” just because they took a gamble and the insurance company’s payment was too low. I have seen this quite a bit with small privately-owned for-proft healthcare businesses like physicians’ offces, imaging centers, and surgery centers. Large not-for-proft hospitals and similar reputable organizations rarely engage in these nickel and dime types of practices.
A physicians’ ability to provide fnancial aid to patients is unique. I want you to understand why.
The plight of the American physician is really the same as the plight of the American small business owner. The small business owner strives to remain independent by warding off big business. They do not have the resources or the money to compete with their large competitors with regard to location, advertising, and highly paid employees. Therefore, they have to run faster, jump higher, and work much harder to maintain autonomy. If they can’t keep up,a they get swallowed up by a bigger company.
For the last seven years, Congress has voted not to reduce or increase Medicare payments to physicians. It is good for the physicians that payments have not been reduced, but unfortunate that they haven’t been