Do you review your claims?

I just went thru all of my claims (except that $10,000+ one from ER that won't be covered b/c we've used up our lifetime max. )
Anyway, I found out that on 3 different dates, my dr's office charged me for my ultrasound, bloodwork AND a physician charge- even though the nurses were doing the sonograms.
I just put a call into them b/c that's $ that could be better spent towards the rest of my outstanding balance - but it annoys me to think that if I hadn't checked I'd be out almost $300 more... I also checked one of my few claims from retrieval day- and found out that I have to pay 10% of my anestesialogist's bill- b/c of HOW it was billed... explain that one? I called Cigna and they told me even though I was with my in-network dr. and it was done at his office, b/c they billed it how they did I'm responsible for this.... I'm so annoyed right now.
IF it had worked, I wouldn't even care- we'd figure out a way to pay the $ and be done with it... but the fact that I know that it didn't work- it's killing me to scrounge up this $$$. IF sucks....

Re: Do you review your claims?

How frustrating!

We pay for everything OOP - so we just pay all at once when we decide what treatment we are going with.. and we don't get any other bills from it.

Re: Do you review your claims?

This happened to me! I never really looked closely at my claims until my last cycle, but I was getting charged double copays for doctor visits when all I had was blood taken that day when I was not seeing a doctor. Everytime I would get a final bill, I would call and dispute some things and sure enough it was wrong. The thing is, I didn't do this early on and just paid what I owed so I know I ended up paying more than I had to in the beginning. It wasn't until my last round of IVF that I caught on.

Message edited 2/26/2009 3:28:25 PM.

Re: Do you review your claims?

So the head of billing at my dr's office just called me back. She claims that if any nurses or nurse practitioners spent any 'real time' with me going over anything- that they can bill me the physician's rate!!!
I explained to her that this is my 2nd stim cycle- so there's really nothing new that i should've needed to sit down w/ anyone to discuss anything in depth. I asked her to pull the file from those days to see why the charges are there- which she's claiming to do... so we'll see how long that takes.
While waiting for the call back from her, I called Cigna back to see if I could get someone more knowledgeable and of course I did. She said "as of right now- they're billing that $10,400 claim at the in-network rate" which is.... get this... $1500 and change!!! She said 'it's still in process so nothing's set in stone but it seems like they're going to pay this' and then told me to "Continue to keep Praying real hard that it doesn't change"
Then she asked her supervisor who said that if my IF benefits are maxed out that I will be responsible for the $10,400. So now I hold my breath and wait... my hope is that if billing comes back to me and agrees with me that I shouldn't have paid those 3 physician fees, that I'll have some $ back in the IF pot, in which case they could put it towards that one claim still in process and give me the discounted rate! This is going to be a killer wait....

Re: Do you review your claims?

Posted by MrsMessina

So the head of billing at my dr's office just called me back. She claims that if any nurses or nurse practitioners spent any 'real time' with me going over anything- that they can bill me the physician's rate!!!
I explained to her that this is my 2nd stim cycle- so there's really nothing new that i should've needed to sit down w/ anyone to discuss anything in depth. I asked her to pull the file from those days to see why the charges are there- which she's claiming to do... so we'll see how long that takes.
While waiting for the call back from her, I called Cigna back to see if I could get someone more knowledgeable and of course I did. She said "as of right now- they're billing that $10,400 claim at the in-network rate" which is.... get this... $1500 and change!!! She said 'it's still in process so nothing's set in stone but it seems like they're going to pay this' and then told me to "Continue to keep Praying real hard that it doesn't change"
Then she asked her supervisor who said that if my IF benefits are maxed out that I will be responsible for the $10,400. So now I hold my breath and wait... my hope is that if billing comes back to me and agrees with me that I shouldn't have paid those 3 physician fees, that I'll have some $ back in the IF pot, in which case they could put it towards that one claim still in process and give me the discounted rate! This is going to be a killer wait....

Re: Do you review your claims?

Posted by Sassyz75

Posted by MrsMessina

So the head of billing at my dr's office just called me back. She claims that if any nurses or nurse practitioners spent any 'real time' with me going over anything- that they can bill me the physician's rate!!!
I explained to her that this is my 2nd stim cycle- so there's really nothing new that i should've needed to sit down w/ anyone to discuss anything in depth. I asked her to pull the file from those days to see why the charges are there- which she's claiming to do... so we'll see how long that takes.
While waiting for the call back from her, I called Cigna back to see if I could get someone more knowledgeable and of course I did. She said "as of right now- they're billing that $10,400 claim at the in-network rate" which is.... get this... $1500 and change!!! She said 'it's still in process so nothing's set in stone but it seems like they're going to pay this' and then told me to "Continue to keep Praying real hard that it doesn't change"
Then she asked her supervisor who said that if my IF benefits are maxed out that I will be responsible for the $10,400. So now I hold my breath and wait... my hope is that if billing comes back to me and agrees with me that I shouldn't have paid those 3 physician fees, that I'll have some $ back in the IF pot, in which case they could put it towards that one claim still in process and give me the discounted rate! This is going to be a killer wait....

wait a second....
what you're saying here is the $10,400 charge is reduce to $1500 that the docs will take if it goes in network? So if the doc is willing to take $1500 from your insurance company, why wouldn't they be willing to take the $1500 from you?

That's what I don't understand about doctors offices- the money they charge isn't rooted in any reality- they charge the insurance company$5k for something but accept $500 for it.. if that's the case- that's what we should all pay- OOP or insured.

Re: Do you review your claims?

ok what I don't understand here is why ER was $10k plus. Cornell charges $6,000 for ER and ET combined. What the are they doing?????? That is insane amount. Does that include the entire cycle? I know you had $10k and you used some for your FET. We know the retail (like that word) price was $4500 and we know they didn't get that from insurance.

They should NOT be charging you for physician fee, ITA on that and it REALLY pisses me off. If you are in for b/w and sono than that is what they should charge you. BUT, when they think insurance is paying for it I guess they just put in what ever the heck they want b/c if its covered you'd never look at it.

They better except your $1500 through insurance. I totally said that wrong but you know what I mean.

As it is one of my RE's got paid twice for a procedure that I paid OOP. B/c in middle of my cycle they switched over to accepting my insurance plan and when I put my claim through they paid the RE not reimbursed me. I am still working on that since October.

Re: Do you review your claims?

Message edited 2/26/2009 5:42:05 PM.

Re: Do you review your claims?

So now I called back to ask about medication because originally I was told that it was pharmacy benefits and not Infertility benefits that the 'self injectable' medications came out of... guess what. That's wrong too!!!! Now ALL IF meds will be 100% out of pocket!!! This day is getting better and better... I think the world is trying to tell me I should just give up...

Re: Do you review your claims?

I hope everything gets resolved as quickly as possible.

Re: Do you review your claims?

it still doesn't make sense to me that after the insurance is maxed out that she shouldn't be able to pay the rate insurance pays, because she does have insurance, they just are maxed out now...

I hate insurance companies- I really feel like THEY Are the ones that make all this stuff so expensive...

I'm sorry you have to go through this

Re: Do you review your claims?

I would call back all docs and ask for an itemized bill- my mom did this when she had to go into the hospital for a lumpectomy- they just said to her, you owe $25,000... she was like.. no- you show me a detailed list of how you got to $25,000... turns out they charged her for all sorts of ridiculous stuff- $250 for TYLENOL!!!! $100 for CLEAN SHEETS!!! $75 for STERILE INSTRUMENTS!!! She wound up settling with the hospital for much less.

I honestly think that doctor's offices and hospitals think they can get away with this stuff b/c people don't look at their claims since it goes to insurance... I would see if you could get an itemized bill and see what happens.

Re: Do you review your claims?

You know what I don't get? Why isn't monitoring covered under the charge for the IVF cycle? Like, they are charging say $10K for ER/ET, I think that should include the monitoring.