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    piggrabb88's Avatar
    piggrabb88 Posts: 40, Reputation: 1
    Junior Member

    Nov 7, 2013, 10:14 AM
    Medical bills
    I had a hormonal injection for my prostate cancer. This is one of 3 injections
    I must have as part of my treatment. I have anthem blue cross blue shield
    Insurance. The cost of the shot is 2700$ ouch. Can that be believable. Well
    I looked on my insurance web site and I'm responsible for 2625$ they won't
    Pay a dime for the injection. They only are paying for part of the visit fee.
    I didn't get bill in mail yet. I want to ask what I can do? I need to see bill when it gets here. Can I get help from any agency's or social security, or what ever,
    I'm only 53 years old. I don't know if the bill is going to come from the Drs. Office I received shot at. I negotiated with a hospital in the past and got a lower
    Bill. I had to put it on my credit card. Can I do that with a small practice?
    Such as my Drs. Office. I need some solid advice to save money.
    smearcase's Avatar
    smearcase Posts: 2,392, Reputation: 316
    Ultra Member

    Nov 7, 2013, 01:13 PM
    Did they explain to your satisfaction why it couldn't be covered?
    And have you considered the insurer's appeal process?
    Does the medical facility and/or Dr. participate in your specific healthcare plan?
    Delay paying for as long as you can until you have exhausted all the options you can find.
    I had a bad episode at a major hospital one time and each time they sent a bill (around $ 7,000), I wrote back and told them that if they would provide proof that I had been notified that it wasn't covered by my insurance and that I had acknowledge the notification- before the procedure was started, that I would pay it. I figured they would come up with something but they never did. Finally, a lady called me at work one day and asked why I hadn't paid my bill and I asked her if she had seen my letters- and she said No. So, a short time later she called back and said she had found my letters and some errors in their billing and it was reduced to something like $ 60. I probably didn't even owe the $ 60 but I gladly paid it at that stage of the game. Not saying you will be as lucky as I was, but the point is, don't roll over until you have thoroughly read your contract and appealed if you determine that you have a case. Also, in U.S. state insurance reps can sometimes cut through some of the red tape. Good Luck.
    LearningAsIGo's Avatar
    LearningAsIGo Posts: 2,653, Reputation: 350

    Nov 7, 2013, 01:37 PM
    I happen to work for a hematology-oncology office. The doctor's office will have at least one employee who can discuss the specifics with you, so I suggest calling to ask for an explanation.

    The insurance carrier you have does not determine your coverage, your employer does. They decide how much insurance will cover and they set a contract. Many times, those decisions are made by employees who are not qualified to make those determinations. Cancer care, especially, is effected because it is such a complicated specialty.

    That being said, what they cover is not something that will change. What you must do as the consumer, is get an explanation of benefits and discuss it with the doctor's staff. If you doctor recommends hormone treatment and insurance does not cover it, the doctors office can either (a) work out a payment plan for you (b) the doctor can recommend alternate therapies (c) they can send you to a hospital outpatient facility for treatment, which are often covered by insurance plans. It gets fairly complicated from there, which is why its best to discuss this with a billing specialist employed by your doctor.

    As the patient/consumer, it's your responsibility to be aware of your insurance coverage. Technically (legally) its' not the medical facilities responsibility to make sure you are covered for their services or not.

    Smearcase's example above is a very lucky (and rare) example indeed. My bet is since that was in "a major hospital" they were more willing to forgive payment since they'd have so many other sources of income and hospitals, under all specialties, bill higher (make more money) per procedure and patient. In a doctor's office, they're not as likely to forgive a bill, but they can and will work with you to either reduce what you owe or agree to a payment plan.

    I hope this helps. Good luck

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