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Doctor Billing Practice

by SomeOneElse18 / January 7, 2010 6:21 AM PST

I started seeing a local oncologist twice each week for chemo. After each visit I stopped by the receptionist desk to make a co-pay and was waved to the door saying "it's all good see you soon". After three months of having no co-pay accepted I stopped making the offering at each visit. NINE MONTHS after first visit I received a bill from the Doc's office saying I owed $800 for co-pays starting with my first visit. Am I liable for this payment?
My take is that the office made it clear to me they did not require co-pays and therefore I owe nada. If they had requested co-pay at each visit I believe and I gave them an excuse not to pay that day I would be responsible for the bill. What say you all? I also believe if you owe, a bill should be sent monthly or at least in a reasonable time.

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Two thoughts
by Steven Haninger / January 7, 2010 6:34 AM PST

First off, chemo twice a week for 9 months seems like a lot of poison but I'm not a oncologist though I've twice been treated by one. But, the co-pay need is based on your insurance plan. You need to consult with them to find this out. If you are to pay a portion of the tab, you either do it through co-pay or will receive an EOB (explanation of benefits) form from your insurance telling you what they paid and what you owe. The physician's billing service bills you for the remainder. Have you received any EOB forms and bills from the doctor? If not, it's probable that you're on a co-pay system. It's also possible that the receptionist was mistaken. However, such a mistake does not relieve you of a co-pay obligation. It's quite possible that's what happened and you owe that amount. Check with your insurance carrier...the sooner the better.

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(NT) Yes, you owe them the money
by Mike_Hanks / January 7, 2010 7:49 AM PST
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Yes, you probably do owe the co-pays ...
by Bill Osler / January 7, 2010 9:22 AM PST

I can't speak to the details of your situation, but there are several issues:
(1) In some cases the physician office does not know what the co-pay will be at the time of service;
(2) Even if the office should have known, if they made a mistake in not collecting the co-pays that will not usually remove your obligation to pay them when you are billed;
(3) The best way to figure out your obligation is to familiarize yourself with the details of your insurance and discuss your situation with your insurance company, as has already been suggested.
That said, if the office filed the charges correctly and if they accurately interpreted the replies from your insurance company, you do owe the co-pays even if they made an error in not collecting them at the time of service.

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2 others could be blamed
by Angeline Booher / January 7, 2010 10:41 PM PST

Some insurance companies are notoriously slow in responding, not only to subscribers, but to doctor's offices. (We had one that always waited almost an entire year before paying claims, as well.) So it is feasible that the doctor's office had a hard time getting information from them, so when they did, had to add up the $$$.

More likely is that the doctor's office doesn't do the actual billing. It became popular for them to hire billing companies for that task.

I must say I am surprised that the office did not ask to see and/or make a copy of your insurance card, on which should be the information they need. Some of my doctors want to copy them at every visit.

I have been having some treatment. Prior to the first one I signed a separate paper that I would pay x amount, which I did when checking out. After that I was told I had a credit, and did not owe anything. I talked to their billing officer, who assured me this was this case, and even put a paper in my file stating same.

I suggest the following actions:

Make arrangements to make monthly payments.

Ask for an up-to-date detailed accounting with dates, including costs at each visit, and amounts paid by insurance.

If you get sand-bagged, try talking with the American Cancer Society which might be able to offer advice.

If our insurance is employer-based, inform your Human Resources Department. Companies review their providers at intervals, and they are less likely to continue with sloppy ones.

Butt at this moment the obligation rests on you to arrange for those monthly payments. it is important you are seen as lokding up your end of the bargain.

Good luck!

Angeline
Speakeasy Moderator

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A thought
by coastie65 / January 11, 2010 5:58 AM PST

First, I'd like to wish you well. My thought on this is with the ordeals associated with Chemo, they didn't want to burden you with the copay at the the time, but just let you focus on getting better. I am a bit surprised that they let the billing go for 9 months though.

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