Does Having Health Insurance Increase What My Doctor Bills Me?

So back in December we took our preschooler to the ENT.  He came highly recommended from a woman on our same insurance plan.  She basically said he is great, and thorough but he doesn’t take our insurance.  I assumed that meant that we would pay out of pocket.

We had our appointment on December 5th 2013.  We filled out all their many forms.  When we turned in our paperwork the woman behind the desk had even more questions.  I don’t remember her exact words but she said we would have to pay today and she could not estimate the cost because it would depend on what we were here for and what the doctor did.  She said something to the effect of us having to pay the full bill today.  We said that would be fine.

After we met with the doctor.  We settled our bill on our way out; $ 253.00.  We paid in full and thought we were done.  We later received a “this is not a bill” explanation of benefits from our insurance provider Cigna.  It shows the amount billed as $ 343.00.  They do point out the lovely “Cigna negotiated discount with the health care professional and facility to save me money” of $ 66.34.  The amount actually paid by my plan a big fat $ 0.00.  The explanation of benefits letter goes on to point out that I owe $ 276.66.  This does not fit the  $ 253.00 that we already paid….Then we get an invoice from the ENT’s biller saying we still owe $ 23.66.

See the bills below





Reviewing the bills I can tell that the original bill was for an Office Consultation Level 3.  We paid this in full.  It was then processed through our insurance.  The 2nd bill was for an Office Consultation Level 4.  Maybe I should call the number on bill number 2 and tell them that it isn’t our bill because we had the Level 3 and we already paid for it so Level 4 couldn’t be us.

The $ 23.66 isn’t going to make or break us but this complete lack of clarity on prices is ridiculous.  It’s like going through the check out line at the grocery store and them charging you based on how nice your cloths look.

Maybe I should charge my clients based on what they drive and what type of profession they are in…oh wait no that’d be and ethics violation.  How is this type of pricing ethical in one industry and completely unethical, so much that you’d loose your license to practice, in another industry?

Going the self pay option and claiming no insurance possibly would have been cheaper.  I know it was in another health care situation that I will be writing about very soon.

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