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Health Insurance Up Front Payment?
I've paid $300 of the $2,000 "deductible and out of pocket" maximum amount for 2013 so far. Does anyone know if a doctor/hospital can say I have to pay $1,500 dollars up front for a surgery and tell me that it's because I haven't met the maximum "deductible and out of pocket" amount for 2013 yet? If it were true that I had to pay all of the deductible and out of pocket expense before the insurance would pay anything then why wouldn't they tell me I had to pay the $1,700 difference? It shows on my schedule of benefits that my highest payment I should have to make up front is $300. I would actually pay nothing if I would be at the maximum amount for the year. At that point the insurance would pay 100%. The doctor and hospital are both in network providers so there is no coinsurance payment required either so the $1,500 payment up front seems highly ridiculous and incorrect. Just 3 1/2 years ago I had a similar surgery performed with the same doctor and at the same hospital. I had the same exact insurance plan back then as I do now and all I paid up front was $300. I seriously think someone is making up their own rules and trying to pull a fast one over on me. Any thoughts, or better yet, proof that I am correct?
As it turns out, the surgeon's office was asking for a down payment. It's been determined that I do not have to pay that amount as the surgeon is covered 100% by the insurance for his services as this is an inpatient procedure. The hospital/facility does have a $300 co-pay and that is all I have to pay up front as this is expected to be a 1 night stay in the hospital. If I am in the hospital for longer than a day, the co-pay is $300 per day for the first 3 days and that's it. That amount accrues and is applied to the out of pocket amount for the year.
@mbrcatz - Nobody pays the first $2,000 dollars of medical expenses up front unless you have some sort of crap insurance policy. As far as having the same insurance plan as 3 years ago, I am correct as far as coverage amounts and co-pays are concerned.
I was correct and my insurance company has confirmed that with the surgeon's office and the hospital. I went yesterday to do all of the pre op testing and admitting paperw
7 Answers
- AnonymousLv 78 years agoFavorite Answer
They can ask, but you can also tell them that you have other claims pending and probably won't owe much, so you prefer to wait until after the claims have been processed properly.
In other words, tell them to pound sand. I wouldn't ever pay up front. I've had hospitals call and ask plenty of times, but I tell them no. There's not much they can say to the claim story though. Otherwise, they could tell you to get the surgery elsewhere. In my experience, they try to get it up front, but have never not backed down.
- AnonymousLv 78 years ago
Yes, they can if they want to.
They're not making you pay $1700, because their cost of services, is only $1500. You pay the first $2000 in medical bills every year. You've paid $300, this is the next $1500, you'll have $200 more to go before insurance starts kicking in.
Don't confuse "no coinsurance" with "no deductible". They are two completely different things.
I find it extremely unlikely that you had the exact same plan three years ago - the number of people whose plans have NOT changed over the past three years, is negligible.
Sorry, can't get proof that you're correct, about something that you're wrong about.
- 8 years ago
When it comes to heath insurance, there are quite a few options out there to choose from. This is especially true for children's plans because they tend to cover more things (like x-rays) than an adult plan because kids are accident-prone, and usually a lot healthier than adults too. However, this can mean that you have a higher premium or deductible if you choose medical insurance for children exclusively.
Source(s): http://www.cehbp.com/ - 8 years ago
They just want the money up front. Your insurance isnt a factor as you basically dont have any insurance as far as they are concerned. They want the money cause they been stiffed A LOT.
Why are you entitled to free medical care at the expense of those who are paying customers?
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- ?Lv 78 years ago
I have never heard a medical professional expect you to pay your deductible up front.
They have the right to ask for your copay only.
Call your insurer and file a complaint
- ?Lv 45 years ago
some hospitals have oral surgeons so they could have the skill to easily bill you or you will could desire to get credit from whichever dentist you pass to...they have their very own "credit enjoying cards" style of element. maximum dentists and oral surgeons do no longer do cost plans for money payers.
- Anonymous8 years ago
They can. Sometimes they will let you make payment arrangements.
