Hi PF,
I wanted to run this scenario by this subreddit to see if anyone had any ideas for recourse for yet another ridiculous medical bill scenario (US>PA). I was referred to a specialist due to lower back issues (had prior surgery years ago, etc.) and they recommended that I do physical therapy for a few weeks to see if it helps since my xrays and other tests looked good.
I have done 6 total sessions and just received a bill for the first 4 as a bundle. Whenever I went to the first appointment, I asked how much would be charged for each session and nobody could tell me. I called my insurance to see if they had a negotiated rate and they said that they did, but it depends on what is charged, that I would pay against my deductible for these sessions. I accepted that I'd be paying against my deductible for these sessions, but the provider nor insurance could give me an estimate. Now perhaps in hindsight I should have waited to get a bill for 1 session and/or not went forward, but on the other hand, I"ve been dealing with this pain for almost a year and wanted to try to get some relief.
For the bill I received, I didn't receive an EOB for each individual session, so I couldn't get an estimate of the cost after one visit (plus the billing was 1 month behind, so I already did 1 session per week by the time I received the EOB). The bill from the provider for 4 physical therapy sessions (core exercises and stretching, no technology, equipment, some light band use) was $2,500 for 4 sessions! I've paid less for surgical procedures. Even though I knew that I'd be paying a bit out of pocket against my deductible, I never expected the cost to be so completely insane. My insurance did give me a discounted rate, but I will still owe over $1,000 for 4 PT sessions with a bill for the other 2 still pending. I stopped treatment immediately upon receiving the bill.
I got an itemized bill from the provider in this case, and they are charging $160 for every 15 min. of exercise, plus $129 for 15 min. of manual stretching (not sure what that is), plus $338 for my first 30 min. evaluation. So, if I did a 45 min. session (1 session), the total cost is be over $600 (160*3 + 129) for me to walk into a room and get stretched on the table, do some squats, core exercises, etc. It is insanely out of line with the service provided.
Now, I've followed the standard procedure of calling the billing department and discussing the charges. They refused to escalate me to a manager as well as telling me that the provider can charge whatever they want to insurance and that the patient has no legal rights or negotiating power in this case. They also told me that is the 'nature of the beast' and how they cannot estimate or quote prices before your service (infuriating). I then went back to the provider and showed them the charges. My PT said that the line items are in line with what he charged in terms of the coding, but that he has no visibility into the charges associated with each. I asked him to reduce the line items in the bill and he said he couldn't do that.
I feel that I have the remaining options before being stuck with this bill: - Continue to fight with the billing department to see if I can get a reduced rate or some other type of reduction (is there not a type of reason test with these charges? Can someone review it?). I have good insurance and if the provider charges weren't so high, my costs would be more reasonable. - Go back to the provider and continue to fight with them to see if they can resubmit the bill with lesser quantities of exercise or something to reduce the bill - Find a way to publicize these ridiculous charges to see if there is some recourse.
I'm not against paying some amount of money for the services but I was expecting ~$300 for 4 sessions (~$50-60 per session), not over $1,000 after insurance.
Any ideas or am I stuck/screwed?
Thanks!
EDIT: This is an in-network provider with PPO insurance, not a high deductible plan. I have standard co-pays for doctor and specialist visits.
Submitted December 10, 2017 at 08:20AM by vielleicht http://ift.tt/2nJ79ty
