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PostPosted: Sat Feb 03, 2018 4:26 am 
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I have a question. Up until last month I was going to a clinic that was cash only yet when I first started going they asked to see my insurance card. I didn’t think anything of it and figured it was to meek track of people going to clinics. Silly possibly but when a doctor tells me cash only no insurance I assume my insurance company will never get a bill.
So about 3 months ago I went online to check all my patient records, submissions etc and noticed I had all these claims for roughly $700 each for labs. At first I thought it was for a surgery I had and because I don’t want bills to go to collections, I’m on top of my medical bills. I have BCBS FEP blue. I figured out it was my sub doctor submitting for my monthly urinalysis, which made no sense because I’m 99.9% positive they never told me my insurance would be billed let alone $700 in addition to the $250 I pay the clinic but if a person sitting next to me didn’t have insurance the UA would be included? In addition to this my insurance only paid for $130 of it leaving me with a balance of almost $4k. During my next visit I mentioned it during “group” asking others if they experienced the same issue but nobody else did. Of course I was also the only person with insurance that actually came from a paycheck. Knowing the group convos are listened too, coincidentally enough the following month they said my urine was inconclusive so I and they needed me To submit a second one! I was livid at this point asking how it was inconclusive or altered when they watch through a Monitor. Anyhow sorry about the sidebar. So I took the second one and told them that after 14 months of being a patient with no issues that I’d find a new doctor. It was my last appt appt anyhow since I was in a job transfer but imagine my shock when I get a letter from my insurance stating I was responsible for rhe fee.

How can a cash only office only bill those with insurance? I know I was told the cash included the drug tests because I would have gone To another doctor.

How is this legal? And why now after 14 months do I suddenly get this bill? And BCBS is now saying they aren’t even paying $140 or it bc “member is terminated as of October 2016”, which is right before I started seeing doctor so they attempted to bill the wrong plan since I didn’t give them an updated insurance. Because k I was paying $$$$’.

I’d makes sense. Advice ?


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PostPosted: Sun Feb 04, 2018 8:00 am 
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I don't know if this is any advice but but ive been on Suboxone for 3.5 years. I've had 3 docs during this ordeal. 1 of the 3 took insurance. The other 2 we're cash only. The first time I went to a cash only doc they also asked what insurance I had. Eventually I started getting the urine screen lab costs sent to my house...I was shocked as hell! I called my doc and they told me your not responsible,for the,Bill. That the lab ppl,over charge and the insurance pays what it should be worth. So take that for what it's worth. I've never paid and it's not effected me. They just randomly disapeer after a few months. I think they just make an attempt to get more money.


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PostPosted: Mon Feb 05, 2018 12:59 am 
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I can't answer to the lab issues because I don't charge patients for lab tests. I have heard other doctors, though, tell patients 'don't worry, they won't charge you', and then the patients ended up going to collections with large bills from the labs. That's sleazy on many levels.

But I CAN answer the cash/insurance issue. When a doc says 'I don't take insurance', what is sometimes meant is 'I don't participate with insurance networks'. I'm doing my taxes right now and I'm shocked at how much overhead adds up; I'm hoping I'll have a positive number when I subtract expenses from income. I don't expect anyone to feel sympathetic, but that is the reason I don't participate with insurers. To be 'in network', the insurer will ignore the $200 fee I've charged patients for the past 6 years, and they'll give me $60 instead. If I accept that money I have to agree to accept it as 'payment in full'. To make it a profitable business I'd have to see 4 people per hour- and I can't work that fast day after day, week after week, and year after year. So I have to set my own fees, and let patients decide if I'm worth it, or if they should instead go to the other guy in town who does buprenorphine, or maybe to the methadone program (although if the person doesn't have medicaid, that will cost MUCH more than my practice).

Anyway-- I tell patients all of this up front (it is on my web site at http://www.fdlsuboxone.com When they come to their appointment they pay the fee, and we also take their insurance card and ask if they want it submitted. Even though I don't participate, some insurers will pay a portion of the cost for 'out of network' doctors, and some will put it toward the person's deductible. They don't HAVE to give me their insurance, but they might be missing out on something if they don't.

Here is the important thing-- in this setting, where insurers pay for out of network docs, they pay the patient DIRECTLY. I have no relationship with the insurer, so they don't send ME a check.

I used to do things differently. If a patient said that their insurance will cover out of network docs, I would wait for that check to arrive, and not charge the patient until it arrived. But they several times I was burned..... the patients disappeared without ever paying anything, and I found out that the insurer had paid them checks, and they were SUPPOSED to pay me! So basically the patients made money seeing me, and I never received anything. A learning experience.... but now I ask for payment, and explain that if insurance pays, they will probably pay the patient. If for some reason they pay ME, I give them the choice-- either I pay them immediately for that amount, or I put it on their account so that the next time they won't have to pay as much.

Hope that explains part of what happened. The lab stuff is a scam-- and I wish someone would investigate what is going on. I've written about it on my blog- but nobody seems very interested.


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Fond Du Lac Psychiatry
Dr. Jeffrey Junig, M.D., Ph.D.

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