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My wife has insurance coverage (Medical/Dental/Vision) through her employer. She wears contacts and glasses.  She went to the optometrist/ophthalmologist in December for her annual checkup and a field of vision/fundus photography test that she is supposed to have to make sure there are no adverse effects from a medication she takes.*** They scheduled both tests for the same appointment. One appointment is obviously preferable because that means only one co-pay. They did the annual exam and told her the machine was down for the field of vision test and they would call her when it was fixed to come back in and get the test. That stinks because it means an extra co-pay, but oh well.

They never called.

Fast forward to a month ago, she decides to use her annual allotment for contacts/glasses on new glasses and remembers she never had the field of vision test so she calls to make an appointment for the field of vision test and to get new glasses. When scheduling, she tells the receptionist about the problem with the field of vision test in December. The receptionist tells her that she couldn't have gotten the annual exam and the field of vision test in the same appointment anyway, that they always schedule separately. My wife figured that was eeird because that wasn't what she was told last time, but it didn't really matter this time so whatever. So she goes in for the test, it comes out fine and she orders new glasses. She pays the co-pay and figures that's that because she's had this test before (from other optometrists) and never received a bill in addition to the co-pay.

Bill for $200 comes. Wife calls the insurance company (Cigna) and asks what gives. Cigna says that the doc billed the test as a medical test and the doc isn't an in-network doctor for medical, so they are only covering X percentage and the rest is on us. Wife asks how that's possibly since she has Cigna for medical and vision. Cigna says talk to the doctor. Wife calls the optometrist and asks what gives. They say that the field of vision test is a medical test and not a vision test, so that's why its billed as medical. Wife says her medical and vision are with the same company and shes never had this issue before. Doc says that they used to take both but sometime in the past 6 months, Cigna split it's medical and vision insurance on their end. They were told that if they wanted to stay on as accepting Cigna medical, they had to do a bunch of stuff. They say they are in the process, but they currently don't take Cigna medical insurance.

If we had known in advance that 1) the test was a medical test and 2) that the optometrist was not it our medical network, we never would have gone to them for this test. I asked my wife if the secretary got her medical insurance card at the beginning or at the end of the appointment. She says she doesn't remember.  I asked because, if they got the card at the beginning, they would have seen that she had Cigna and could have said, "we're in the process of getting back with Cigna medical, but we don't take it right now." Since they didn't do that, I think this extra $200 should be on them. But if they didn't ask for her card until the end, obviously they couldn't have warned her. However, they knew she had Cigna because that's what she had during the last visit before the medial and vision split. Either way, they never told us until we got the bill. And they knew they were billing it as medical because they specifically asked for the medical insurance card. Seems like pretty crummy business practice to me.

Anyway, I guess I'm not necessarily asking for advice, but feel free to give it if its productive. I guess I'm just curious if you guys agree with my opinion that the doctor should have disclosed that they no longer accept our insurance considering it was always accepted in the past and they knew they were going through an ordeal with Cigna. Do that have any responsibility to do that here? Legally? Ethically? Am I completely wrong for thinking the doctor should just eat the $200 considering they never tried to tell us that their deal with Cigna had changed since the last time we went in?


***My eyes are fine and I don't go to the eye doctor, so forgive me if I got some of the stuff wrong that you people with contacts/glasses know much better than me.

Member Summary
Optometrist is no longer "in-network" so we have to pay $200 for a test that has always been covered in the past. Optometrist never told us that they stopped accepting our insurance.
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meade18 said:   ***My eyes are fine and I don't go to the eye doctor, so forgive me if I got some of the stuff wrong that you people with contacts/glasses know much better than me.
I'll spare rufflesinc the effort of typing out the question:  How do you know your eyes are fine if you don't go to the eye doctor?

meade18 said:    I guess I'm just curious if you guys agree with my opinion that the doctor should have disclosed that they no longer accept our insurance considering it was always accepted in the past and they knew they were going through an ordeal with Cigna. Do that have any responsibility to do that here? Legally? Ethically? Am I completely wrong for thinking the doctor should just eat the $200 considering they never tried to tell us that their deal with Cigna had changed since the last time we went in?
  
Ethically, yes. Legally, no. Practically, the receptionist at the office probably isn't terribly well-versed in the differences and doesn't want the hassle of helping people figure it out.

Here is normally where I would rant about how medical billing is outdated, unnecessarily complex, opaque, and anti-consumer, but I'm kinda sick of doing that.

I'd write the doctor a brief note outlining your concerns about the unexpected bill and asking them to accept what their negotiated rate with Cigna was/would have been (which may be the amount Cigna already paid). If they refuse you could continue to pursue via BBB and other means or just pay it and write a crummy review on the internet.

I do this sort of stuff all day.

Here is my take on it. Looks like you were billed for an office visit and the visual field. The visual field alone isn't that expensive. Insurance payment for the field is ballpark $60-$80. Visit is probably the same. Cigna vision and Cigna medical are 2 separate things. The insurance world is a very confusing labyrinth. Cigna vision is typically VSP i believe, but that doesn't matter at this point.  

I would just call and speak with the insurance person and let them know everything you just told us. If that doesn't get you what you want then voice your concerns to the doctor. It shouldn't be too difficult to get the bill reduced. They should of told you what it would cost, but it is also your responsibility to ask if there is any out of pocket cost. Kind of like when you order lobster at market price. Don't assume anything when it comes to medical care. 

meade18 said:   I asked my wife if the secretary got her medical insurance card at the beginning or at the end of the appointment. She says she doesn't remember.  I asked because, if they got the card at the beginning, they would have seen that she had Cigna and could have said, "we're in the process of getting back with Cigna medical, but we don't take it right now." Since they didn't do that, I think this extra $200 should be on them. But if they didn't ask for her card until the end, obviously they couldn't have warned her. However, they knew she had Cigna because that's what she had during the last visit before the medial and vision split. Either way, they never told us until we got the bill. And they knew they were billing it as medical because they specifically asked for the medical insurance card. Seems like pretty crummy business practice to me.
  
I would expect that they took your wife's insurance card before the appointment -- in between taking a new photo of her, making a copy of driver's licence, issuing a payment contract signed in blood, making a copy of her car keys in case they wanted to seize the vehicle in 90 days, etc. (sarcasm)

As far as I know, doctors' office staff don't have any obligation to make sure ahead of time, on your behalf, that your exact insurance plan covers all that the doctor might charge for in the upcoming appointment.

That's why you should always clear an upcoming appointment/treatment with your insurance company, and make sure the doctor is still in your plan, before assuming that it'll all be covered.

A couple of years ago, I had asked some doctor's offices' appointment bookers if they took my plan, and they said they did, so I made various appointments, saw the doctors, then later it transpired that those offices actually did not take my plan and I got billed more than I expected. When I asked why they had initially told me that they do take my plan, they said they couldn't know all the intricacies of everyone's insurance and it was my responsibility to know for sure.
One of the clinics had at one time been covered by that plan, but then the directors of the clinic wouldn't sign the new annual insurance company contract (which they had not informed their appointment bookers about), so suddenly they were not covered by the time of my appointment.
Another clinic said, "Oh, our west-side location is in your plan, our east-side location is not, your doctor works in both of our offices, and our receptionist set you up to see the doc in the east-side location because it had the earliest availability (without telling me that that location wasn't in my plan), so your visit ended up not being covered."
...The system is nuts.

The only sure way to know if you are covered is to speak to someone live at your insurance company's customer service number prior to the appointment (the insurance companies' find-a-doctor search features on their websites are sometimes out of date, so it's best to call), and be so specific as to get permission that the actual street address is covered.  (Maybe it's not a widespread issue, but I have found that several of my doctors who work out of a network of different offices are only covered by my insurance in a portion of the locations.) 

----
By the way, I don't have vision insurance, needed a new set of glasses, went in for the necessary glasses-prescribing eye exam (not a whole vision exam), and at the beginning of the appointment the receptionist told me it would be $35, and I said fine.  She said she needed to take a copy of my credit card (wouldn't wait until the appointment was over for me to pay her), so I gave it to her and she made a copy of the card, front and back.  I was seen by the dr.  On my way out, I went to the desk to pay, and they said it would be $50.  I said, "But, that lady right over there, 2 chairs away from you, told me it would be $35."  She looked over and admitted that this is what she had told me 30 minutes earlier.  They said that they'd raised their charges without telling her (? it was a small clinic with 3 eye doctors and one reception desk...), that it wasn't her fault she had thought it was $35, but that I owed them $50.  I think the least they could have done was to stick with what I'd been quoted moments earlier.  Slippery. 

oppidum said:   
meade18 said:   I asked my wife if the secretary got her medical insurance card at the beginning or at the end of the appointment. She says she doesn't remember.  I asked because, if they got the card at the beginning, they would have seen that she had Cigna and could have said, "we're in the process of getting back with Cigna medical, but we don't take it right now." Since they didn't do that, I think this extra $200 should be on them. But if they didn't ask for her card until the end, obviously they couldn't have warned her. However, they knew she had Cigna because that's what she had during the last visit before the medial and vision split. Either way, they never told us until we got the bill. And they knew they were billing it as medical because they specifically asked for the medical insurance card. Seems like pretty crummy business practice to me.
  
I would expect that they took your wife's insurance card before the appointment -- in between taking a new photo of her, making a copy of driver's licence, issuing a payment contract signed in blood, making a copy of her car keys in case they wanted to seize the vehicle in 90 days, etc. (sarcasm)

As far as I know, doctors' office staff don't have any obligation to make sure ahead of time, on your behalf, that your exact insurance plan covers all that the doctor might charge for in the upcoming appointment.

That's why you should always clear an upcoming appointment/treatment with your insurance company, and make sure the doctor is still in your plan, before assuming that it'll all be covered.

A couple of years ago, I had asked some doctor's offices' appointment bookers if they took my plan, and they said they did, so I made various appointments, saw the doctors, then later it transpired that those offices actually did not take my plan and I got billed more than I expected. When I asked why they had initially told me that they do take my plan, they said they couldn't know all the intricacies of everyone's insurance and it was my responsibility to know for sure.
One of the clinics had at one time been covered by that plan, but then the directors of the clinic wouldn't sign the new annual insurance company contract (which they had not informed their appointment bookers about), so suddenly they were not covered by the time of my appointment.
Another clinic said, "Oh, our west-side location is in your plan, our east-side location is not, your doctor works in both of our offices, and our receptionist set you up to see the doc in the east-side location because it had the earliest availability (without telling me that that location wasn't in my plan), so your visit ended up not being covered."
...The system is nuts.

The only sure way to know if you are covered is to speak to someone live at your insurance company's customer service number prior to the appointment (the insurance companies' find-a-doctor search features on their websites are sometimes out of date, so it's best to call).

----
By the way, I don't have vision insurance, went in for an eye test last year, and at the beginning of the appointment the receptionist told me it would be $35, and I said fine.  She said she needed to take a copy of my credit card (wouldn't wait until the appointment was over for me to pay her), so I gave it to her and she made a copy of the card, front and back.  I had the eye appt.  I walked out, went to the desk to pay, and they said it would be $50.  I said, "But, that lady right over there, 2 chairs away from you, told me it would be $35."  She looked over and admitted that this is what she had told me 30 minutes earlier.  They said that they'd raised their charges without telling her, that it wasn't her fault, but that I owed $50 nonetheless.  I think the least they could have done was to stick with what I'd been quoted moments earlier.  Slippery. 

  Moral of the story: If seeing 2 or more different doctors for something routine or non-emergency in a short period of time, be sure to run insurance through several cardio specialists in advance even if current issue(s) are not cardio-related (and do make sure they plan no changes for the next few months) as one may start to experience symptoms of cardiac dysfunction from all of the run-around with other doctors and insurance "networks".

Thanks for the replies. I think we'll try a few more phone calls and see where it gets us. If we get out of paying or get some sort of discount on the $200, I'll come back and post about it. If you don't see another reply from me, just assume that we didn't get anywhere and paid the $200.

Cool story bro


Brool Story Co
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