Negotiating medical bills- Update in OP

[isabel]

The short story is that I got an IUD put in and my insurance won't cover it. My doctor billed insurance $2,600. They dropped the bill 35% for self-pay, so it's now about $1,700. Still in-fucking-sane. Especially since I thought it was going to be covered in full. My fault and I'm beyond pissed at myself, but there's nothing I can do now.

I haven't heard of anyone paying more than $1,000 for Mirena insertion. Anyone have advice for negotiating this down? I think this bill is crazy and don't want to overpay.

UPDATE: I called the office manager today. I explained the situation and she dropped the bill to their cost for the Mirena and 35% off the insertion fee and pregnancy test. So, Just over $1k now. Thank God. I was happy with how she handled it and she was very nice.

After we settled up on that, I explained that this was on me, but that I felt like someone in the office should have mentioned to double check insurance, perhaps when I was making the appointment, since they ask what you're coming in for. I told her I wasn't aware there were plans that were grandfathered in and didn't have to comply with the ACA rules. She said it's something they discuss "frequently" and that they have "several patients in my situation." To which I'm like, WTF? If you talk about it, and you know it's an issue, why can't you tell the reception team to mention it when people make appointments for stuff like this?

Anyway, I said what I wanted to say and it was about as good as the conversation could have gone. Now I just need to get set up on a payment plan or pay it in full. Depends on whether they're going to charge me interest, I guess.

Anyway, thank you all so much for the advice and help. I really appreciate it.

[isabel]

Sept 28, 2015 15:56:44 GMT -5 puddleofgrace said:

I always laugh at how easy people make it seem that you can "negotiate" shit. Most hospitals I have dealt with required full payment or a payment plan with a minimum of $50 a month or they would send us to collections.

Most places are willing for a payment plan, at least.

I would also contact your insurance and your HR dept. about why it wasn't covered.

Good luck!

I wouldn't have a problem with it except that the price of the device should be standard and I think my doctor is charging way more for it than most practices.

[Deleted]

First I would ask for an itemized bill so I knew where my $$ was going because doctors will charge insurance more than they charge you (which you've seen and I think it's insane and part of why insurance costs are so high) and then I would appeal to your insurance company. If that fails, then I would tell them you need a payment plan.

[isabel]

Sept 28, 2015 16:03:49 GMT -5 @licia said:

Sept 28, 2015 15:58:29 GMT -5 isabel said:

Do you have an itemized bill? I would see if they could break it down as far as possible, and research pricing. 

Then, start talking to them. Plead your case, and I would tell them straight up what you want to negotiate to (or lower, so you have a little room to play). Hopefully, they'll budge the price. And I would think, at the very least, they'll be able to get you on a payment plan.

At least you won't have more babies to pay for in the future? Sorry about the bill surprise. That's the worst.

I do have an itemized bill. There's a charge for a pregnancy test ($30) and the insertion fee from the doctor ($275). The remainder is the IUD itself.

[rodeored]

When I had the Mirena inserted a few years ago I think the doctor told me it cost somewhere around $700 for the Mirena itself. Can you call a pharmacy and ask what it would cost to order one to see if your doctors office is jacking up the price?

[kirra]

You're screwed.

You can probably get 10% off if you pay in full.

[cinderbella]

I would still fight this. Absolutely, 100000% take it to the next level of appeals.

Eta: did you get documentation of the misquote on the part of the insurance company? Or am I confusing you with someone else?

[isabel]

Sept 28, 2015 16:00:22 GMT -5 puddleofgrace said:

Sept 28, 2015 15:58:29 GMT -5 isabel said:

I wouldn't have a problem with it except that the price of the device should be standard and I think my doctor is charging way more for it than most practices.

I didn't mean I was laughing at you, btw. That probably didn't read very nicely. I just have a very strong hate for insurance companies and bullshit hospital billing. (heart)

Thanks. I'm like way overly sensitive about this right now too. My anxiety level about it is through the roof.

Thanks for your sympathy.

[gault]

From your bill breakdown, it sounds legit.

When I was doing research on IUD's with my insurance, they were not covered, and the cost for the device itself through my insurance was at least 700 dollars. That plus the insertion fee and pg test, sounds accurate.

[isabel]

Sept 28, 2015 16:11:13 GMT -5 cinderbella said:

I would still fight this. Absolutely, 100000% take it to the next level of appeals.

Eta: did you get documentation of the misquote on the part of the insurance company? Or am I confusing you with someone else?

It's not a misquote. My insurance straight up doesn't cover it. My plan is apparently grandfathered in and they aren't required to cover birth control. I don't think there's any point in appealing it with insurance.

[isabel]

Sept 28, 2015 16:16:22 GMT -5 gault said:

From your bill breakdown, it sounds legit.

When I was doing research on IUD's with my insurance, they were not covered, and the cost for the device itself through my insurance was at least 700 dollars. That plus the insertion fee and pg test, sounds accurate.

So why are they charging me more than an insurance company would pay? They're trying to charge me almost double that just for the device.

[gault]

Sept 28, 2015 16:18:53 GMT -5 isabel said:

Sept 28, 2015 16:16:22 GMT -5 gault said:

From your bill breakdown, it sounds legit.

When I was doing research on IUD's with my insurance, they were not covered, and the cost for the device itself through my insurance was at least 700 dollars. That plus the insertion fee and pg test, sounds accurate.

So why are they charging me more than an insurance company would pay? They're trying to charge me almost double that just for the device.

Hell if I know. lol.
I misread your new payment and thought it said 1,200 not 1,700.

First I'd check your benefit's website and look up the cost of the device alone. I know you didn't use insurance, but this will give you an idea, and they have your insurance information anyway. Use that price when you call billing.

[isabel]

Sept 28, 2015 16:24:30 GMT -5 gault said:

Sept 28, 2015 16:18:53 GMT -5 isabel said:

So why are they charging me more than an insurance company would pay? They're trying to charge me almost double that just for the device.

Hell if I know. lol.
I misread your new payment and thought it said 1,200 not 1,700.

First I'd check your benefit's website and look up the cost of the device alone. I know you didn't use insurance, but this will give you an idea, and they have your insurance information anyway. Use that price when you call billing.

Ok, I feel dumb, but how do I find the cost of the device? There's a website for our plan and I can login. Would it be there? Or can I call my insurance and ask them?

[gault]

Sept 28, 2015 16:33:51 GMT -5 isabel said:

Sept 28, 2015 16:24:30 GMT -5 gault said:

Hell if I know. lol.
I misread your new payment and thought it said 1,200 not 1,700.

First I'd check your benefit's website and look up the cost of the device alone. I know you didn't use insurance, but this will give you an idea, and they have your insurance information anyway. Use that price when you call billing.

Ok, I feel dumb, but how do I find the cost of the device? There's a website for our plan and I can login. Would it be there? Or can I call my insurance and ask them?

Yep, log in and then search for your drug coverage specifics, like you would for a prescription. Find the option to search for a specific drug/prescription. Hopefully you can do that on the website!

I wanted to make sure I was giving you the right info, and logged into my plan. The cost for mirena is $844 (I use BCBS) so I hope it's something like that for you.

[kirra]

Sept 28, 2015 16:18:53 GMT -5 isabel said:

Sept 28, 2015 16:16:22 GMT -5 gault said:

From your bill breakdown, it sounds legit.

When I was doing research on IUD's with my insurance, they were not covered, and the cost for the device itself through my insurance was at least 700 dollars. That plus the insertion fee and pg test, sounds accurate.

So why are they charging me more than an insurance company would pay? They're trying to charge me almost double that just for the device.

Because they can. Our medical system is just messed up.

I paid $500 for a bone density test that would have been $200 if my insurance paid and $200 if I didn't have insurance and paid myself. Since I was covered but insurance denied, according to hospital policy they charged me what they billed insurance (but the insurance company would negotiate it down). I spent more than six months fighting it before I finally borrowed money to pay it off.

[kirra]

Sept 28, 2015 16:36:35 GMT -5 kooshball said:

I thought obamacare made birth control required to cover including iud?

There are some grandfathered in plans that don't have to. She has one of those plans.

[gault]

Sept 28, 2015 16:36:35 GMT -5 kooshball said:

I thought obamacare made birth control required to cover including iud?

Sort of.

Insurance companies can decide to charge for name-brand contraceptives, if there is a generic version available. So if your body hates the generic Loesterin, but for some reason does better with the name brand, you will have to pay.

There aren't any generic versions of Mirena or Paraguard yet.

If someone has better info, please correct me, but this is what I know.

[isabel]

Sept 28, 2015 16:45:50 GMT -5 kooshball said:

Sept 28, 2015 16:42:17 GMT -5 gault said:

Sort of.

Insurance companies can decide to charge for name-brand contraceptives, if there is a generic version available. So if your body hates the generic Loesterin, but for some reason does better with the name brand, you will have to pay.

There aren't any generic versions of Mirena or Paraguard yet.

If someone has better info, please correct me, but this is what I know.

sure makes sense but they are paying zero which doesn't match. I guess either her plan is from 2010 and grandfathered in it works at a religious place?

It's grandfathered. I didn't even know this was a thing until they refused to pay it.

[cinderbella]

Sept 28, 2015 16:16:54 GMT -5 isabel said:

Sept 28, 2015 16:11:13 GMT -5 cinderbella said:

I would still fight this. Absolutely, 100000% take it to the next level of appeals.

Eta: did you get documentation of the misquote on the part of the insurance company? Or am I confusing you with someone else?

It's not a misquote. My insurance straight up doesn't cover it. My plan is apparently grandfathered in and they aren't required to cover birth control. I don't think there's any point in appealing it with insurance.

But didn't you call and they told you it was a covered benefit?

[vmars]

You can ask for a payment plan or a reduced cost if you pay in full asap.

[isabel]

Sept 28, 2015 16:39:30 GMT -5 kirra said:

Sept 28, 2015 16:18:53 GMT -5 isabel said:

So why are they charging me more than an insurance company would pay? They're trying to charge me almost double that just for the device.

Because they can. Our medical system is just messed up.

I paid $500 for a bone density test that would have been $200 if my insurance paid and $200 if I didn't have insurance and paid myself. Since I was covered but insurance denied, according to hospital policy they charged me what they billed insurance (but the insurance company would negotiate it down). I spent more than six months fighting it before I finally borrowed money to pay it off.

Fuck me. I bet this is what's going on. I want to cry. And throw up. This is so much fucking money.

[isabel]

Sept 28, 2015 16:49:16 GMT -5 cinderbella said:

Sept 28, 2015 16:16:54 GMT -5 isabel said:

It's not a misquote. My insurance straight up doesn't cover it. My plan is apparently grandfathered in and they aren't required to cover birth control. I don't think there's any point in appealing it with insurance.

But didn't you call and they told you it was a covered benefit?

No. I assumed it was covered because it's birth control and it's supposed to be. We also have crazy good insurance and I never would have dreamed it wouldn't be covered regardless of the health care laws. It's on me for being stupid about it but I'm still really pissed. I had no idea about grandfathered plans.

[cinderbella]

Sept 28, 2015 16:54:17 GMT -5 isabel said:

Sept 28, 2015 16:49:16 GMT -5 cinderbella said:

But didn't you call and they told you it was a covered benefit?

No. I assumed it was covered because it's birth control and it's supposed to be. We also have crazy good insurance and I never would have dreamed it wouldn't be covered regardless of the health care laws. It's on me for being stupid about it but I'm still really pissed. I had no idea about grandfathered plans.

Well, shit. I'm sorry - I totally thought you had called and had a misquote.

Do they cover other forms of bc?

[isabel]

Sept 28, 2015 16:56:06 GMT -5 cinderbella said:

Sept 28, 2015 16:54:17 GMT -5 isabel said:

No. I assumed it was covered because it's birth control and it's supposed to be. We also have crazy good insurance and I never would have dreamed it wouldn't be covered regardless of the health care laws. It's on me for being stupid about it but I'm still really pissed. I had no idea about grandfathered plans.

Well, shit. I'm sorry - I totally thought you had called and had a misquote.

Do they cover other forms of bc?

Yes, basically everything else is covered.

[waffletime]

Sept 28, 2015 16:05:42 GMT -5 isabel said:

Sept 28, 2015 16:03:49 GMT -5 @licia said:

Do you have an itemized bill? I would see if they could break it down as far as possible, and research pricing. 

Then, start talking to them. Plead your case, and I would tell them straight up what you want to negotiate to (or lower, so you have a little room to play). Hopefully, they'll budge the price. And I would think, at the very least, they'll be able to get you on a payment plan.

At least you won't have more babies to pay for in the future? Sorry about the bill surprise. That's the worst.

I do have an itemized bill. There's a charge for a pregnancy test ($30) and the insertion fee from the doctor ($275). The remainder is the IUD itself.

I got mine in a week ago, $12 for the pregnancy test, $125 for the insertion, and $815 for the IUD (also Mirena), and that's what my insurance was billed. $1700 is insane! I'm so sorry. I spent two hours trying to figure out if mine was going to be covered because I wasn't sure my clinic was in network; I had to call 5 or 6 different people to figure this out. Insurance/health care in this country is ridiculous. I wish I had helpful advice for you

[kirra]

Sept 28, 2015 16:52:24 GMT -5 isabel said:

Sept 28, 2015 16:39:30 GMT -5 kirra said:

Because they can. Our medical system is just messed up.

I paid $500 for a bone density test that would have been $200 if my insurance paid and $200 if I didn't have insurance and paid myself. Since I was covered but insurance denied, according to hospital policy they charged me what they billed insurance (but the insurance company would negotiate it down). I spent more than six months fighting it before I finally borrowed money to pay it off.

Fuck me. I bet this is what's going on. I want to cry. And throw up. This is so much fucking money.

I'm really sorry It shouldn't happen, but it's legal, so it does.

I've basically resigned myself to the fact that I'll be in medical debt until I die. We hit our OOP max last year, but it was a high deductible plan, and I was still in debt from the year before, and so far this year I'm almost at 4K OOP. I can't pay it off as fast as it accumulates. I always have multiple payment plans.

[gummy]

At my clinic they charge $1400 for the Mirena and $175 for the insertion so to me the rate doesn't seem outrageous but everything is regional.

The amount they're asking you to pay is the amount that they charge for those services/supplies. The way insurance works is your insurance co. and all the others negotiate with the clinics and they say for example "we'll only pay you $1000 for the Mirena and $150 for the insertion" and the clinics agree to those prices and to not charge you above and beyond that because they want to get paid. It's why people without insurance or under insured (you - Mirena not being covered) get screwed.

Call and speak with the patient care coordinator or clinic admin/manager and see what they are willing to do. Unfortunately a lot of times the response will be that it's your responsibility as a patient to know your insurance coverages etc. I'm sorry


ETA: What is the exact reason the insurance company is denying coverage?  Sometimes it can be something as simple as the diagnosis code attached being wrong.  Does your itemized bill show the diagnosis codes submitted?

[pugz]

your best bet is to ask for a discount if you pay in full or a payment plan. Hospitals work with people more than individual doctors offices though so they may refuse.

[livinitup]

We have a Commumity Health Advocate who will negotiated bills like this. Call/Google non-profits and ask around if someone, somewhere will help advocate for you. Start at Planned Parenthood and keep trying - you may get lucky.

Also try 'Ombudsmen', 'Navigator' and your representatives (elected officials) - we get referrals from elected official's offices often.

Good luck.

[MamaMaui24]

It may be too late this time since it's already done, but you might be able to see if your pharmacy/prescription benefits would cover it (then pay separately for MD to insert).

www.mirena-us.com/how-to-get-mirena/insurance-coverage.php