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anyone working in medical billing or insurance?

MelzombieMelzombie Charleston, SC Posts: 200
in All Encompassing Trip
anyone work for a health insurance company or medical billing or know how the hell medical insurance works?
I got a question

I went to my eye doctor for an infection didn't have to pay a co-pay and was told they would bill my insurance company
ok cool. I went to my insurance portal (I have United healthcare) and saw the claims, what they covered, etc.
ok cool.. but they have a button that says "pay now". From my experience I've always gotten a bill from my doctors, NOT the insurance company.
I will say I do NOT trust insurance companies especially medical insurance. 
well anyway, I click "Pay now" and it takes me to a third party site called Insta Med or something like that
Shouldn't I get a bill from my doctor? I want to make sure it goes to my doctor and not some third party crap. 
anyone? like should I call United Healthcare and probably waste my time?? 
advice?

Comments

  • deadendpdeadendp Northeast Ohio Posts: 10,434
    Wait until you get a bill from your doctor. Do not pay a third party. There is most definitely some fee somewhere there you will have to pay to go through them. 

    Worked for a doctor billing insurance companies and clients. Believe me, a doctor will most definitely bill you. 
    2014: Cincinnati
    2016: Lexington and Wrigley 1
  • MelzombieMelzombie Charleston, SC Posts: 200
    deadendp said:
    Wait until you get a bill from your doctor. Do not pay a third party. There is most definitely some fee somewhere there you will have to pay to go through them. 

    Worked for a doctor billing insurance companies and clients. Believe me, a doctor will most definitely bill you. 
    why is there a "pay now" option? to scam people?


  • deadendpdeadendp Northeast Ohio Posts: 10,434
    Okay, I just popped in on InstaMed. It actually really is a thing, not just some odd Backyard Bob's Bill Pay Serv-us. 

    Perhaps contact your eye doctor to see if they prefer you pay direct to them or through InstaMed. 

    I saw my dentist yesterday. Love the guy. Told the ladies to skip sending me a bill, just call me and I will pay over the phone. Looks like we won't owe, but just in case...
    2014: Cincinnati
    2016: Lexington and Wrigley 1
  • deadendpdeadendp Northeast Ohio Posts: 10,434
    Melzombie said:
    deadendp said:
    Wait until you get a bill from your doctor. Do not pay a third party. There is most definitely some fee somewhere there you will have to pay to go through them. 

    Worked for a doctor billing insurance companies and clients. Believe me, a doctor will most definitely bill you. 
    why is there a "pay now" option? to scam people?
    I don't know. That causes me to hit the brake a bit until you confirm with the office how they would like you to pay. Seems weird to loop through from insurance that way, but maybe that is some thing that the doctors office has set up with them. 🤷‍♀️
    2014: Cincinnati
    2016: Lexington and Wrigley 1
  • rgambsrgambs Posts: 13,576
    I wouldn't mess with InstaMed.
    We own an optometry practice and we've heard of them but never had any dealings.  It's probably not a scam, but it probably also doesn't benefit anyone.  Your eye doctor will bill you, if there is a balance that they are allowed to charge.  We are required to write off most of what an insurance doesn't pay.  
    We charge $$$, you see that and assume that the "covered" amount means that charge is paid by the insurance, but really the insurance pays $ and we write off the rest.
    Monkey Driven, Call this Living?
  • MelzombieMelzombie Charleston, SC Posts: 200
    rgambs said:
    I wouldn't mess with InstaMed.
    We own an optometry practice and we've heard of them but never had any dealings.  It's probably not a scam, but it probably also doesn't benefit anyone.  Your eye doctor will bill you, if there is a balance that they are allowed to charge.  We are required to write off most of what an insurance doesn't pay.  
    We charge $$$, you see that and assume that the "covered" amount means that charge is paid by the insurance, but really the insurance pays $ and we write off the rest.
    On my health insurance website is says this:
    amount billed: $94
    plan discount:$38.74
    plan paid: $0
    you may owe: $55.26 

    so I owe $55.26?? 
    it's all so confusing. 
    I miss my old insurance (blue cross) with my old employer

  • deadendpdeadendp Northeast Ohio Posts: 10,434
    Melzombie said:
    rgambs said:
    I wouldn't mess with InstaMed.
    We own an optometry practice and we've heard of them but never had any dealings.  It's probably not a scam, but it probably also doesn't benefit anyone.  Your eye doctor will bill you, if there is a balance that they are allowed to charge.  We are required to write off most of what an insurance doesn't pay.  
    We charge $$$, you see that and assume that the "covered" amount means that charge is paid by the insurance, but really the insurance pays $ and we write off the rest.
    On my health insurance website is says this:
    amount billed: $94
    plan discount:$38.74
    plan paid: $0
    you may owe: $55.26 

    so I owe $55.26?? 
    it's all so confusing. 
    I miss my old insurance (blue cross) with my old employer

    Wait for a bill. "You may owe" does not mean "your balance due is."
    2014: Cincinnati
    2016: Lexington and Wrigley 1
  • deadendpdeadendp Northeast Ohio Posts: 10,434
    Our insurance is through my husband. His county may pay their naturalists the least of all the 88 counties, but at least we do have fabulous insurance. 
    2014: Cincinnati
    2016: Lexington and Wrigley 1
  • rgambsrgambs Posts: 13,576
    Melzombie said:
    rgambs said:
    I wouldn't mess with InstaMed.
    We own an optometry practice and we've heard of them but never had any dealings.  It's probably not a scam, but it probably also doesn't benefit anyone.  Your eye doctor will bill you, if there is a balance that they are allowed to charge.  We are required to write off most of what an insurance doesn't pay.  
    We charge $$$, you see that and assume that the "covered" amount means that charge is paid by the insurance, but really the insurance pays $ and we write off the rest.
    On my health insurance website is says this:
    amount billed: $94
    plan discount:$38.74
    plan paid: $0
    you may owe: $55.26 

    so I owe $55.26?? 
    it's all so confusing. 
    I miss my old insurance (blue cross) with my old employer

    You will probably owe a $35 copay, but the office themselves won't know until they get the EOB from UHC, which sucks and we hate lol

    Half the time, "copay" is just a euphemism for "the paltry amount your doctor must accept" and they don't actually makewmake a cooperative payment withyouat all.

    It's very confusing, people make entire careers out of failing to fully understand it all.
    Monkey Driven, Call this Living?
  • mickeyratmickeyrat up my ass, like Chadwick was up his Posts: 35,641
    edited September 2020
    try this, getting trt from a compounding pharmacy. my ins pharmacy plan is covering all but 150. cvs compounding is writing that off. nothing out of pocket for me. they ship to my dr. I get the shot every 10 weeks. have had 2 now. my dr office submitted a claim on the med. first claim was $1750.00. second was for $2250. actual cost $1125.
    I view this as fraud. A. they werent billed for it and didnt pay for it. B upcharging by 75% then 100%.

    my insurance proper paid the discounted rate on the first claim. denied the second. of course the health org my doc is a part of billed me... all while pharmacy benefit took care of it already....
    Post edited by mickeyrat on
    _____________________________________SIGNATURE________________________________________________

    Not today Sir, Probably not tomorrow.............................................. bayfront arena st. pete '94
    you're finally here and I'm a mess................................................... nationwide arena columbus '10
    memories like fingerprints are slowly raising.................................... first niagara center buffalo '13
    another man ..... moved by sleight of hand...................................... joe louis arena detroit '14
  • deadendpdeadendp Northeast Ohio Posts: 10,434
    mickeyrat said:
    try this, getting trt from a compounding pharmacy. my ins pharmacy plan is covering all but 150. cvs compounding is writing that off. nothing out of pocket for me. they ship to my dr. I get the shot every 10 weeks. have had 2 now. my dr office submitted a claim on the med. first claim was $1750.00. second was for $2250. actual cost $1125.
    I view this as fraud. A. they werent billed for it and didnt pay for it. B upcharging by 75% then 100%.

    my insurance proper paid the discounted rate on the first claim. denied the second. of course the health org my doc is a part of billed me... all while pharmacy benefit took care of it already....
    My husband also has TRT. The billing has been interesting. 

    He had this for several years through the primary care physician. Every three weeks, same amount, for years. Dr's office sells to Cleveland Clinic. The billing then changes from $160/visit, we paid about $55 each visit to $880 FOR THE EXACT SAME SERVICE within the same month. 

    I phoned Medical Mutual and flagged it for fraud. Talked to a lovely guy for about an hour. Took about 8 months, but my husband's doctor knew that I flagged it. It wasn't him. It was Cleveland Clinic. 

    We ended up owing several hundred dollars (deductible was a chunk of that) and the insurance said they would not pay for that service at the office any longer. His doctor referred him to an endocrinologist who 1. charges $200/visit for the same thing CC charged $880 for and 2. taught my husband how to give himself injections to avoid that charge through the office. 

    Are self injections a possibility for you? Honestly, my husband feels a bit more empowered by having as much control over TRT as he can have. 

    As far as flu  shots go, we go to the pharmacy which costs us nothing out of pocket. If we went to our doctor's office (CC), we would probably pay about $60 each. 
    2014: Cincinnati
    2016: Lexington and Wrigley 1
  • mickeyratmickeyrat up my ass, like Chadwick was up his Posts: 35,641
    edited September 2020
    deadendp said:
    mickeyrat said:
    try this, getting trt from a compounding pharmacy. my ins pharmacy plan is covering all but 150. cvs compounding is writing that off. nothing out of pocket for me. they ship to my dr. I get the shot every 10 weeks. have had 2 now. my dr office submitted a claim on the med. first claim was $1750.00. second was for $2250. actual cost $1125.
    I view this as fraud. A. they werent billed for it and didnt pay for it. B upcharging by 75% then 100%.

    my insurance proper paid the discounted rate on the first claim. denied the second. of course the health org my doc is a part of billed me... all while pharmacy benefit took care of it already....
    My husband also has TRT. The billing has been interesting. 

    He had this for several years through the primary care physician. Every three weeks, same amount, for years. Dr's office sells to Cleveland Clinic. The billing then changes from $160/visit, we paid about $55 each visit to $880 FOR THE EXACT SAME SERVICE within the same month. 

    I phoned Medical Mutual and flagged it for fraud. Talked to a lovely guy for about an hour. Took about 8 months, but my husband's doctor knew that I flagged it. It wasn't him. It was Cleveland Clinic. 

    We ended up owing several hundred dollars (deductible was a chunk of that) and the insurance said they would not pay for that service at the office any longer. His doctor referred him to an endocrinologist who 1. charges $200/visit for the same thing CC charged $880 for and 2. taught my husband how to give himself injections to avoid that charge through the office. 

    Are self injections a possibility for you? Honestly, my husband feels a bit more empowered by having as much control over TRT as he can have. 

    As far as flu  shots go, we go to the pharmacy which costs us nothing out of pocket. If we went to our doctor's office (CC), we would probably pay about $60 each. 

    wife is a nurse, so she was doing it for me but we were inconsistent with timing. so my levels were rarely stable. this is a higer dose both by volume and mg per dose...

    we just started with this particular protocol.
    Post edited by mickeyrat on
    _____________________________________SIGNATURE________________________________________________

    Not today Sir, Probably not tomorrow.............................................. bayfront arena st. pete '94
    you're finally here and I'm a mess................................................... nationwide arena columbus '10
    memories like fingerprints are slowly raising.................................... first niagara center buffalo '13
    another man ..... moved by sleight of hand...................................... joe louis arena detroit '14
  • deadendpdeadendp Northeast Ohio Posts: 10,434
    Ahhh. My husband started with a cream from a compounding pharmacy. It was like taking a baby aspirin for a break. Just did not work. They have the dosage balanced and I, not a nurse, make him do his own shots. :smiley:

    TRT is such a whole body need. Mental, digestive, energy, sleep...
    2014: Cincinnati
    2016: Lexington and Wrigley 1
  • rgambsrgambs Posts: 13,576
    mickeyrat said:
    try this, getting trt from a compounding pharmacy. my ins pharmacy plan is covering all but 150. cvs compounding is writing that off. nothing out of pocket for me. they ship to my dr. I get the shot every 10 weeks. have had 2 now. my dr office submitted a claim on the med. first claim was $1750.00. second was for $2250. actual cost $1125.
    I view this as fraud. A. they werent billed for it and didnt pay for it. B upcharging by 75% then 100%.

    my insurance proper paid the discounted rate on the first claim. denied the second. of course the health org my doc is a part of billed me... all while pharmacy benefit took care of it already....
    The piece of the puzzle that your missing is that the pharmacy benefit "covering" it doesn't actually necessarily mean the doctor is getting paid for it.
    Monkey Driven, Call this Living?
  • mickeyratmickeyrat up my ass, like Chadwick was up his Posts: 35,641
    edited September 2020
    rgambs said:
    mickeyrat sa7thid:
    try this, getting trt from a compounding pharmacy. my ins pharmacy plan is covering all but 150. cvs compounding is writing that off. nothing out of pocket for me. they ship to my dr. I get the shot every 10 weeks. have had 2 now. my dr office submitted a claim on the med. first claim was $1750.00. second was for $2250. actual cost $1125.
    I view this as fraud. A. they werent billed for it and didnt pay for it. B upcharging by 75% then 100%.

    my insurance proper paid the discounted rate on the first claim. denied the second. of course the health org my doc is a part of billed me... all while pharmacy benefit took care of it already....
    The piece of the puzzle that your missing is that the pharmacy benefit "covering" it doesn't actually necessarily mean the doctor is getting paid for it.

    I am being billed for the medication by my dr office. my dr office is receiving the med and admininistering it. thats all. they are paid for the part they do. give the injection.  because the med lasts for longer than 30 days it goes to the bulk home delivery side, express scripts. EXPRESS SCRIPTS IS COVERING THIS. I have the letter stating so. CVS Compounding says express scripts is covering and has paid both times which is reflected with each delivery.

    this was a preauthorization by insurance.

    my dr office admits the mistake. billing doesnt pick up and I'll be fucked if I waste more than the half hour I spent on hold to correct my dr office mistake. Next step is to inform my ins company then the state.
    I am being billed for an already paid for med, on top of that its been marked up by 75% and 100% respectively for the 2 doses I have received.

    my dr wrote the script. filled out the preauth, recieves the controlled substance, gives the injection. thats it. they didnt pay for the med.
    Post edited by mickeyrat on
    _____________________________________SIGNATURE________________________________________________

    Not today Sir, Probably not tomorrow.............................................. bayfront arena st. pete '94
    you're finally here and I'm a mess................................................... nationwide arena columbus '10
    memories like fingerprints are slowly raising.................................... first niagara center buffalo '13
    another man ..... moved by sleight of hand...................................... joe louis arena detroit '14
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