Medical Billing 101.

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I am on hold with our pediatrician’s office, trying to figure out how much Princess P’s visit from last week would end up being.  We actually haven’t had a sick visit since we started on that insurance, so I ‘m interested to see how it shakes out.

Mind you, we’re saving 300 dollars/month by doing this plan.  Our total out of pocket is pretty close to what it would be on Drew’s plan, but we are required to pay the office visits, there is no co-pay.

Here’s some information you need to be a good health consumer:

1.  Doctors (or medical providers, we saw an NP) bill a certain code for how extensive their visit with you was.  I’m hoping she didn’t bill for much, because she certainly didn’t spend much time in the room.  I mostly didn’t need her to see her, but I digress…

2.  That code has a dollar amount the doctor’s office sets.  I think she said this was 90 dollars.  BUT, then it goes your insurance, and they have a certain amount that they’re in contract to pay, which is the dollar amount I will end-up paying.  I will also end-up paying for the strep culture.  She said that is usually around 10 bucks, after insurance.

So, just because they SAY this particular visit would be 120 bucks or whatnot, you need to find out what your insurance has contracted to pay for a specific code.

But, here I am a week later and no one has a clue what the cost will be.

I mean, would you walk into Ross and just say, “I’m going to get that shirt and it doesn’t matter how much it costs, I just want it.”  But, doctors offices hide behind your copayment and just bill whatever they want.  Which is annoying.  I realize they can’t really tell you what the MD is going to need to bill for until after they see you, but after that it seems fair they could come up with a bill.

But they can’t.

Did I mention that is annoying, because it is.  It makes me extra happy I bought those strep cultures.

Pulling Curls blog by Hilary EricksonCheck out Hilary's Most Popular Posts ~ Learn more About Hilary

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  1. says

    This is frustrating for me too. Same at dentist!!

    Nice to see your family the other day. Everyone looks great! P is a charmer! : )

  2. Edwina Andreas says

    I’d be frustrated too if I was in your shoes, Hilary! One tip you could add there is to never forget the power of asking questions. Remember that you are the client and the center of the medical team. It means that you have the right to know what’s going on because you are paying for your health. This’ll help you know what to expect and enable you to adjust accordingly. Stay healthy!

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