drumboy said:

---

aTm2004 said:

---

Somewhat Tine COVID related...if you have children and something comes up and you decide to take them to Texas Children's Urgent Care, they now require an appointment.

---

Yep, I had to wait an hour for my 3yo to get in to get the huge bead removed from her nose a couple weeks ago.

---

It's dumb. They're essentially becoming a pediatrician with extended hours. When my wife picked up our 2 year old from the sitter on Monday, the sitter showed her a rash she had seen on his arm. They checked the rest of his body and it was only on his upper arm. By around 6 or so, it had spread on his arm and was also on his leg, so we decided to take him to TCUC that is a few minutes up the road. I walked in and the lady asked if I had an appointment, and I was like "appointment?" She told me that because of COVID, they required an appointment now, so I would have to go out to my car and schedule one. Well, they didn't have before like 10:30, so I called my wife and told her I was taking him to another UC, and she told me to come home.

We did a FaceTime call with my SIL (who is a PA), and she looked at it, asked some questions, and told us to give him a Zyrtec and check it before we went to bed and again in the morning. If it was still there or worse, take him to the pediatrician. Luckily, he was all but gone yesterday morning and completely gone by the afternoon.

This summer, something happened to our 7 year old on a Sunday night around 7:50, so I ran her up to the same TCUC clinic (which closes at 8 on Sunday), and my wife called them to let them know we were on our way and to see if they could say open, and she was told they do not take appointments and they'd see us if we got there by 8. I passed a HPD officer in a 40 mph zone doing 70 with my flashers. He didn't even blink.

TXTransplant said:

---

Diggity said:

---

oh, I didn't pay it.

---

If you gave them an insurance card, they shouldn't have billed you for the office visit at all.

I like TX Children's, but what a blatant money grab.

---

I posted earlier in this thread about the 2 year old I mentioned above being sick a month or so ago, and my wife took him to the pediatrician who is a one of the Texas Children's clinics. Even though he tested positive for strep, they still wanted us to take him to get a COVID test, so my wife had to drive out to The Woodlands to have it done. 100% a money grab.

htxag09 said:

---

What are the requirements for your travel destination?

---

USVI requires proof of a negative test within 5 days of arrival.

gougler08 said:

---

Texas Children's sent us a bill for something that my wife had already paid for up front and when I called they said, "oh that's our fault we applied to payment to the wrong thing"

I'm sure they get plenty of people to pay extra with crap like that all the time

---

This is what bugs me. I know there are people who pay without questioning it.

Heck, we are on an HDHP, and my son had to have a couple of minor outpatient procedures. Every time we saw the doctor (total of four visits, I think). They asked for my cc. I wanted to be cooperative, so I let them charge me - until it got up to $800+ and the EOB statements started rolling in. Nothing submitted to BCBS matched up with what I was charged.

When I questioned the staff at the doctor's office, she said "Well, you are on an HDHP with a $1500 deductible". She did give me a number to call about billing, and they did say that I'd probably overpaid, but they are still waiting for BCBS to process a couple of claims.

But I think the doctors office saw that deductible and used it as the opportunity to charge me what we they wanted under the guise of "you haven't met your deductible, yet".

TXTransplant said:

---

gougler08 said:

---

Texas Children's sent us a bill for something that my wife had already paid for up front and when I called they said, "oh that's our fault we applied to payment to the wrong thing"

I'm sure they get plenty of people to pay extra with crap like that all the time

---

This is what bugs me. I know there are people who pay without questioning it.

Heck, we are on an HDHP, and my son had to have a couple of minor outpatient procedures. Every time we saw the doctor (total of four visits, I think). They asked for my cc. I wanted to be cooperative, so I let them charge me - until it got up to $800+ and the EOB statements started rolling in. Nothing submitted to BCBS matched up with what I was charged.

When I questioned the staff at the doctor's office, she said "Well, you are on an HDHP with a $1500 deductible". She did give me a number to call about billing, and they did say that I'd probably overpaid, but they are still waiting for BCBS to process a couple of claims.

But I think the doctors office saw that deductible and used it as the opportunity to charge me what we they wanted under the guise of "you haven't met your deductible, yet".

---

They have a chargemaster that lists all charges per CPT code. Each insurance company and policy is different regarding physician reimbursement. The doctor's office honestly doesn't know what the costs will be until they submit the claims to the insurance company and the insurance company processes them according to the terms of the network participation agreement that is applicable.


I love how people are mad at physician practices when BCBSTX's parent company profits were up 58% this year. Focus your rage on the people actually profiting from you.

or just buy shares. Anthem seems undervalued if what you're saying is correct

Diggity said:

---

or just buy shares. Anthem seems undervalued if what you're saying is correct

---

They're facing a lot of lawsuits right now and just settled a class-action for a 2015 data breach to the tune of $115 million.

Healthcare billing is complicated, but I am astounded by just how many people have no idea how it works. Spot on about focusing your rage on the right people. When your procedure or something else isn't covered, 99% of the time it is because of your insurance company. If you want to be mad at someone for our healthcare system, be mad at the insurers.

Q3...woof!

The Wonderer said:

---

TXTransplant said:

---

gougler08 said:

---

Texas Children's sent us a bill for something that my wife had already paid for up front and when I called they said, "oh that's our fault we applied to payment to the wrong thing"

I'm sure they get plenty of people to pay extra with crap like that all the time

---

This is what bugs me. I know there are people who pay without questioning it.

Heck, we are on an HDHP, and my son had to have a couple of minor outpatient procedures. Every time we saw the doctor (total of four visits, I think). They asked for my cc. I wanted to be cooperative, so I let them charge me - until it got up to $800+ and the EOB statements started rolling in. Nothing submitted to BCBS matched up with what I was charged.

When I questioned the staff at the doctor's office, she said "Well, you are on an HDHP with a $1500 deductible". She did give me a number to call about billing, and they did say that I'd probably overpaid, but they are still waiting for BCBS to process a couple of claims.

But I think the doctors office saw that deductible and used it as the opportunity to charge me what we they wanted under the guise of "you haven't met your deductible, yet".

---

They have a chargemaster that lists all charges per CPT code. Each insurance company and policy is different regarding physician reimbursement. The doctor's office honestly doesn't know what the costs will be until they submit the claims to the insurance company and the insurance company processes them according to the terms of the network participation agreement that is applicable.


I love how people are mad at physician practices when BCBSTX's parent company profits were up 58% this year. Focus your rage on the people actually profiting from you.

---

I'm not angry at the doctor's office, I just think it's interesting that they kept wanting to charge my card.

And what the doctors office ~submitted~ to BCBS was significantly less than what they charged my card. No itemization of services. Just as I left "oh, that will be $400". Next time "oh, that will be $300". Time after that "oh, that will be $100". Finally, I said, I'm not paying any more money until I start to see some EOBs.

Why not charge a one time deposit and then bill the rest? I understand that the doctors office is worried that some people will never pay, but patients should also not be expected to overpay by hundreds of dollars and have to wait for reimbursement.

My company is self-insured. BCBS is just a paperwork pusher. I don't know how that affects anything (if at all).

But, yes, you are correct. The doctors office has no clue about billing. They gave me the number of some woman in North Carolina to call.

if they don't charge you on site, chances of collection drop precipitously.

Not sure how a deposit system would work. Not much incentive for the practice to mess with it though.

Diggity said:

---

if they don't charge you on site, chances of collection drop precipitously.

Not sure how a deposit system would work. Not much incentive for the practice to mess with it though.

---

This was a relatively inexpensive service. If they would have charged me $500-$600 right off the bat, that would have wound up covering the majority of it (and matched up with the EOBs that I've seen so far).

And I would have paid for the rest, had they billed me, but I know a lot of people wouldn't.

I got annoyed when I realized they wanted to charge me $100 for a follow-up office visit for the procedures. IMO that should have have been covered in the cost of the procedure itself (and I'd already given them $800 at that point), but I know they have to code the procedure separately from the follow up visit for insurance purposes.

Diggity said:

---

if they don't charge you on site, chances of collection drop precipitously.

Not sure how a deposit system would work. Not much incentive for the practice to mess with it though.

---

This. If they don't get their money upfront, most people would never pay.

TXTransplant said:

---

Diggity said:

---

if they don't charge you on site, chances of collection drop precipitously.

Not sure how a deposit system would work. Not much incentive for the practice to mess with it though.

---

This was a relatively inexpensive service. If they would have charged me $500-$600 right off the bat, that would have wound up covering the majority of it (and matched up with the EOBs that I've seen so far).

And I would have paid for the rest, had they billed me, but I know a lot of people wouldn't.

I got annoyed when I realized they wanted to charge me $100 for a follow-up office visit for the procedures. IMO that should have have been covered in the cost of the procedure itself (and I'd already given them $800 at that point), but I know they have to code the procedure separately from the follow up visit for insurance purposes.

---

Yep. Follow_ups have their own CPT codes and have to be submitted separately.

The Wonderer said:

---

TXTransplant said:

---

Diggity said:

---

if they don't charge you on site, chances of collection drop precipitously.

Not sure how a deposit system would work. Not much incentive for the practice to mess with it though.

---

This was a relatively inexpensive service. If they would have charged me $500-$600 right off the bat, that would have wound up covering the majority of it (and matched up with the EOBs that I've seen so far).

And I would have paid for the rest, had they billed me, but I know a lot of people wouldn't.

I got annoyed when I realized they wanted to charge me $100 for a follow-up office visit for the procedures. IMO that should have have been covered in the cost of the procedure itself (and I'd already given them $800 at that point), but I know they have to code the procedure separately from the follow up visit for insurance purposes.

---

Yep. Follow_ups have their own CPT codes and have to be submitted separately.

---

So, serious question. Maybe you explained it above and I just didn't understand.

We are on an HDHP, so I expected to pay for this procedure entirely OOP. The benefit of filing it on insurance is 1) I pay the BCBS negotiated rates and 2) I get the credit towards my deductible (although, I know I could file this myself).

But why does the doctor's office submit charges to BCBS that are less than what they charged me?

That's where the frustration lies. I've paid the doctor $800, but, last I checked, they've only submitted about $500 in charges to BCBS (and that's about what BCBS says I owe).

And I have no idea what services I've paid for because none of the bills from the doctor's office are itemized. They just asked for my card at the end of every visit and charged something different every time (despite the fact that he had the same procedure done twice plus two follow up visits).

The lady in NC confirmed I overpaid, but she couldn't tell me by how much because not all of the claims had been processed by BCBS. She also told me not to give them any more money (I have since gotten a bill in the mail for another $30).

TXTransplant said:

---

The Wonderer said:

---

TXTransplant said:

---

Diggity said:

---

if they don't charge you on site, chances of collection drop precipitously.

Not sure how a deposit system would work. Not much incentive for the practice to mess with it though.

---

This was a relatively inexpensive service. If they would have charged me $500-$600 right off the bat, that would have wound up covering the majority of it (and matched up with the EOBs that I've seen so far).

And I would have paid for the rest, had they billed me, but I know a lot of people wouldn't.

I got annoyed when I realized they wanted to charge me $100 for a follow-up office visit for the procedures. IMO that should have have been covered in the cost of the procedure itself (and I'd already given them $800 at that point), but I know they have to code the procedure separately from the follow up visit for insurance purposes.

---

Yep. Follow_ups have their own CPT codes and have to be submitted separately.

---

So, serious question. Maybe you explained it above and I just didn't understand.

We are on an HDHP, so I expected to pay for this procedure entirely OOP. The benefit of filing it on insurance is 1) I pay the BCBS negotiated rates and 2) I get the credit towards my deductible (although, I know I could file this myself).

But why does the doctor's office submit charges to BCBS that are less than what they charged me?

That's where the frustration lies. I've paid the doctor $800, but, last I checked, they've only submitted about $500 in charges to BCBS (and that's about what BCBS says I owe).

And I have no idea what services I've paid for because none of the bills from the doctor's office are itemized. They just asked for my card at the end of every visit and charged something different every time (despite the fact that he had the same procedure done twice plus two follow up visits).

The lady in NC confirmed I overpaid, but she couldn't tell me by how much because not all of the claims had been processed by BCBS. She also told me not to give them any more money (I have since gotten a bill in the mail for another $30).

---

Likely inexperienced staff taking "deposits," at least I would hope that versus actual nefarious taking advantage of you. You are correct in your statement of the benefits of filing on insurance.

When the office staff said "Well, you're on an HDHP, and your deductible ~is~ $1500", that validated my decision to stop handing over the CC.

TXTransplant said:

---

When the office staff said "Well, you're on an HDHP, and your deductible ~is~ $1500", that validated my decision to stop handing over the CC.

---

?itemid=8825329

ChipFTAC01 said:

---

Does a $1500 deductible really meet a hdhp threshold?

Not saying that derisively. I'd kill for a $1500 deductible.

---

Our plan is called a HDHP- 100% on me up to $3K, then 10% between $3001 and $5000, 100% covered above $5K. Even paying $3K out of pocket the premiums and so forth are substantially cheaper than the gold plan (or whatever it's called) with a really low deductible.

I want to say that with premiums and OOP the "gold" plan cost me like $14K for a family of 4. The HDHP knocked that down to like $7K total, including premiums.

ChipFTAC01 said:

---

Does a $1500 deductible really meet a hdhp threshold?

Not saying that derisively. I'd kill for a $1500 deductible.

---

Ours is $3k total, $1500 for each person on the plan (there are two of us).

For 2020, the IRS defines any plan with an individual deductible of at least $1400 or family deductible of at least $2800 as high deductible. That's staying the same for '21 too.

Quote:

---

For 2020, the IRS defines a high deductible health plan as any plan with a deductible of at least $1,400 for an individual or $2,800 for a family. An HDHP's total yearly out-of-pocket expenses (including deductibles, copayments, and coinsurance) can't be more than $6,900 for an individual or $13,800 for a family. (This limit doesn't apply to out-of-network services.)

---

looks like just barely.

I don't even know what my deductible is. I just hope to never meet it.

Diggity said:

---

Quote:

---

For 2020, the IRS defines a high deductible health plan as any plan with a deductible of at least $1,400 for an individual or $2,800 for a family. An HDHP's total yearly out-of-pocket expenses (including deductibles, copayments, and coinsurance) can't be more than $6,900 for an individual or $13,800 for a family. (This limit doesn't apply to out-of-network services.)

---

looks like just barely.

I don't even know what my deductible is. I just hope to never meet it.

---

You either never want to meet it or you want to completely blow past it. I have several friends that have HDHPs and hit deductible within the first month of the year and then the InsCo gets stuck for $8+k/mo the rest of the year. It truly is the best insurance program for them.

Mine has a max OOP, too. So, even if we hit the $1500/$3k deductible, I'm still on the hook for $4500 per person or $9k total.

Most years we have no claims. Kid broke his arm a couple of years ago and TX Children's sent me a bunch of seemingly random bills that ultimately totaled to $4500.

A lot of stuff that I would have expected to pay OOP for ends up covered. I had an annual exam last year and they asked me to come back for an ultrasound. I wasn't billed for that (fully expected to be).

Like I said in a previous post, even if you haven't met your deductible, you still want to file a claim because you will only owe the negotiated rate for the service, which is usually a substantial "discount".

Big negative to our HDHP is that it covers very few prescription drugs. Pretty much only covers generic maintenance stuff, and I don't think prescription drug costs count toward the deductible.

We don't take anything, but if you had a really expensive prescription, it wouldn't be a good choice.

Fort Bend raised their level to red.

https://www.khou.com/article/news/health/coronavirus/fort-bend-county-covid-update-threat-level/285-84e7409b-38be-44bb-8ad2-ad981fa385a2

What were we, orange? Not sure this changes anything though

Keegan99 said:

---

spadilly said:

---

Fort Bend raised their level to red.

https://www.khou.com/article/news/health/coronavirus/fort-bend-county-covid-update-threat-level/285-84e7409b-38be-44bb-8ad2-ad981fa385a2

---

"Why was it ever not on red?!"

---

Is that her scepter and her orb on the table behind her?

So for Christmas, if everybody over the age of 11 except my parents have had it, can we still infect them? My parents have become CoronaKaren & CoronaKen.

Good Lord. Is there a picture she doesn't have a deer in the headlights look?

dead lifeless eyes