# Received a bill from doctor even after I paid the co-pay



## debodun (Nov 29, 2019)

My ophthamologist is billing me even after I have paid what they asked me to up front.


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## Keesha (Nov 29, 2019)

Possibly an honest mistake?
Phone and ask them. 
Did you save your receipt?


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## debodun (Nov 29, 2019)

Of course I save ALL my receipts. Probably Medicare didn't pay for some of it.


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## Keesha (Nov 29, 2019)

That’s good. I figured as much. Just call Medicare up and find out how much they paid and why there is a difference remaining.


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## debodun (Nov 29, 2019)

I see that my Medigap paid some. Unfortunately, their office is closed for the holiday weekend.


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## win231 (Nov 29, 2019)

Most likely simple greed, rather than a "mistake."  If you call them on it, they'll usually say, "Sorry; it's a mistake."
I saw such a doctor 12 years ago at my diabetes diagnosis.  He immediately tried to soak my insurer for thousands of dollars by telling me I needed to be hospitalized for "dehydration" when lab tests showed I wasn't the least bit dehydrated.  Then, after I paid the bill in full, he started sending me additional bills which I ignored for two months.  Then he started calling me, asking for payment.  I suggested he do some "research" & talk to his billing department & hung up on him.  After he verified that my bill was paid in full, he sent me an e-mail, telling me "You are correct; ignore the bill."  I responded:  "I already ignored your bill as soon as I received it."
Am I a sarcastic prick, or what?


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## debodun (Nov 29, 2019)

This new ophthamologist I don't like at all. I was seeing a doctor and getting along with him just fine, then he retired and sold the practice. The new owner demands copays up front and seems arrogant to me. I kept complaining about the sudden blurriness in my left eye, he gave me glycerin drops for it. On returning for my follow-up appointment, he didn't even bring the subject up an only seemd concerned that I may have glaucoma. When I complained again about the blurriness, he sighed and gave me a perfunctory vision test and grudgingky wrote a prescription. The eye test never really did away with the blurriness. Right now I have to sit with my nose practically on the computer monitor and I am getting scared to drive.


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## Liberty (Nov 29, 2019)

debodun said:


> This new ophthamologist I don't like at all. I was seeing a doctor and getting along with him just fine, then he retired and sold the practice. The new owner demands copays up front and seems arrogant to me. I kept complaining about the sudden blurriness in my left eye, he gave me glycerin drops for it. On returning for my follow-up appointment, he didn't even bring the subject up an only seemd concerned that I may have glaucoma. When I complained again about the blurriness, he sighed and gave me a perfunctory vision test and grudgingky wrote a prescription. The eye test never really did away with the blurriness. Right now I have to sit with my nose practically on the computer monitor and I am getting scared to drive.


deb, have you been checked for  cataracts? I assume if you are given a comprehensive glaucoma test you would have had a test that medicare doesn't pay for - I get a bill for $40 for that each year.  Worth it, thought.


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## debodun (Nov 29, 2019)

I have had cataract surgery in both eyes. The right one was one 10 years ago and the left was 4 years ago, but by a different surgeon. The right eye was about the same afterwards, the left eye was much better afterwards until about 6 weeks ago when suddenly it got blurry. That's what prompted me to see the doctor. I didn't know the business was under new management.

If he saw anything amiss, he didn't say anything except that I may be in the early stages of glaucoma. My left eye is watering like crazy, also, but he didn't seem to think that was significant, or at least didn't say so; just gave me some glycerin drops. I do not like his reticent, uncommunicative attitude. A friend of mine goes to him and she thinks he's wonderful.

Thanks for thatinfo on Medicare. I can never figure out what they pay for. Just got a bundle of booklets today about the changes to Medicare and my Part D for next year. I wouldn't understand it if I read it!


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## gennie (Nov 29, 2019)

debodun said:


> This new ophthamologist I don't like at all. I was seeing a doctor and getting along with him just fine, then he retired and sold the practice. The new owner demands copays up front and seems arrogant to me. I kept complaining about the sudden blurriness in my left eye, he gave me glycerin drops for it. On returning for my follow-up appointment, he didn't even bring the subject up an only seemd concerned that I may have glaucoma. When I complained again about the blurriness, he sighed and gave me a perfunctory vision test and grudgingky wrote a prescription. The eye test never really did away with the blurriness. Right now I have to sit with my nose practically on the computer monitor and I am getting scared to drive.


You need a new doctor.


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## gennie (Nov 29, 2019)

Medicare sends a quarterly statement showing what they have paid on your behalf. Start reading it.  I once saw a payout to an eye doctor for a visit I never made.  I had seen him about a year earlier but not that year. 

 I called his office and the clerk said "Well, it was time for you to see him again."  

Me: "But I wasn't even in Page, AZ last July.  I was on the east coast."  

Clerk:  "Well, if  you knew how expensive it was to keep this office open, you wouldn't complain.  Anyway you shouldn't care.  It didn't cost you anything,  Medicare paid."

Me:  "Tell your boss that he had better get his records ready for an auditor from Medicare."

I did report it to Medicare office but THAT clerk said, "Oh that happens all the time.  It's such a small amount, it probably isn't worth investigating."  

Medicare was set up to work on the honor system and when it comes to honor vs. greed, honor often looses.  If we don't check our records and verify charges, it is wide open for fraud and when the fraud is small, Medicare doesn't care.


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## debodun (Nov 29, 2019)

What gets me is they keep you coming back for follow-up visits when they probably aren't necessary.


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## DaveA (Nov 29, 2019)

In our area it seems pretty straightforward, the payments that is. I always go with my $10 in hand as that is my usual co-pay.  Some days, for certain exams, they tell me there's no co-pay for that particular test or lab work.  Never seemed to be a problem. 

 In the past, when co-pays first appeared, they'd forget to ask and I didn't remember to offer. later I'd get a bill in the mail for the 10 bucks.  Nothing ever seemed sinister to me?


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## debodun (Nov 29, 2019)

I saw these two ratings on this doctor on a medical review site (his name removed). Of course, other gave him good reviews.


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## jujube (Nov 29, 2019)

Quick lesson: it's called "back billing" and it's ILLEGAL as long as they are billing you for the difference between what they billed and what medicare "allows".  Doctors used to do it all the time. If the patient was savvy, they'd say it was a billing mistake. If the patient didn't object, the doctor would make off with some extra moolah. It was getting blatant and Medicare stomped on a few doctors and scared the rest.

NOW, if you have a procedure that Medicare DOESN'T allow, the doctor can bill you for the full amount and you're on the hook.

To recap.....your procedure costs $100..
.Medicare allows/pays $40 for it. Doctor HAS to accept $40 in full payment. If the procedure isn't allowed by Medicare, he can bill you the full $100 for it. If they're nice, they may only bill you the $40.


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## debodun (Nov 29, 2019)

Here is the bill. There are so many columns on it, I don't understand it all.


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## Liberty (Nov 29, 2019)

debodun said:


> I have had cataract surgery in both eyes. The right one was one 10 years ago and the left was 4 years ago, but by a different surgeon. The right eye was about the same afterwards, the left eye was much better afterwards until about 6 weeks ago when suddenly it got blurry. That's what prompted me to see the doctor. I didn't know the business was under new management.
> 
> If he saw anything amiss, he didn't say anything except that I may be in the early stages of glaucoma. My left eye is watering like crazy, also, but he didn't seem to think that was significant, or at least didn't say so; just gave me some glycerin drops. I do not like his reticent, uncommunicative attitude. A friend of mine goes to him and she thinks he's wonderful.
> 
> Thanks for thatinfo on Medicare. I can never figure out what they pay for. Just got a bundle of booklets today about the changes to Medicare and my Part D for next year. I wouldn't understand it if I read it!


MIL had cataract surgery and had to have an additonial operation.  That might be what's happening with you.  New doc is needed, of course, gal.
Read that a lot of folks need additional surgery after initial cataract operations.  Guess its fairly common.


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## Liberty (Nov 29, 2019)

Do you have an advantage plan or a medicare supplement plan?


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## Kaila (Nov 29, 2019)

Liberty said:


> Read that a lot of folks need additional surgery after initial cataract operations. Guess its fairly common.


Yes, it's a simpler and quicker procedure that is done in an office.  I think you'd be best to go either to the eye surgeon who did that eye cataract or to a different new one, to find out if that's the correction you need.  If it is, then it IS correctable, but a lens refraction correction with glasses will *not* improve it, if that is the problem.


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## Kaila (Nov 29, 2019)

About the bill, Deb, you could tell that office that you want to wait (and not pay the bill) untill you get the Explanation Of Benefits form in the mail from Medicare, which will show you the maximum that you can be charged.


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## Butterfly (Nov 29, 2019)

If I were you, I would go to a different doctor.

Here, doctors' offices always collect the co-pay p front.  Nothing weird about that part.

Ask the office if the doc accepts Medicare "assignment."  It is my understanding that if he doesn't, he can bill you the difference between what Medicare pays and what he charges, not to exceed 15% over what Medicare allows.


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## Kaila (Nov 29, 2019)

That bill actually looks very possibly accurate to me, Deb, but I am not an expert on any one else's matters.


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## debodun (Nov 30, 2019)

Liberty said:


> Do you have an advantage plan or a medicare supplement plan?


I have traditional Medicare A & B. I have to stay on that or I'll lose my Medigap coverage, which is paid through my former employer. Also have Part D (Silver Script) through the same plan.


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## debodun (Nov 30, 2019)

Liberty said:


> MIL had cataract surgery and had to have an additonial operation.  That might be what's happening with you.  New doc is needed, of course, gal.
> Read that a lot of folks need additional surgery after initial cataract operations.  Guess its fairly common.


You'd think the ophthamologist would have recommended that if he noticed anything amiss.


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## Liberty (Nov 30, 2019)

debodun said:


> I have traditional Medicare A & B. I have to stay on that or I'll lose my Medigap coverage, which is paid through my former employer. Also have Part D (Silver Script) through the same plan.


Sounds like you've got good coverage then.


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## debodun (Nov 30, 2019)

I probably shouldn't gripe over a bill that is less than $25, but it likely stems from a misunderstanding I had that between Medicare and Medigap, everything was covered. Probably these charges are co-pays left from the Medigap (United Healthcare) I have. When it says "National G crossed over to United Healthcare", does that mean Medicare fobbed it off on my Medigap?


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## Liberty (Nov 30, 2019)

debodun said:


> I probably shouldn't gripe over a bill that is less than $25, but it likely stems from a misunderstanding I had that between Medicare and Medigap, everything was covered. Probably these charges are co-pays left from the Medigap (United Healthcare) I have. When it says "National G crossed over to United Healthcare", does that mean Medicare fobbed it off on my Medigap?


Who knows...we sometimes get crazy bills and then the next month they disappear.  We don't pay them unless we are sure of what they are - so much corruption out there. We just ignore them and they eventually fix the finger fumbles.  

I'm guessing because of the amount in your case  its probably a "not registering the deductible for the year" so its a rebill.  That would be my guess anyway.  When you call the doctor's office it may be a "duh" we don't know - "Medicare told us to bill you this" or something...lol.


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## Judycat (Nov 30, 2019)

Maybe find a different eye doctor.  I suffered with someone because the place where I had been going moved out of town and sent my records to a new place. I went two times and the second time was worse than the first. I took it upon myself to find a different eye doctor and wow what a difference. Some places make you feel like an animal at the vet, that's how I describe the kind of experience you had.


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## Kaila (Nov 30, 2019)

debodun said:


> You'd think the ophthamologist would have recommended that if he noticed anything amiss.



You're right, he should have, and hopefully did,
but it is common, and I don't know for sure if that doctor is skilled and attentive to detail, or not, from what you said.



debodun said:


> does that mean Medicare fobbed it off on my Medigap?



I don't think they can do that.  Medicare had to come first, (pay first) when I was more familiar with it than now.
I don't know for certain, how the details are done now.

I see your point, Deb, that even though its not a big leftover charge for those tests,  that between both insurances, it seems like you shouldn't have more co-pay left, but I don't know.  

It is interesting what @Liberty  said though, about the bill, so it's worth waiting, and not paying now, and trying to confirm (with that office or better, with one of the insurances) that you truly owe the remaining amount.


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## Kaila (Nov 30, 2019)

Judycat said:


> Maybe find a different eye doctor. I suffered with someone because the place where I had been going moved out of town and sent my records to a new place. I went two times and the second time was worse than the first. I took it upon myself to find a different eye doctor and wow what a difference



I agree that it's easier to switch and find a new eye doctor, than other types of doctors, IF you decide to,

and to have your records of the eye tests that you had, sent to the new one, since the insurances will not cover them twice so soon, but it is much easier to do with eye doctors, than it is, to find and switch to a different GP.


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## debodun (Nov 30, 2019)

Not that may ophthamologists around here. Also depends on what insurance they take and if they are accepting new patients.

https://www.forbes.com/sites/nextav...-your-doctor-wont-take-medicare/#6ae81b0a65cd


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## Kaila (Nov 30, 2019)

Oh you are right, plus I also momentarily forgot that they all have long waits for next appointments, now too!


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## debodun (Nov 30, 2019)

Even established patients usually have to wait up to six months for doctor appts. I tell my doctors that by that time I'll either be better or dead. Usually after an office visit, they insist on scheduling a follow-up to avoid confusion. Sometimes I can't plan that far ahead.


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## Liberty (Nov 30, 2019)

debodun said:


> Even established patients usually have to wait up to six months for doctor appts. I tell my doctors that by that time I'll either be better or dead. Usually after an office visit, they insist on scheduling a follow-up to avoid confusion. Sometimes I can't plan that far ahead.


You gotta be kidding.  Down here we can call a doc and get in very quickly as far as I know.  Of course we are near the largest medical facilities in the country.
Over 100,000 people work daily at the Harris County Med Center in H Town.  Have never heard of any medicare patient  being turned down  by a doc.  It must be way different in areas around the country.


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## debodun (Nov 30, 2019)

My PCP is very difficult to get an appointment with on short notice. I'm usually given a date about 6 weeks away. Of course, they say if they get a cancellation, I'll be bumped up on her waiting list. Of course, with only two doctor's offices in a town of over 5000 plus surrounding communities, I am not surprised at that.


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## Kaila (Nov 30, 2019)

Some of the medical practices here, (northern USA) accept a limited percentage of their patients, at any one time, to have Medicare. And there are also some who do not take it.  

Both of which, make the waits longer for those doctors who do accept it, and for patients who need to use it.

The wait lists for appointments vary here, but can be long, for established patients too, and even longer for new ones.


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## Liberty (Nov 30, 2019)

We use our cardiologist as our primary care physician.  He does all the blood work.  Yikes, are you close to any major cities that you could see a doc sooner and establish an ongoing relationship with the medical care facilities in that area?


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## debodun (Nov 30, 2019)

Yes, there is a city about 30 miles away.


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## Liberty (Nov 30, 2019)

debodun said:


> Yes, there is a city about 30 miles away.


I'd definitely checkout docs in that area.  My guess is they will be better suited to your needs!


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## JB in SC (Dec 1, 2019)

I would suggest a cornea specialist.


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