[Yucatan2]

I am excited to try the Villages health care, it seems like a great idea. But as I am filling out the new patient forms this morning, page 4 is the authorization to release information page. At the bottom it says I agree to be responsible for payment of the difference if insurance benefits don't cover. I will be responsible for the entire amount due for professional services rendered if the expense is not covered by my policy.

Is this the norm at all doctor's offices these days? I sure don't recall signing something like that in the past, but I've had the same doctor for the last 15 years and I know things have changed.

I have a high deductible plan so we could be paying a lot anyway, if we suddenly had to start seeing a doctor.....as of now, we go to our once a year check up and that's about it.

[Irishmen]

I would assume that is standard as promise to pay.

[NH to Fl]

Don't sign it. You may not have to.

[skyguy79]

I don't recall if there was a specific time when acknowledging one's responsibility to pay for services are rendered started, insurance or not, but I can't remember a time when I didn't have to sign a similar agreement when filling out similar forms. I'm sure it's done because of providers being stiffed too often by patients or clients. Most though are not target of this requirement and people shouldn't take this requirement personal, unless of course they're one of those big stiffs being targeted!

Urban Dictionary: stiff

[Birdie Dreamer]

Originally Posted by NH to Fl

Don't sign it. You may not have to.

Can you elaborate?

[blueash]

The insurance company processes your claim based on the service code and the diagnostic code submitted by the provider. Almost all of your care should be a covered procedure. However, there are things done in a doctor's office that may not be covered at all. Elective (botox for your wrinkles) and non-standard (hypnosis for your wart) are not going to be covered at all. In a non-covered situation you are responsible for 100% of the billed charge. But in a situation where you are covered by a carrier the insurance company first adjusts the charge to their allowable then you are responsible for that lower adjusted fee in the amount the insurance did not cover. For example you are seen for a sore throat. Your doctor bills the carrier using code 99213 and charges $120. The carrier only allows $85. The doctor, assuming they are participating or in network with the carrier ( be sure he is) must write off the $35. The most they can receive is $85. If you have a copay of $25 per visit, you pay the first $25. Then the remaining $60 is handled depending on the deductible and any coinsurance provisions. If you have not met your deductible, you also owe the $60. If you have a 20% coinsurance you owe 20% of the $60 or $12 and the carrier pays the other $48.

Thanks to the Affordable Care Act (AKA Obamacare) you are 100% covered for a well exam once a year no matter what the other provisions of your insurance. If all you have is a well exam you will get no bill at all. You might want to be sure when you are seen that it is coded as a well exam, not an evaluation and management visit.

[Yucatan2]

Thank you for your explanation, Blueash. The sore throat analogy is exactly what would happen if we went to a doctor for that. Our high deductible plan covers the wellness visit and certain preventive testing, and then we are on our own until the deductible is met. I guess I started getting concerned, thinking about how much a hospital visit could be, or even some doctor visits, because of the plan we have chosen. We are not retired nor on Medicare for many years yet. Luckily we do have a health savings account to cover these expenses (hopefully!).

In the old days, we didn't even worry about doctor visits, everything was covered through our excellent insurance, with both of us working in the medical field. Times have sure changed, now we have to really need to go to the doctor since we will be paying for it.

[Irishmen]

Thanks to the OCA you'll wait avg of 2 years to sniff a doctors office if at all for your free 100% well exam. Well exam under the OCA pays the doctors $11.75. 115,000 people are waiting in The UK 18 months for a hospital bed. Govt run VA back logged 14 months just to here back a denial or approval. I say No Thanks!

[blueash]

Originally Posted by Irishmen

Thanks to the OCA you'll wait avg of 2 years to sniff a doctors office if at all for your free 100% well exam. Well exam under the OCA pays the doctors $11.75. 115,000 people are waiting in The UK 18 months for a hospital bed. Govt run VA back logged 14 months just to here back a denial or approval. I say No Thanks!

Irishmen, you have got to do more educational reading. There is no OCA, there is an ACA and your claims couldn't be more incorrect. The ACA does not set any payment level, (your evidence for the $11.75 is what??) Payment is set by the private insurance company you or your employer has selected. The ACA did not establish any single payer system, although the insurance company with the highest patient satisfaction ratings and the lowest overhead is run by the government.
Medicare Beats Private Plans for Patient Satisfaction: Survey - US News and World Report

I always try to give a link for claims and statements, from non-fringe websites, and ask that you provide one for your assertion that 115000 people are waiting 18 months for beds in UK (not that the NHS has any relationship to anything in the US either presently or in the ACA yet to be implemented) Just FYI there are about 135,000 hospital beds in UK.
Statistics » Bed Availability and Occupancy Data – Overnight The average patient would have to be staying in that bed for about 16 months for your statement to be close to accurate. I and Mrs. B have had no problem having our well visit done and covered. The doctor was paid $110.89 for the well visit and my bill was zero.

[cmfjr]

Yes, the statement is now standard on most questioners due to the various health insurance companies and the various plans within each company. Quite often the administrative staff can't keep up with all of the detail in each contact that they participate in. You might have a specific plan like a PPO or HMO offered by a health insurance company "A" and call your doctor/provider to verify coverage and they say yes, we accept company "A" but in fact they do accept"A" but not the PPO or HMO! You now think you have coverage, in network, when you do not.
One area that gets over look is laboratory tests. The doctor may be part of your network but the lab may not. As a member of a major insurance companies grievance committee, I see this happen very often. I recommend that one call their doctor to see what lab they use and with that information, call your insurance to verify coverage. As a rule whenever possible call for verification before receiving the medical service! Today the consumer needs to know as much as possible about their plan in order to get the services paid.

[gomoho]

My initial visit and then follow up for the physical at The Villages Health was a disaster.
Not only was I totally dissatisfied with the doctor (who is no longer there) but have been dealing with insurance issues since February. I have BC/BS and am entitled to an
annual physical; however said doctor coded the visit incorrectly and it was next to impossible to get someone to correct that. Fortunately a new office manager came in, listened to my case and proceeded to have it corrected (took 5 months). They also did not send my blood to the correct lab as mentioned above, but wrote the charges off as their error. They are really geared towards medicare billing so just keep a keen eye on the coding if you do not yet have medicare.

[Bizdoc]

The biggest question is if your insurance is on their list of companies which they accept. If they are a preferred provider for your company, then they have agreed to accept assignment (and to accept certain rates for specific diagnostic codes) and can't balance bill. Of course, you are still responsible for paying deductible and copay.

[Mallory Voice]

Originally Posted by Yucatan2

I am excited to try the Villages health care, it seems like a great idea. But as I am filling out the new patient forms this morning, page 4 is the authorization to release information page. At the bottom it says I agree to be responsible for payment of the difference if insurance benefits don't cover. I will be responsible for the entire amount due for professional services rendered if the expense is not covered by my policy.

Is this the norm at all doctor's offices these days? I sure don't recall signing something like that in the past, but I've had the same doctor for the last 15 years and I know things have changed.

I have a high deductible plan so we could be paying a lot anyway, if we suddenly had to start seeing a doctor.....as of now, we go to our once a year check up and that's about it.

Be sure your current insurance carrier is covered by the Center. My husband and I are participating - it's a good thing and the Marcus Welby style of dispensing medical care is long in coming to The Villages!
Have Fun! Mallory Voice MV