My spouse & I both see doctors regularly. Sometimes, several different ones.
In the last few years, I noticed that doctors offices regularly charge more (up front) than their contract with specific insurance will allow. Sometimes, a LOT more - $100's more than they know the insurance will allow for say, routine, follow up office visit.
And, many don't want to give the over charges back, once the insurance processes the actual claim & allows considerably less that what the doctor's office said "will be your cost / co-pay / patient amount for today."
1st, doctors that have some sort of "insurance benefits coordinator" on staff, can very quickly get reasonable benefits, from your insurance company (using your member ID). They will know if you've met your deductible & a reasonable value of what that insurance plan is going to allow for given service.
Yet, I see MDs, dentists, optometrists regularly charging considerably more than they (should) know will be allowed under their CONTRACT with a specific insurance co.
Even for an * exact * billing code, they often tell me, "Your insurance plan allows $XX for this procedure / office visit / billing code." And it often turns out the insurance allows MUCH less, for that exact billing code. One recently wanted me to pay ~ $330 (as "my insurance allowed amount") for a routine, follow up to get refills. The insurance wound up allowing $97 (which would be my total responsibility).
Now, I didn't pay that $330 up front, but I had to speak to their insurance coordinator AND office mgr, over the phone, while standing at receptionists desk - before I saw the doc. Most people will NOT do that. Then they gave me another (fictitious) cost, using a different billing code. Which I paid. Turned out the insurance allowed much less for that billing code, also.
I understand any business doesn't want to be constantly trying to collect debts. But these medical providers aren't just over charging by $10 - 20. As I said, once the insurance processes the claims & shows the patient over paid, the providers don't want to quickly credit it back to say, your credit card. Almost always, I have to call & request a refund.
Even when I call them, they often don't want to credit it back. Or, it may take them months (while they use all patients' over charges, interest free). One optometrist said, "We usually just keep any over charges as a credit on your account - for the next time patients come in."
It may be 1 or 2 yrs before your next visit.
I'm fed up w/ having to call almost every medical provider to request they credit the overages back to my card.
It can take quite a while on the phone, just to speak to "the right person."
Now, if anyone thinks this is chump change for a thriving medical practice, I ran some quick numbers - based on conservative assumptions. I'll provide those calculations, if anyone's interested.
For a booked up (one) doctor, over charging thousands of patients an average of $75, would be several hundred thousand dollars (in their pocket).
Keeping those overages for only 2 months before making refunds, at a very modest 5% return on investment could quite easily generate $32,000 / yr of extra income. It's likely MUCH more than that. Why?
1) It probably takes over 2 months, on average, for them to credit back the overages. I've seen it take 4 mo. & heard of it taking much longer. The longer they keep the overages, the more they make from investing it.
2) The average over charge is probably more than $75, as many patients have more expensive procedures.
They would've overcharged me $233 (JUST FOR AN OFFICE VISIT), if I'd been stupid enough to pay it.
3) When they (regularly) invest hundreds of 1000's per month (say, with a broker), they can easily average more than 5% return.
I am looking for ways to start the process of ending this practice, which many would consider predatory pricing and a form of consumer fraud.