In America, your doctor does not know what is not covered. Do not rely on doctors for medical billing questions.
Adam Rifkin stashed this in Personal Finance
Source of the Personal Finance Healthcare PSA below and 500+ Reddit comments:
Real Talk from a Redditor about US healthcare costs:
I work for a medical group and we see this quite a bit. The physician will say one thing and then the patient finds out that it isn't covered and health insurance nightmares quickly ensue.
Your physician is not familiar with your insurance plan and what they may or may not cover. They have a pretty good idea but when it comes down to healthcare and non-price transparent services PLEASE always use caution. You will be the one paying not them.
There are several ways to go about this. #1, which your physicians office sometimes will do, is get a pre-certification or a pre-authorization. This is basically them calling the insurance and saying we're going to do X and we want to know it's covered. Insurance will give them some sort of documentation and then you can generally expect that service to be covered.
#2 you can call your insurance company and inquire. Please be advised this is not full proof and they will not hold their people responsible for telling you the wrong thing. Please default to #1 above if in doubt.
For our Medicare patients; if you ever get an ABN or advanced beneficiary notice they are telling you that whatever you are doing or having done is NOT covered. Please be aware of this.
US healthcare is ridiculous because patients must commit to a procedure before knowing how much it will actually cost.
Another Redditor adds:
Knowing whether it's "covered" is only half the battle. The other half is how much the procedure is billed for at a given provider with your insurance plan. If you haven't hit your deductible and out-of-pocket limit yet, you're going to be paying some percentage of that cost, whatever it is.
Even with something like an uncomplicated childbirth, where you have lots of lead time to research, it's practically impossible to shake a number out of a hospital even after hours on the phone, let alone compare costs...
The US health care economy is seriously the worst. Individuals can't even compare prices, yet they're on the hook for paying. Ambulance takes you to the wrong/out-of-network hospital? Hospital brings in a specialist who isn't in your network? You may not even have been conscious for it, but you are already financially fucked.
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