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Never sign a doctor or medical facility form that says ESTIMATED COST
I am using this subject because I am a breast cancer survivor and I feel I need to get this information out there to protect all patients, especially seniors. I had blood work done at an Atlantic Health lab in NJ. The clerk gave me a paper to sign because Medicare might not pay for it. (From CMS-R-131). The previous year that test had been paid for by Medicare and in addition, the “estimate” Atlantic Health provided on the form was $15.08. The form says I am responsible for payment. I was not counseled on the ramifications of signing the form. I figured that it was ok because the cost would be about $15.08. I am being billed $144. Dealing with their billing department has been a nightmare. In fact, when BCBS asked for a copy of the Medicare EOB, they were told they sent it once and were not sending it again. In any event, that form only binds the patient to the contract. The provider is not responsible for their part at all because it is “estimated.” I am saddened to find out that Medicare does not seem to care about its constituents…seniors and disabled people. Apparently this is done by many providers and the patient is totally responsible. I feel that I need to get the word out there for people, especially Medicare recipients, to NEVER, NEVER, NEVER sign any form that uses the word “ESTIMATED”or a comparable word. The ESTIMATE is low balled but you will end up with a large charges.
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Do you have traditional Medicare with a supplement, or do you have a Medicare Advantage plan? If the test was medically necessary, it possibly wasn’t coded correctly.
My insurance broker that I use for my supplement has a separate customer service department that deals with situations just like this, on behalf of their clients. It is usually remedied by resubmitting with the necessary coding.
Best of luck to you.
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1 ReactionI have been asked to sign the form and it always concerns me.
Once for a mammogram other times it was for blood test.
For mammogram, I was freaked out, needed to verify lump was scar tissue, but it had not been a year since last mammogram. . I signed, and Traditional Medicare / BCBS supplement did pay for. I think problem was how the dr originally ordered.
The blood tests were for Ferritin that Medicare does not cover, and if Medicare does not cover, my supplemental (BCBS) will not cover. In that case, Mayo charged me the estimated amount on form, which I paid.
Medicare guidelines states the estimate should be within $100 or 25% of the actual costs, whichever is greater.
If you do not sign form, they will not perform test, so it is tough decision.
If you have a choice, I would not use that lab again. Their billing system obviously is not accurate, when they gave an estimate based on ICD code of test, it should of matched what the billing dept actually charges for test.
Laurie
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3 ReactionsIt is a requirement of Medicare that you be informed and if the hospital is audited, they will check that they are providing you with the form letting you know how much you could possibly owe. Also, if you refuse to sign it, then the hospital or clinic will just write on the form that you refused to sign but were given the information. You would still be responsible for what Medicare or insurance doesn't pay. With that said, the estimated cost should not have been that far off from what was billed. I agree with the person that said it could be a coding error.
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3 ReactionsI have signed them and refused to sign them, they are obligated to provide them as @auksst said. It didn’t affect the billing process either way.
There is much financial burden to cancer, and this is just one more thing we need to deal with.
Here is a page about financial toxicity I remembered from a while back, and our moderator graciously supplied me with.
https://connect.mayoclinic.org/discussion/the-financial-burden-of-cancer-are-you-willing-to-share-your-story/
I have seen more denials from my insurance for coverage in the last year than in the 20 previous years put together, have any of you noticed this?
Our pharmacy dropped us after 20 years because tricare does not pay enough anymore, how about pharmacy denials?
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4 ReactionsI was having routine blood work done by Quest and was told that one of the tests wasn't covered by my insurance. So I had the other tests done and, when I got home, called Quest to find out the cash price, that is the worst case scenario, for that test that I skipped. But I also called my doctor's office and they re-coded the test. I went back to Quest with the re'coded prescription and it was covered by insurance. But at least I knew the cash price if it weren't covered and I wanted to get it done anyway.
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3 Reactions@callalloo I recently had the same thing happen, also with Quest. Except they sent me a bill for $500! Somewhere there was a mix-up, the dr office pointing at Quest for not taking their re-coding of a test, Quest pointing the finger at the dr office for not sending it in. So they sent it to a collection agency! I have all the documentation and phone calls listed, including to Medicare. And have heard nothing in the last 6 weeks. First time there had been a mess-up like this!
Ginger
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