I saw a provider for a routine checkup appointment (there was no surgeries, no procedures, … nothing). Provider billed over $6,000 for this 30 mins appointment, and my insurance “only” covered $4,900 so I just received a medical bill for $1,100. I’m in shock.
I already called my insurance and they said they covered the maximum allowed under my plan.
I’m not willing to pay this bill and would like advice to negotiate this?
This is in NY State, and apparently medical debt is not reported to credit agencies. Am I correct to assume it will not impact my credit score? I also don’t plan to need any loan or credit in the foreseeable future.
They could always sue, but I assume it’s not in their interest as legal fees could be more expensive than the invoice?
Debt collectors are a possibility, but again that means provider would only recoup only a fraction of the bill?
Would reporting to BBB or State medical board help?
Something is missing from this story. This bill is too high for insurance to pay for a routine medical exam. The facility may be lying about what they did, making a mistake (like mixing up your services with another patient or billing the wrong code), or the service you received might not be considered routine and could be classified as a procedure, even if you didn’t understand that at the time.
I suggest you start by calling the doctor’s office to ensure that what they billed makes sense before you get too upset about the bill.
I updated my post: I called the provider to negotiate, but they told me they had to send this invoice as a good faith effort. However, they confirmed that I don’t owe them anything.
With out-of-network (OON) services, the provider doesn’t have to accept the amount that the insurance company considers allowable charges. If you went to this provider knowing they were OON, it’s hard to argue your case. You can ask them, but they charge what they believe their services are worth. From my experience, your insurance paying $4,900 of a $6,000 billed claim is a good outcome; I’ve seen insurance companies approve much less. I recommend finding an in-network doctor in the future.