insurance surprise--price of 3 stitches

[Anonymous]

In August we were in NYC and our toddler fell in our hotel room. The concierge sent us to an urgent care a block away rather than the ER. The urgent care doc suggested a plastic surgeon they "always send people to." So DH stayed to pay for urgent care, I took a cab to plastic surgeon with DS, their nurses rushed us in and the secretary said "we'll do paperwork afterwards." So DS gets 3 stitches (in less than 15 minutes) just below his eyebrow. We then check out and sign the paperwork and they tell us they'll send the bill to Aetna, but that they aren't contracted with Aetna. I didn't think much of it. We pay our ped. directly and Aetna reimburses us 90-100%.

Anyway, you know where this is going. Today I get a bill saying their "Complex would repair--eye" was $4,500 and Aetna paid $2,880--so we owe $720. That seems outrageous to me. Reading the CPT coding, I don't see how it was complex--seemed simple to me, literally 3 stitches. And it seemed like somewhere along the way--at urgent care when they made the referral and called to make an appt. for us, or at some point, they should have said--and by the way, these three stitches will cost 5k.

So what do I do? Write a letter to the doctors office asking for them for the exact CPT code? Say the price is outrageous and offer to pay $200?

Or do I go to Aetna?

[Anonymous]

You can try to negotiate with the doctor's office. But I wouldn't hold your breath. I hate insurance/billing so much.

[Anonymous]

You should have asked at the Dr office, what the cost was. Best case, they should have disclosed the cost at the time. 2 things should have alerted you to this being expensive 1) out of network, meaning more cost born by you. 2) a specialist

you could call the dr office and see what they can do, but probably not much

[Anonymous]

Is there a deductible involved?

[Anonymous]

Anonymous wrote:You should have asked at the Dr office, what the cost was. Best case, they should have disclosed the cost at the time. 2 things should have alerted you to this being expensive 1) out of network, meaning more cost born by you. 2) a specialist

you could call the dr office and see what they can do, but probably not much

They wouldn't have given her a price. They never will.

[Anonymous]

What is their insurance-negotiated rate? Just because they don't contract with Aetna doesn't mean they don't have negotiated rates with other insurers. Doesn't mean they're obligated to give you that rate, but...

[Anonymous]

Anonymous wrote:

Anonymous wrote:You should have asked at the Dr office, what the cost was. Best case, they should have disclosed the cost at the time. 2 things should have alerted you to this being expensive 1) out of network, meaning more cost born by you. 2) a specialist

you could call the dr office and see what they can do, but probably not much

They wouldn't have given her a price. They never will.

Exactly! I have asked many times how much something will cost because I have a high deductible and they never know. They have negotiated rates with each insurance company so Aetna might pay $4200 for stitches which BCBS will only pay $800. It's a huge racket, I know. I hate the whole system. Now that we have ACA, perhaps it's time to look at some of the billing practices. That's a big part of the problem.

And, yes, OP. That is outrageous.

[Anonymous]

OP: My beef is that they didn't say they were out of network when called from Urgent Care, or when we showed up they didn't do paperwork until after the procedure.

There's no way I'm paying $700. I get that we have to pay something, but honestly I think they overcharged Aetna. GRR. I hate our medical billing system.

Thanks for the reality check though. Any plastic surgeons out there? 3 stitches is a Complex wound repair?

[Anonymous]

Anonymous wrote:OP: My beef is that they didn't say they were out of network when called from Urgent Care, or when we showed up they didn't do paperwork until after the procedure.

There's no way I'm paying $700. I get that we have to pay something, but honestly I think they overcharged Aetna. GRR. I hate our medical billing system.

Thanks for the reality check though. Any plastic surgeons out there? 3 stitches is a Complex wound repair?

Does your child have a scar or not? If not, maybe you should simmer down a little and be thankful for the service you were provided.

[Anonymous]

Anonymous wrote:

Anonymous wrote:OP: My beef is that they didn't say they were out of network when called from Urgent Care, or when we showed up they didn't do paperwork until after the procedure.

There's no way I'm paying $700. I get that we have to pay something, but honestly I think they overcharged Aetna. GRR. I hate our medical billing system.

Thanks for the reality check though. Any plastic surgeons out there? 3 stitches is a Complex wound repair?

Does your child have a scar or not? If not, maybe you should simmer down a little and be thankful for the service you were provided.

Shut up. Being thankful her kid wasn't hurt more doesn't mean she can't be pissed about an outrageous bill.

[Anonymous]

OP: Actually, he has a bad scar and I think the Dr. did a crappy rush job. So that might be playing into my pissed-off-ed-ness.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:OP: My beef is that they didn't say they were out of network when called from Urgent Care, or when we showed up they didn't do paperwork until after the procedure.

There's no way I'm paying $700. I get that we have to pay something, but honestly I think they overcharged Aetna. GRR. I hate our medical billing system.

Thanks for the reality check though. Any plastic surgeons out there? 3 stitches is a Complex wound repair?

Does your child have a scar or not? If not, maybe you should simmer down a little and be thankful for the service you were provided.

Shut up. Being thankful her kid wasn't hurt more doesn't mean she can't be pissed about an outrageous bill.

What if the cheaper alternative left the child with a scar?

It's all a matter of perspective. The plastic surgeon offered expertise, and presumably no scars.

Just saying look at it differently. Imagine if kiddo had been stitched by someone else for $500 instead of $5,000. Would you choose that option?

It only seems outrageous now. In the great scheme of things, she's out of pocket $700.

[Anonymous]

Anonymous wrote:OP: Actually, he has a bad scar and I think the Dr. did a crappy rush job. So that might be playing into my pissed-off-ed-ness.

In that case, I withdraw my comment about simmering down (and the post after yours posted before I read this). Carry on with your pissed off self.

[Anonymous]

So should I send a photo of the scar back instead of the $700? And did I mention that I had to be the one to hold him down because they were "short a nurse."
Okay, I'm going to go make dinner and figure it out later.
Hope no one's toddler trips tonight!!

Thanks 17:36 I'll be pissy. He also still says it hurts--which I'm sure is psychological.

[Anonymous]

Wouldn't you have assumed they were out of network since you live in DC and you were going to a specialist in NY?