Question on Fairness (Doctor Fee)?

Discussion in 'Fibromyalgia Main Forum' started by Manwithfibro, Aug 1, 2011.

  1. Manwithfibro

    Manwithfibro New Member

    I started seeing a Lyme Doctor who believes I have lyme as well as some other co-infections. The first couple of visits, I just had to pay my co-pay $25 plus the fees for the supplements which get expensive. He does this muscle testing called ART.

    Now, at last visit, I got stuck not only with a co-pay and supplements but $50 for ART testing.
    This seems like a backdoor way to get $75 for a co-pay in addition to my insurance instead of $25. Thing is that I spend a FORTUNE for this insurance. My 25% coverage is $390 ($1560 is full amount) a month for my family, which is just my wife and kid.

    Do you think it is fair for this doctor to add this extra $50 fee? I am not even sure I believe in ART, but I do believe we are on right track with the lyme/co-infections. There is no other explanation.

  2. Manwithfibro

    Manwithfibro New Member

    I am not on Medicare. My insurance is a fortune and reimburses about $200 for an office visit plus another $25 for my co-pay so the doctor makes $225 plus whatever the mark-up is on the supplements. Is throwing another $50 in there right? Isn't my office visit for $225 (his return) enough? I cannot afford $75 co-pays plus Rx's plus supplements. Hard enough at $25 co-pays. It seems like a tricky way to get my co-pay up to $75 or a tricky way to get another $50 out of me. I am rather upset.

  3. Manwithfibro

    Manwithfibro New Member

    I realize they take training but isn't that what the OFFICE VISIT FEE is for? They get $200 from my insurance plus $25 from supplements that can cost up to $300 per visit and now they want $50 for ART muscle testing? Why isn't the muscle testing part of the OFFICE VISIT fee? Basically, most of the office visit is doing this ART. Seems like a double dip to me. DO you think if I called my insurance, they would advise what to do or am I opening a big can of worms, so to speak?

  4. rockgor

    rockgor Well-Known Member

    there's any correct answer to your question. All depends on the doctor and his
    bookkeeper and the insurance company.

    First time I went to see my current doctor, he sent me a bill for what insurance didn't
    cover. I ignored it. He's never sent another bill. Someone told me the doctors do
    this so they can show a loss when it comes to income tax time.

    For the last three months I've been getting a lab bill for about $165. The bill does
    not show the name of the doctor or the date of service. I think it's a scam. I'm
    am ignoring that bill too.

    I already pay for Medicare and for Blue Cross. If that's not enough, the medical
    establishment can sue me. I doubt any jury would award any money.

    Of course it might be arbitrated, but I don't really think so.

    Good luck.

  5. Mikie

    Mikie Moderator

    I have a co-pay for office visits. If there are any tests run, I have a 20 percent co-insurance for that. Sounds as though your insurrance works like this too. I'm sure it doesn't seem fair to you, after paying so much for premiums, that the co-pay doesn't cover testing but usually, it doesn't.

    Most docs these days are in a crunch by having to contract with the ins. co's., take a much lower payment, and write off the rest. Their overhead is killing them and the more they get crunched by the ins. co's, the less incentive they have to continue providing services. Either that, or they add other services and testing. Still, a lot of the equipment they have to have costs a fortune.

    Basically, what I'm saying is that both docs and patients are being crunched by ins. co's while they make record profits. We desperately need better healthcare in our country. No one healthcare plan is perfect so I think we will have to continue to work at it.

    I'm sorry you are being crunched.

    Love, Mikie