r/HealthInsurance • u/InternetMedium4325 • Dec 06 '24
Plan Benefits Can you dispute a medical bill?
Hi, I recently attended a physician for an annual checkup. This was my first time visiting this doctor. The visit was very short and the doctor did the usual checks and asked me a few question. One of the questions the doctor asked was about my acne on my face which I had been getting around that time but seeing a dermatologist for treatment. The doctor said something about possible rosacea but at the time I wasn't sure what the cause of it was. The doctor said she would give me a prescription for some cream that I could try to treat this. Not thinking anything of this I said thank you and left my appointment.
My health coverage covered one annual physical per year so I expected to not see any charge for my visit. However a few weeks later I got two explanation of benefits statements from the doctor's office. Once was for an annual check up with which I was not responsible to make any payment since it was 100% covered by my insurance (Cigna). The other however was for a separate charge for the diagnosis of Rosacea. I found this surprising as I figured everything would have been covered under the same visit. But it seems the doctor billed it to my insurance as two separate services with two separats codes (one preventative, and the other diagnostic).
It turns out I did not even have Rosacea, nor did I even pick up the cream the doctor prescribed. The dermatologist has been treating me for hormonal acne and it has since subsided. So I am a little frustrated that I am now on the hook to pay a bill for a service I did not seek out. I was there to get my bloods done, vitals checked and all the usual routine stuff the doctor does during a physical. I am wondering if anybody can please advise me on whether or not I should try to file some sort of dispute?
Many thanks!
3
u/dumb_username_69 Dec 06 '24
This is unfortunately super common and I didn’t realize it until it happened to me too. I now try to inform anyone I can in my own life and on here (when it’s relevant) that you absolutely cannot talk about any concerns during a well visit. Ever.
I got downvoted last time I shared my experience, but will risk it again in an attempt to help:
My experience was also about a rash on my son’s face, which the doctor brought up and asked if he had been sick lately. I mentioned he’s in daycare so he’s got an indefinite runny nose. I wound up with a second bill and called the doctors office to inquire. They told me they diagnosed him with an upper respiratory infection with contact dermatitis. I told them that he was never sick, that diagnosis was a wild exaggeration. I didn’t come to the office for the rash, I came for the well visit. I didn’t bring up the rash, the doctor did. After some back and forth I said that it made me feel as if the doctor was just trying to pad the invoice and I couldn’t trust them with my child’s care anymore if all conversations were money-driven rather than health-driven, especially since the doctor is the one who brought up the off-topic comment. The finance rep on the phone was like “oh no we don’t want you to feel that way, we’ll waive your $30 copay.” That got me off the hook for my responsibility, but they kept the money they collected from my insurance company for the sick visit, which was like $150, so I imagine not collecting my $30 wasn’t that detrimental for them.
And actually, a lot of times the initial visit with a new doctor isn’t technically your annual physical, so you’re actually lucky they coded it that way. There are posts here all the time where what they thought was their annual we’ll check was coded as a new patient establishing care, which was true but of course never explained to them.
I feel ya, I do. It’s so so so annoying. They did the technically right thing in your case even if it wasn’t morally right. You may try to dispute it and maybe you’ll be successful, but don’t count on it.