Who Should Pay The Bill: Doctor, Patient or Insurer?

(PND) – As the cost of health care rises, insurance companies don’t want to pay the difference any more than the patients or the providers do.  However, the insurer has the power to decide what they will and won’t cover, which is leaving the patient responsible for a variety of new charges.

Providers increasingly are forced to charge patients extra fees as insurance companies become stingier.  Elisabeth Rosenthal, of The New York Times, found several examples of surprising fees not covered by insurance.

• A California mother had to sign a form agreeing to pay for a sling for her daughter’s broken arm in the event that the insurance company did not reimburse the provider.
• A Chicago man went for his annual physical exam, for which the insurance company covered $600 of the $900 bill but left the patient responsible for $300 of blood work.

Cindy Weston of the American Medical Billing Association told the Times that the physicians should decide which services to include in their principal payment and what might require an extra charge. Another industry spokesperson said “If a provider chooses to do something beyond what’s covered, there may be charges.”

However, doctors don’t actually have the luxury of knowing which insurer covers what under each plan.  In fact, physicians often spend time they don’t have arguing with insurance customer service personnel on behalf of their patient about what test is medically necessary.

The Chicago man, for example, was billed for blood work because the doctor had reason to test his thyroid function, but the insurer did not  think it was necessary.