#SurpriseBill #PhysicalTherapyCosts #InsuranceCoverage
😱 Received a surprise bill from PT for over $3,500
If you’ve found yourself in a similar situation where you received a surprise bill from a physical therapy clinic for over $3,500, you’re not alone. Dealing with unexpected medical bills can be stressful and overwhelming, but there are steps you can take to dispute the charges and hopefully reduce or eliminate the amount you owe.
In this article, we’ll discuss your options for disputing the bill and provide some tips on how to navigate this challenging situation.
## Understanding the Charges
Before you can dispute the bill, it’s essential to understand where the charges are coming from and why they were not previously disclosed to you. In the case of the individual mentioned in the context, it seems like there was a miscommunication between the physical therapy clinic and the patient regarding insurance coverage and payment responsibilities.
Here are a few key points to consider when trying to understand the charges:
– Check your insurance coverage: Review your insurance policy to see what services are covered and what your financial responsibilities are for physical therapy.
– Request an itemized bill: Ask the physical therapy clinic for an itemized bill that breaks down the charges and explains why you owe over $3,500.
– Compare your insurance statements: Cross-reference the charges on the bill with the claims submitted to your insurance company to ensure accuracy.
## Disputing the Bill
Once you have a clear understanding of the charges, you can begin the process of disputing the bill. Here are some steps to take:
1. Contact the physical therapy clinic: Call the clinic and ask to speak to the billing department. Explain the situation and express your concerns about the surprise bill.
2. Request documentation: Ask the clinic to provide documentation that supports the charges and explains why you owe $3,500.
3. Appeal to your insurance company: If you believe the charges are incorrect or unjust, reach out to your insurance company and file a dispute.
4. Seek legal advice: If you are unable to resolve the issue with the clinic or your insurance company, consider consulting with a legal professional who specializes in medical billing disputes.
## Taking Action
Dealing with unexpected medical bills can be frustrating, but it’s essential to take action to protect your financial well-being. Here are a few additional tips to help you navigate this challenging situation:
– Keep detailed records: Document all communications with the clinic, your insurance company, and any other relevant parties.
– Stay organized: Create a filing system for all paperwork related to the dispute, including bills, statements, and correspondence.
– Stay persistent: Follow up regularly with the clinic and your insurance company to ensure that your dispute is being addressed.
– Consider payment options: If you are unable to dispute the bill successfully, inquire about payment plans or financial assistance programs that may be available.
In conclusion, receiving a surprise bill from a physical therapy clinic can be a frustrating and stressful experience. By understanding the charges, disputing the bill, and taking proactive steps to resolve the issue, you can work towards a positive outcome and protect your financial well-being. Remember that you have rights as a consumer, and it’s essential to advocate for yourself when facing unexpected medical bills.
Did you ever ask your insurance company directly if it was covered? They are the ones that determine eligibility. Service providers often make errors in coverage which is why it’s important to check with insurance first.
You will ultimately and legally owe the money – you probably signed a document when you started treatment that you would be responsible if insurance doesn’t pay.
Also, asking if a provider is in network is different from asking if they take your insurance as they may be out of network.
Unfortunately, the PT office told you wrong. And, whatever the insurance will cover, they will make that payment to you directly to then pay the PT office. Ask the office if they will reduce your debt since you were told incorrect info. They may not take the verbal reassurances as proof so for the next time, ask them by email so you have written proof. They messed up and caused you to accumulate medical debt by accident. Do you have an FSA or HSA account that you could use to pay the balance?
Could it be that you exceeded the number of visits that your insurance allowed for the PT visits. I know that mine was limited to six weeks. The office wanted me to continue my visits but I chose not to as it would not have been covered.
Are you able to request the correspondence from your provider via mail or an app?
My insurance company provides an app that shows me my upcoming appointments along with status page on insurance approvals. Not sure if PT would be similar. I make sure the visit or test or prescription is covered in advance. In my app it shows up under Messages- Referral notifications. There is also an option for me to receive correspondence via mail.
This is to ensure I’m not charged unexpectedly. There are times my copay is higher though.
I hope you find a resolution!
You should’ve gotten an EOB from your insurance explaining what the insurance covers and doesn’t cover. Balance billing (charging the difference between what the clinic fees are and what the insurance negotiated fee schedule pays for a particular service) typically goes against the contract the provider has with the insurance company and isn’t allowed based on the No Surprises Act of 2023.
Make sure the office isn’t trying to balance bill you in this instance because if they are you aren’t legally responsible for paying that.
They will always tell you they accept your insurance they just won’t tell you it’s out of network. You have to ask very specifically if your insurance is in network there or you get a surprise bill. Scum practice butnit happened to me too
I work in a clinic and am wondering what type you go to. We outsource our billing department (it’s in the home office) and just make sure our records match the system. I would ask the clinic for a record of every check you brought in and the amount it totals to, and get the information from the billing department if there is one. Once you have these, reach out to your insurance company and ask them to help. They can be persistent little buggers, and partly what they are there for.
It sounds like this provider was out of network if insurance was sending you checks. OON providers always cost more and you may have had a deductible that needed to be met.
You’re going to learn an expensive lesson. In the future, when a clinic tells you that you are “out-of-network”, you might as well leave then and there. Assuming you have other options that are in network, you are going to save yourself a lot of time, money, and hassle. Dont go to a clinic just because it’s close or convenient if they are OON. Let me also say in general, just because a clinic is in network, does not mean every single physician or PT, or any provider is in network. A clinic can be in network, and a specific provider may not be. Clinics and providers are not synonymous if there are multiple providers in one clinic. You need to double and triple ensure that the specific provider you are seeing is in network and the address they provided is correct.
Unfortunately a lot of these places will straight up lie to you. Always ask for it in writing not just verbal.
You should have an EOB from your insurance company for every PT visit that shows what was charged, what insurance paid, and what you owe. You need to get all of these documents and then review how much you paid in co-pays and through the checks.
Does you insurance plan have a deductible, $3500 sounds like a fairly average deductible, meaning you’re being charged upto your deductible limit and afterwards insurance will begin covering a percentage.
So you owe $2500 on top of the checks from your insurance you signed over to them? How much were the checks?
Always, always, always ask for a good faith estimate before treatment and follow up with your insurance. I’m still paying on a 8,000 dollar therapy bill because they coded it as a behavioral rehab instead of a group therapy program for first responders (which it was). A good faith estimate they have to adhere to, and in the mean time apply for financial assistance thru the provider you took care from, they typically always knock something off the bill.
Here is one thing I’ve found over the years: any provider will say “sure, I take your insurance.” That doesn’t mean that they are “in-network,” that your insurer will approve and cover all charges, or that your only financial responsibility will be copays.
Oftentimes, a provider will rely on your insurer to do the legwork to determine the inflated “customary and usual” charges for your procedure codes, then bill you for that.
Source: I have a provider that does just this.
Wow didn’t expect all these comments overnight… Long story short, I gave em a call and they very easily without a fight cleared the charge saying that sometimes a bill can get sent out that isn’t matching what’s actually owed with the plan. I owe a couple of copays that were missed but that’s all.
Thanks for those who were supportive and not just downvoting me/assuming I was simply being ignorant 🙂
This happened to us. We were in network and insurance covered a portion. They had my husband going 3 times a week, by the time we got the first insurance adjusted bill, insurance had paid thousands and we were out of pocket $1600 for 12 visits. Each one hour visit he went, they hit 6-7 different billing codes. We tried to fight it but were told it was accurate. We called other in offices in town that told us they would have charged 2-4 codes for those visits. I always check my insurance portal regularly and call but my husband isn’t as proactive.
> I asked them both over the phone and in the office for my first visit if they accepted my insurance. They assured me that it covered everything and I just had to pay a copay for each visit, which I did.
What did your insurance say when you talked to them before going to the PT?
Check this out and present it in writing to the office https://www.cms.gov/newsroom/fact-sheets/no-surprises-understand-your-rights-against-surprise-medical-bills there should be a penalty if they don’t comply .