Excess "Medical" Fee

[ACbob]

Maybe this is now the norm is big cities, but it sure caught this small town boy by surprise. I had an appointment with a specialist in the Baylor, Scott, and White building in Cedar Park. Got in, paid my co-pay and had a short wait. Saw the PA, not the doc I had the appointment with, but OK. So a week goes by and we get another bill from the doctor's office for $60. We call and say we already paid the co-pay, and they say oh-no that's a building use fee! What?!? A building use fee?!? She said yes, rather ashamedly. So now we know to ask future doctors if they also have this new fee. They get you from every side now. Maybe we'll just have the docs come to the car from now on.

[jlp04c]

I could be wrong, but I believe this falls under "balance billing" basically you get charged a price up front, and then they send you the actual bill (more) later... It's illegal in alot of states, but not Texas. Ridiculous practice!

[flywise]

Might have something to do with the folks filling every ER waiting room across this state.
Lots of folks using the system with no intention of paying any of the associated cost.
They make up some name for it so you don’t know the truth.

[OldRiverRat]

No way I’d pay that


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[Greenheadless]

That’s BS. I would tell them to file it with the insurance company for payment.

[Hunteraudit]

As stated, I wouldn’t pay it either. Never even heard of such a thing. This type of shady business practice would have me finding another doctor as well.

[Huntsman27]

I wouldn't pay it either.

Do you have a PPO plan and was the doctor in network? if so, he has agreed to a negotiated reimbursement and you co-pay covers part of the negotiated re-imbursement and the insurance company pays the rest of it. Providers who agree to accept the negotiated rates pursuant to a PPO also are agreeing not to balance bill patients for PPO Discounts.

I don't think this would be a balance bill which is what you receive when the insurance company pays less than the billed charges. I think this would be a bill for charges not covered by your insurance company. Generally there is language in the plan documents that say something like charges for things that are not medically necessary are not covered. Do you know if the provider submitted the charges to the insurance company, did you get an explanation of benefits from the insurance company, if so look to see if there are denied charges in the amount of the building usage fees.

What this doctor is doing is offsetting his rent for his office at the facility with an extra charge. I would liken it to the grocery store adding $10 to your bill after the groceries are rang up for building usage.

[rebelbow]

nope
aint paying it

[Huntingfool]

Man I have sold health insurance for 42 years - in fact I am licensed to sell Scott and White medical insurance and have many customers with them.

NO WAY would I pay for that. Ask them to show you in writing where they are allowed to charge a building use fee. Ridiculous

[Gumbo Man]

That’s BS. I would tell them to file it with the insurance company for payment.

I’d tell em to file it in their butt and get a proctologist to withdraw the payment for them.

[ACbob]

Insurance actually paid half! If insurance companies refused this kind of garbage it wouldn't be happening. It is negotiated with the original cost shown as $239 and the approved price was $120. Insurance paid half and so did we. Obviously not going back, and will ask all future providers if they practice the same shady business.

[STX_Shooter]

Had a kidney stone a few years ago, I had one doctor come into my room tap me on the shoulder and say “you’re going to be ok”. Never saw that doctor again while I was there. I received a bill for $300 of the original $600 from her staffing agency. The doctor was a traveling doctor originally from Austin and was contracted by the hospital. I still owe that money and I don’t intend to pay.

[T-roy66]

No way I would pay a building us fee.

[warrington]

If you are a new patient with commercial insurance, your contracted rate is going to be around $120 for the intial office visit. (99203).


Was there any charges besides that for your visit

[Shinesintx]

If you are a new patient with commercial insurance, your contracted rate is going to be around $120 for the intial office visit. (99203).


Was there any charges besides that for your visit

Just out of curiosity, what does the office bill for a 99213 (established patient)?

Also, wouldn’t the office be required to submit a CPT code for “building use”…which does not exist?