Wow, once I saw that most of the people here were not answering my actual question I pretty much decided not to respond.
I was purely interested in learning about the collection process and consequences. I was not interested in the discussion about the rights and wrongs of the bill. The facility obviously think they are right to bill me, I think they are wrong to bill me.
Since so much has been said about the case, much of it incorrectly, I will expand on the details.
Firstly, we do as a matter of course, verify what is covered and not covered for everything we do under insurance. We do this for everything. Vision, dental and are most wary about medical.
I've also done this for home insurance, car insurance and my umbrella policy.
So here are the details.
- Under our insurance, a preventative visit is covered up to $500.
- We took our child to see the same doctor as the year before for a preventative visit.
- The prior year, a test was performed DURING the visit by the doctor as part of the visit.
- All costs to do with the preventative visit were paid by the insurance
- The next year, without asking or informing, the doctor performed the EXACT same test DURING the visit.
- Insurance declined this charge saying it is medically unnecessary to perform the test yearly and that national guidelines specify the exact ages and frequency with which to perform the test.
My contention is simply that the doctor is the professional and should know what the medical guidelines are for testing frequency and age. They know them for vaccinations, prostate, women's preventative. The guidelines are common knowledge amongst the medical profession.
Additionally, the doctor did not announce they are doing that particular test. Indeed it appears to any observer that it is another "check" rather than a test. They just did it along with all other checks they do. So for example, if they place a stethoscope on your chest, is that a separate chargeable "test" or is it part of a series of checks in the preventative visit?
So the rights and wrongs of this are a grey area. They constitute a dispute between two parties.
Therefore, I was interested in what avenues such a dispute takes. I am not interesting in revealing medical history.
Therefore all the responses here that assume that this is some sort of test that we authorized and are now trying to skip out of paying are way off mark.
But I guess you will never stop people reading what they want into the question, which is why it is always a better idea for many to just answer the question asked rather than one that was not!
