Finances and RE's office

chicagobride_07

I'm reaching my wits end with my RE's office and need to know (honestly) if I am overreacting and how I should handle this.

DH and I started seeing an RE last month (end of Dec).  Thus far, we've been in 4 times- across 2 different offices.  We've had the initial consultation, some day 3 bloodwork, a post coital and an SA.  I'm pretty sure that I don't have coverage for infertility diagnosis (I've called 5 different people at BC/BS and get 5 different answers) and am absolutely sure that I have no coverage for treatment.

Person at the front desk (she calls herself a "nurse") is pretty unprofessional- let's call her Joan.  While we're in the waiting room, she spends time talking (loudly) on the phone with friends about personal things, etc.  I think she is actually related to the RE (might be his niece).  Anyway, as I understand it, she does all of the billing for the practice (2 locations).  As I am OOP for everything, I need to know where I stand financially.  I've only gotten one form (from the other location) stating that day 3 bloodwork was $748.  I have no idea about the other charges and RE wants to draw bloodwork again this week.

The idea is to submit claims to insurance, get them denied, so I can get the EOB and try to get reimbursed for some of these expenses from my FSA.

Last visit with the RE- I asked Joan if she could give me a ballpark estimate of the charges I'd incurred to date.  She was super flustered, and told me "insurance companies take their sweet time on processing claims".  I reminded her that I have no insurance- just need to plan for my financial liabilities.  Then she acted even more flustered and said she couldn't help me.  She was the only one doing billing for the practice and she was still back on November billings. 

Later in the appointment, I was in the restroom and heard her complaining about me to a medical assistant.  The appointment itself went great (I really like the RE!).

On the way out, Joan kept looking at me cross eyed.  We had to make another appointment for next week, and I am likely going on injectibles.  She muttered something about them being really expensive (I know that they are thousands) and kept rolling her eyes.  I felt bad, so I tried to be super nice and told her (sincerely) that I wished her a nice weekend.  She responded that she was planning on having a great day with her son and newborn baby. (WTF- I am not really sensitive, but I honestly think she was saying this because she thought I would be).

WWYD here?  Is it wrong for me to want a general idea of the RE's charges within a month or so of when I accrue them?  I am just trying to be responsible and plan.  And, I don't want to be surprised with a bill for thousands of dollars months from now when she finally gets the time for these billings.

Another (large) clinic I am considering mentioned that they have a full benefits department that pre verifies your coverage before your first appointment and in the case of no coverage, talks costs.  I would go here instead, but it is more like a factory and I like the one-one attention this other practice gives me with the RE.

Sorry so long. 

happywifemomofone

I would talk with your RE about Joan's behaviors and your concerns.  Your RE likely supervises Joan and can put a stop to the behavior that is upsetting to you.  Won't be so quick to assume that your insurance won't cover the diagnosis and testing though.  It is Illinois law that this is covered by most employer plans.  I do think that you have  a right to know your costs upfront and your clinic should be providing you with this information.

Adi

(ticker warning)

I think my jaw dropped in several places in your story. I think you should talk to the RE, if the receptionist has time to gossip about the patients to the medical assistants, and carry on personal conversations, then she should have time to work through the billing. Seriously, November? Today is January 31st. He needs to know how far behind she is, and either have a serious talk with her, or get some help for the front desk so she's not so over "whelmed"(and you don't have to deal with her attitude)

chicagobride_07

Thanks, ladies.  I think Joan is his relative so it becomes a bit more difficult.  I spoke with DH again on his way home from work and we will give this practice one more shot this week- if things don't get better, we will just go to FCI (large fertility practice here in Chicago).  As much as I like the solo practitioner thing and personal attention- I also need the practice also to be on their game with the non medical support.

DH and I both have insurance through work.  My employer is based out of state and self insured and does not have to offer IF coverage (and doesn't).  DH works for one of the largest employers in the state of Illinois- they offer no coverage for IF treatment- I don't know how, given the mandate (maybe because they are self insured too), but I am 100% sure of this.  It was written all over their plan summaries during open enrollment, and DH verified with HR.

annalisel

Based on my personal experience, the lack of cost transparency is odd. At my clinic, they give you the price list for everything at every visit unless you refuse. 

RE: large companies getting around IF coverage. I'm pretty sure that self-covered companies (ones that pay providers directly for their employees' health costs rather than buying insurance from a health insurance company) are exempt from the state-mandated IF requirements. So sorry. I sympathize.

Lastly, I am outraged by the attitude of the billing/receptionist at the office. Her comment sounds deliberately hurtful. If you decide to switch clinics, I'd tell the RE her comment, how she was gossiping about you (and if there was any medical information released during the gossip, mention that because it would be a HIPAA violation), and how you can't use an office that won't tell you up front how much everything will cost.

Reilly626

I agree with others! I got a cost sheet and a call from their financial person revealing everything! Sorry yours is so awful!

mtlaurel

I would tell the RE, even though it might be uncomfortable if she's a relative of his, if you really like the doctor. Surely, you won't be the only one who has problems with her attitude, behavior and incompetence. My old and new clinics have you meet with a financial counselor at initial visits, and a price sheet for all services is provided. Good luck.

Amyaggie97

I agree with everyone else.  Talk to the RE.  Write out your concerns/comments before you see him.  That way you won't forget anything and will sound more credible.

 

My RE's office verified my insurance and when I met with them gave me a cost summary based upon my insurance benefits or lack thereof.

Country Girl in the City

I agree with all of the other ladies.  I have a nurse assigned to my case.  I work with her as much as I work with the RE.  If you have that in addition to Joan that might be another person that you could talk with about your issues.  If not, then I would talk to the RE in a concerned but nonconfrontational way.

chicagobride_07

OK- now I definitely don't feel so crazy.  We are going back to the RE this weekend and I'll have a discussion with him.

versace1008

Chicago Bride

if you don't mind me asking who did you go to? I just want to make sure I dont go there in case I switch. I like my RE but her hours at the location I go to are 9-1:45 on W or F, that's it, its hard to get there from work too...and my work is moving locations in March so it will be even farther! I think there is another dr there so maybe if she has better hrs for my schedule I can hopefully switch!

I go to FCI-the one in Hoffman Estates, they have a bunch of locations, my 1st appt was in Nov, I had baseline blood tests done on  day 3 then another consult a few weeks ago, taking injectable meds now next cycle...which they know I was self pay and they did give me 2 boxes so I will prob need to buy 1 more....that was actually very nice of them bec those are like $500 a box!!!!

When I met with the nurse she did tell me that the New England Journal is doing a study on them with their protocol, she did say they are the #2 fert clinic in the US? I don't know if thats true or no?

I think you have every right to know how much this is going to cost you. You want to be able to know your limitations!

chitwngal2010

wow that's crazy! I started with FCI in Dec and they are great! everyone is super nice and i am oop too as well but they put everything they can through insurance and told me upfront what to expect as far as charges.

tst1998

That's awful.

I'm not in a IF mandated state, and don't have any coverage. Our clinic offers a cash discount to patients who are 100% OOP, as do most of the clinics in our area. You have to pre-pay for all services, but they have packages for all procedures, which cover all necessary ultrasounds and labs so there are no surprise costs at the end.

One other thing, which may not apply in all cases, but is something to consider: the contract our clinic has with the insurance company requires them to bill the patient the full cost of the procedure if insurance denies the claim. So if they submit a claim to insurance, and insurance denies it, instead of getting the discounted OOP cost, we then are responsible for the full cost that was billed to insurance.

You have every right to know the costs of things before you agree to them. Only in medicine are you expected to purchase something without knowing the cost. And they should be able to tell you the cost. They know how much they are charging the insurance company for. Besides that, her attitude is just unprofessional. When you are dealing with people going through such an emotional time 1) you should be able to tell them how much it is going to cost them and 2) you should treat them respectfully.

I don't know what I would do in your situation. I too hate the factory RE clinics, but I also hate inefficiency and rude people. Good luck with whatever you decide!

chicagobride_07

Versace- sorry, I did not see your email until now.  I sent you a PM with the RE name.