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Thread: Cleveland Clinic frusteration

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    im so blessed is offline Registered Member
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    Default Cleveland Clinic frusteration

    So, I live in PA and i have medicaid. I want to get a 2nd opinion at CC. I called 9 days ago. First, before they will schedule me they need to see if my insurance covers. I know it does not, But ok. They will call me when they know. If im not covered, i will pay $900 out of pocket. Wow. Ok. So i have called them 3 times since. Someone is always going to call me as soon as they get the no from my insurance. I have been given 4 different prices now that i will pay out of pocket. Anywhere from $400-$900. And they will still not put me thru to scheduling. I have to pay the full amount ( whatever that is???!!!!) before they will schedule me. Does anyone have advice? They are only 4.5 hours and i really want to go there!!!!

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    I'm guessing that your trying to get past the billing department. If you have the number for a specific doctor you want to see, you might want to try calling that office first and try to get their help in pricing and billing.

    While CC has a lot of great docs who provide great care, the billing department seems to have issues. If @BookNut reads this, perhaps she can offer some guidance...
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    [QUOTE=im so blessed;110401]So, I live in PA and i have medicaid. I want to get a 2nd opinion at CC. I called 9 days ago. First, before they will schedule me they need to see if my insurance covers. I know it does not, But ok. They will call me when they know. If im not covered, i will pay $900 out of pocket. Wow. Ok. So i have called them 3 times since. Someone is always going to call me as soon as they get the no from my insurance. I have been given 4 different prices now that i will pay out of pocket. Anywhere from $400-$900. And they will still not put me thru to scheduling. I have to pay the full amount ( whatever that is???!!!!) before they will schedule me. Does anyone have advice? They are only 4.5 hours and i really want to go there!!!![/QUOTE

    Don't know how old you are. Do you qualify for Medicare? We have medicare and also supplemental insurance that covers out of state medical services. It was still a nightmare getting them to honor the medicare negotiated price. We were approved after various maddening hitches. Then when we were done with treatment they were billing us for the difference between the negotiated medicare cost and their official charge which is an illegal billing practice. They ended up sending us to a collection agency. It was a nightmare. I think they finally gave up, not because they admitted they were wrong but because my hubby is a former insurance adjuster and knows all the legal jargon. They knew we were not about to give up. The billing dept is extremely incompetant. I would not have a treatment or appointment there without having a statement in writing of the exact amount due for each treatment. The medical staff is great. Support staff not so much. I made a typo when typing above the phrase "billing dept". It came out "bilking dept". Perhaps I should not have corrected it. The typo might have been closer to the truth. �� Again the medical staff and treatments were great. It is the "bilking dept" you have to watch out for! ��
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    I'm guessing that if you are on Medicaid, then CC is assuming you don't have the money to pay for the consult and they want you to pay upfront in order to avoid a "non-payment" later. I think the only thing you can do is keep plugging away for a quote, you might get one, but, if you do, I wouldn't expect it to be fair and reasonable.

    However, their reluctance to quote you a price is also normal. Most likely, they don't have an exact actual price for a specific procedure, at least, not a price you would be willing to pay. From what I gather, the medical providers, be it a hospital, doctor, lab, whatever, will have an ultra-high price that they charge the insurance company. That will be the one you see on your bill. And, then, they have an "acceptable" price, which will be the calculated or negotiated "fair" price that the insurance company actually pays. The "fair" price will be much lower than what was billed.

    Most of the "fair" prices are different from one insurance company to the next and also different from one provider to the next. Our medical system is one big con game. Medicare is one of the lowest paying. That is why many doctor offices now have signs that say they are no longer accepting new medicare patients. The reason is because the private insurance companies pay more. Normally, providers can balance out the medicare with the better-paying private insurance companies, eat the loss on medicare and still make ends meet. It is the doctor's prerogative to do that -- their is nothing illegal or even immoral about the practice.

    when we were done with treatment they were billing us for the difference between the negotiated medicare cost and their official charge which is an illegal billing practice
    Booknut, That's not an illegal practice. Many times I have gone to a doc's office and they have asked me to sign an agreement to pay the difference between what they charge and what the insurance company pays. Normally, I just sigh and sign, but several times I have refused. Each time, the receptionist has gone to the billing person and received and ok to proceed without the signature. I suspect they have a legal claim to the difference whether I sign or not. They just want you to sign in order to shortcut any messy legal processes or collection agency.
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    Interesting. Our insurance told us it was not legal for them to do this. Maybe because they had not told us upfront? We were not asked to sign any agreement. We were simply approved for treatment.
    Jacquie (aka Lifelong Booknut)

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    I don't know if medicare is different in Pa. as is in Ohio, but when I was on Medicare I had to pay a spenddown to medicare before I wasn't charge at drs. appts and hosp. or scripts.. But my spendown was 900.00. Like was mentioned before ALOT of drs will not see pts on Medicare. I do know that CC offers financial assistance. Like Pete said it might be best to call the drs office directly to make the appt.I am going up there this Wed to see my rheumy at 1:00 if anyone is going to be around there
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    I can't remember if I mentioned that I was going to Mayo or not. My memory has really gotten bad. Anyway, I'm going to Mayo for a week of apt's (research?) on 20Mar. Apparently, I'm interesting. I have considered giving my cold dead body to one of the universities, but haven't decided which one.
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    Quote Originally Posted by vdub View Post
    I can't remember if I mentioned that I was going to Mayo or not. My memory has really gotten bad. Anyway, I'm going to Mayo for a week of apt's (research?) on 20Mar. Apparently, I'm interesting. I have considered giving my cold dead body to one of the universities, but haven't decided which one.
    Mayo has a med school so ask them about it when there.
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    Good luck at Mayo vdub. I wish they could find something that will help you more. Do you remember saying I can have your car once you finished it !!!!
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    im so blessed is offline Registered Member
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    So i am still waiting for a call. I have called 2 times since my post. I have been very firm with them that when they give me the correct price i will pay it so i can schedule. Someone will call me...just leave a message on her voice mail...yadayadayada....it feels impossible!

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