Billing Discrimination

[justinw76]

What is the name of your state? MD
I received an insurance statement recently for 4 Dr. visits. The bill reads as follows:
Requested Charges
$800
Allowable Charges
$229.62
Plan Obligation
$149.62
Par Dr. Savings
$570.38

I went for a very short period without insurance coverage during this time where I had to pay out of pocket for a single visit immediately after these 4. The Dr. charged me $200, which I paid. I received this statement after the fact. However, I feel that it must be discriminatory and/or illegal for the Dr.'s office to offer the insurance company a ~75% discount for the same visit and not offer me the same discount. By my calculations, the insurance paid about $57 per visit.

I am planning on contacting their office to request a credit, but I want to know if what they did is legal and if I'm justified.

Thanks in advance.

 

[I AM ALWAYS LIABLE]

My response:

It sure looks like you're being discriminated. It's probably because you're not White.

IAAL

 

[BelizeBreeze]

My response:

It sure looks like you're being discriminated. It's probably because you're not White.

IAAL

nahhhh.
It's because of being 1/8th trailer dweller ....

 

[cbg]

No, it is neither illegal nor discriminatory for them to offer such discounts to the insurance carrier and not to you. In fact, it may well be included in their contract.

They are acting perfectly legally. You are free to request a credit but they have no legal obligation to do so.

 

[purple2]

Insurance companies get discounts because they do a volume of business with the providers and because they negotiate for discounts. You have done neither; that's why you didn't get a discount. You can certainly try negotiating and see what happens.

 

[ablessin]

You could try to negotiate a self pay discount, some providers offer sliding self pay scales.

It is not discrimination, as stated above, insurance carriers negotiate allowed amounts for "most" services (I say most but it's probably most likely all) that if the provider is willing to "accept" that payment, the carrier agrees to make a timely payment, usually it's within 45 days of getting the claim in the mail (or electronically).

It's an agreement, called a participating provider. it's also privileged information, meaning, John Q Public can't call and ask for that info between (for example) Aenta and Dr. Smith.

Your provider had all legal rights to bill you the cost of the office set charge. That is why self pay patients get screwed - -they get slammed with full charges while insurance carriers generally is about 50% - but that is per contract, some pay more, some less....... that is just the name of the game.

Sorry - you have no recourse.