Consumer Watch: Avoid Getting Overbilled For Your Doctor's Visit
EDMOND, Oklahoma - Spencer Albracht knew something was wrong when he started getting pains in his stomach and shedding a lot of weight fast.
After a check up with his doctor, it was discovered he had a growth in his colon. So he went to Dr. Amit Saha at Advanced Colorectal Services to have it removed.
He paid his $20 as stated under his insurance coverage. But the real pains began when Albracht got a second bill.
Albracht said the doctor's office told him, "We're going to need more money than this. The insurance didn't pay the full amount."
Albracht thought there was an error and checked with his carrier.
Albracht said the doctor's office told him, "No, we're outside the insurance company. It's just between the patient and the doctor's office."
We did some checking. And it appears he's a victim of what's called "balance billing", when a health provider tries to get more money from the patient than the insurance allows.
In this case, Advanced Colorectal Services billed Spencer an additional $797.59, the exact amount of the provider discount, a direct violation of balance billing.
We took Albracht's case to the Oklahoma Insurance Department.
"This is a major red flag when the provider is trying to come back onto their patient and make them be responsible for an out of pocket expense that's typically not warranted," Deputy Insurance Commissioner Mike Rhoads said.
Rhoads adds, to avoid being overbilled, we need to understand our medical plans.
"Consumers need to know what is covered and what is not, what is in network and what is not to avoid these types of situations," Rhoads said. "If they do that, they better understand their obligations."
If you do go out of network, the provider can ask you, the patient, for the balance of the bill.
In Albracht's case, he was in network. We talked with his doctor's office. They blame Spencer's insurance for not picking up more of the cost. And some good news, they say they've worked it out with the insurance company to pay the difference, so Albracht won't have to.
If you feel you are a victim of balance billing, first ask your insurance company to get involved. They might be able to stop the bill.
You can also report it to the Oklahoma Insurance Department at (800)-522-0071 or (405)-521-2828.