NY: Being asked to pay estimated bill in advance
Location: NYC, NY 10003
Provider system: Mt. Sinai Health
Plan: Healthfirst Bronze Premier (marketplace), 5k deductible not yet met
I have an upcoming new patient appointment with a cardiologist (in network at this location) and upon "e-checkin" in the patient portal, it is giving me a bill for $293 and asking whether I want to pay it now or upon arrival. I was required to sign 3 different financial responsibility statements in order to check in ("you owe whatever insurance won't pay" business)
Screenshot of estimate here
When I originally made the appointment, I asked for a "ballpark" cost and/or the billing codes. They said they can't know that until after the visit b/c they don't know how much time/what the doctor will do. Only that there is an office/dr visit fee and a facility fee.
It's not clear how this estimate was reached or if it's anywhere near accurate. They are billing $75 copay plus "fees not covered" (whatever that means). I have a $75 copay after deductible is met, which it is not yet.
It is my understanding that I should owe the insurance contracted rate for the office visit + the facility charge. I can't know that until the EOB arrives later. None of my previous appointments with other kinds of providers have cost anywhere near this much w/ insurance rate.
My concerns:
-They will not let me be seen by the dr w/out paying this seemingly made up $ first
-I pay it and then it turns out I've been overcharged and have to fight tooth and nail for a refund
-This is likely the 1st of 2 or 3 appointments and I can't be shelling out potentially 1k before getting any EOB's yet.
Any suggestions or experience here? Thank you.
Edit: Found a detailed estimate w/ codes. How can they bill me for items that may or may not be performed? And why do I get charged 2x for 1 office visit (once under hospital charges and once under dr charges)?
Getting conflicted answers here, yes they can refuse to see me or no I can refuse and pay EOB later. This dr and facility is in network.
submitted by /u/photochic1124
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