“Not my fault, its theirs.”

(Location: Texas, 75287
Insurance: BlueCrossBlueShield PPO
Deductible: $750.00
Individual Out of pocket maximum: $1,700
Age: 24
Income: currently N/a )

Hello, I had an eye procedure (laser surgery) to fix a hole in my eye (Sept 10th 2020). I had come in originally only for a diagnosis of symptoms. Being broke, prior to the procedure I confirmed with the Dr. / receptionist that the procedure would not add any cost (to what would be a normal 15$ copay diagnostic visit). Afterwards, I paid my 15$ copay and left, feeling incredibly lucky.

Now, over 4 months later I’m barely being told that my insurance in fact did not cover the full cost ($1,741.22) and I owe upwards of 600$. We emailed and the Dr.’s office insisted the fault was not on them, but on my insurance for applying the charge to my deductible.

Dr.’s Email Quote: “they (BCBS) declined paying for your laser because of your deductible. Instead of paying us they decided to apply it to the deductible , we are never sure on what the insurance companies will do. Please understand us as well. It’s a hit or miss with them. They will tell us one thing and do something different, the money that we were supposed to get paid by your insurance they took it and applied it to your deductible.”

After talking to BCBS they said the fault was on the Dr.’s office since “Everything was done correctly on our (BCBS’s) end”.

The Dr’s office sent me their version of an EOB and in the appointment notes is written “BCBS #My-Account-Number 15$ copay, no deductible $1685”. I’m not sure where the “$1685” figure came from, I cant find it in any other place, or combination of figures. I do still have possession of the Dr’s digital EOB, I thought this line was also relevant

“Oct 1, 2020 10:38:14 PM Primary Insurance status changed from “ERA Received” to “ERA Denied”.

Is this $600+ payment my responsibility? How could I have known the end cost when I was directly told the procedure would not add any? Also, If the Dr.’s have had confirmation of the “ERA Denied” back in October, why am I barely being contacted Feb 1st 2021?

Thank you so, so much for your time. I cannot stress enough how much I appreciate you.

(Edit: formatting, new to posting)

submitted by /u/The_bidding
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(Location: Texas, 75287 Insurance: BlueCrossBlueShield PPO Deductible: $750.00 Individual Out of pocket maximum: $1,700 Age: 24 Income: currently N/a ) Hello, I had an eye procedure (laser surgery) to fix a hole in my eye (Sept 10th 2020). I had come in originally only for a diagnosis of symptoms. Being broke, prior to the procedure I confirmed with the Dr. / receptionist that the procedure would not add any cost (to what would be a normal 15$ copay diagnostic visit). Afterwards, I paid my 15$ copay and left, feeling incredibly lucky. Now, over 4 months later I’m barely being told that my insurance in fact did not cover the full cost ($1,741.22) and I owe upwards of 600$. We emailed and the Dr.’s office insisted the fault was not on them, but on my insurance for applying the charge to my deductible. Dr.’s Email Quote: “they (BCBS) declined paying for your laser because of your deductible. Instead of paying us they decided to apply it to the deductible , we are never sure on what the insurance companies will do. Please understand us as well. It’s a hit or miss with them. They will tell us one thing and do something different, the money that we were supposed to get paid by your insurance they took it and applied it to your deductible.” After talking to BCBS they said the fault was on the Dr.’s office since “Everything was done correctly on our (BCBS’s) end”. The Dr’s office sent me their version of an EOB and in the appointment notes is written “BCBS #My-Account-Number 15$ copay, no deductible $1685”. I’m not sure where the “$1685” figure came from, I cant find it in any other place, or combination of figures. I do still have possession of the Dr’s digital EOB, I thought this line was also relevant “Oct 1, 2020 10:38:14 PM Primary Insurance status changed from “ERA Received” to “ERA Denied”. Is this $600+ payment my responsibility? How could I have known the end cost when I was directly told the procedure would not add any? Also, If the Dr.’s have had confirmation of the “ERA Denied” back in October, why am I barely being contacted Feb 1st 2021? Thank you so, so much for your time. I cannot stress enough how much I appreciate you. (Edit: formatting, new to posting)
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