United Healthcare price Estimate Cost glitch?

kv78b

New member
I have a United Healthcare Choice Plus plan with a deductible for $3,200 and out of pocket limit of $5,200. Earlier in March, I did my due diligence and researched podiatrists in the area for a fracture ankle. I went to Find Care & Costs > Estimate Cost > View all estimates > typed in Podiatrist. I made an appointment for my current podiatrist because her estimated what I would owe would be $40 vs a orthopedic doctor which would be around $75.

At the appointment, I asked to pay and the receptionist advised she would send me the bill. I go home and I research additional podiatrists again (I wasn't satisfied with the service) and noticed the out of pocket cost has gone up to $233. I thought this was strange and thought nothing of it.

Come this week, I received the bill of $249, plan discount of $124.21 and I owe $124.79 and it was coded as New doctor visit, 45+ minutes. My appointment was 15 minutes.

I didn't think to take screenshots when I was researching. Was this overnight increase due to the security hack? I understand I am at fault because I didn't get the cost in writing prior to the appointment but the estimated cost tool has always been accurate for me before. It accurately told me the cost of my MRIs and XRays depending on the facility I selected that month so I didn't think the estimated cost tool would fail me.

Is there action I can take? I'll take this as a learning opportunity for the future to confirm the cost.

Sidenote: Injuries are expensive. Primary care doctor, X-Rays, MRIs, CAM boot, crutches, knee scooters, shower chairs, Podiatrist, second X-RAY to ensure bone has healed, physical therapy

I know there was new legislation passed in my state.

2023 Florida Statutes

Title XXIX - Public Health

Chapter 395 - Hospital Licensing and Regulation

Part I - Hospitals and Other Licensed Facilities (Ss. 395.001-395.3041)

395.301 - Price transparency; itemized patient statement or bill; patient admission status notification.

(b)1. Upon request, and before providing any nonemergency medical services, each licensed facility shall provide in writing or by electronic means a good faith estimate of reasonably anticipated charges by the facility for the treatment of the patient’s or prospective patient’s specific condition. The facility must provide the estimate to the patient or prospective patient within 7 business days after the receipt of the request and is not required to adjust the estimate for any potential insurance coverage. The estimate may be based on the descriptive service bundles developed by the agency under s. 408.05(3)(c) unless the patient or prospective patient requests a more personalized and specific estimate that accounts for the specific condition and characteristics of the patient or prospective patient. The facility shall inform the patient or prospective patient that he or she may contact his or her health insurer or health maintenance organization for additional information concerning cost-sharing responsibilities.
 
@kv78b Estimates are exactly that, estimates, not guarantees. There are a lot of variables. Did you do the estimate as a new or established patient? Did you choose the same level of difficulty? New patient exams have higher costs than established. How many minutes for the exam? Providers bill in 15-minute increments. Providers can bill for both the prep/post time and time the patient is seen in the clinic. You can see the same provider but at different locations, and the price will be different. Has the price estimator been updated recently? Contracts can change, and that can change cost.
 
@susienaps Thanks for the information. I did notice the price estimator went up from $40 to $233 after my appointment.

I consulted my medical coding friends and they advised that this is normal. Check in time, them asking me how much I weigh and what my height, podiatrist reviewing my notes prior to seeing me, me sitting in the room waiting for the doctor, the podiatrist chatting with me for 15 minutes where she advised to me order an boot online. I asked what type, brand, and size. I asked if an aircast was a good choice. She asked me what an aircast was. I proceeded to pull up my Amazon app to show her and she advised that would suffice. She didn't advise what size or brand. That contributed to the complexity of the appointment.
 

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