Is OB/GYN appointment credit a means tested public benefit

[K + M 47]

My wife went to the OB/GYN recently and we didn't think anything of it, we pay the fee and everything is good.  We got her bill in the mail and it says "Previous payments and credits" and it is taking about 90% of the cost of the bill off.  We were wanting to know this credit to help with the payment for her OB/GYN visit, is this classified as means tested public benefit? On the bill it says "Charges for services at a rural or federally qualified clinic.  Your Medicare summary may have additional charges not on this statement".  Of course she doesn't have Medicare for obvious reasons, and then under the description of the visit it also says a line - "Credit - Provider Adjustment"  Are we going to have to pay back this credit to help with the OB/GYN appointment?

 

Thank you in advance

[Boiler 45,467]

Might want to check with your Insurance Company.

[K + M 47]

1 hour ago, Boiler said:

Might want to check with your Insurance Company.

Talked to insurance, talked to the billing agency, talked to the place where the appointment was conducted but no one knows about if this is a means tested public benefit.  I explained the situation and seem to just keep getting the run around.  I figured out the name of the program is a "sliding fee discount program."  But I can't seem to find any concrete answers on if this is a means tested public benefit.  Even reached out to HRSA as it says about federally qualified clinic on the bill and thought they may know specifics but still no concrete answers.  Last time she was there we just paid a prompt pay the day of service, I asked if we can do that again so we don't deal with any federal funding but they said they aren't taking payments in the clinic anymore, and we need to talk to billing, but that's kind of hard when billing said for us to talk to the clinic. 😒  Not really sure what to do here with this situation, do we just call and have the discount taken off so no chance of means tested public benefit?  Or do we pay the discounted rate and just see if anything comes in the mail from the billing agency about reimbursement to the agency?

 

Thanks again in advance.  

[Boiler 45,467]

It seems that nobody pays the full amount and that what they charge is a black art You should know if you applied for a public benefit.

[K + M 47]

24 minutes ago, Boiler said:

It seems that nobody pays the full amount and that what they charge is a black art You should know if you applied for a public benefit.

What you mean by black art?  In this scenario would this be classified as a means tested public benefit? 

[Lemonslice 4,836]

"You should know if you applied for a public benefit."

 

It does not "fall" from the sky, you have to apply, so you would know... If you didn't fill forms, then that's not it.

[K + M 47]

I was not personally allowed into the clinic but my wife did fill out paperwork.  The paperwork she filled out gave consent for treatment and all of the normal stuff, but she also released our income to the clinic which they used to figure out how much our bill would be.  

24 minutes ago, Lemonslice said:

"You should know if you applied for a public benefit."

 

It does not "fall" from the sky, you have to apply, so you would know... If you didn't fill forms, then that's not it.

I was doing some further research and I took this from health and human services -  Early versions of PRWORA contained a definition of ``Federal means- tested public benefit'' that could have encompassed benefits provided by both discretionary spending programs and mandatory spending programs. (These early versions provided that, with certain exceptions, ``the term `Federal means-tested public benefit' meant a public benefit (including cash, medical, housing, and food assistance and social services) of the Federal Government in which the eligibility of an individual, household, or family eligibility unit for benefits, or the amount of such benefits, or both are determined on the basis of income, resources, or financial need of the individual, household, or unit.'' 

 

From everything I am seeing about this, it seems any time you receive assistance based on the definition of income it would be this means tested public benefit, which we here did so this would classify this as a means tested public benefit?  If so we should reach out and get this credit cancelled and pay the full amount?

Edited November 13, 2020 by Kerri and Myles

[Lemonslice 4,836]

She should ask for a copy of what she signed ... No one here can know for sure.

[K + M 47]

1 hour ago, Lemonslice said:

She should ask for a copy of what she signed ... No one here can know for sure.

We went forward and got the benefit taken off and are going to pay the full price of the appointment.  Better safe than sorry with this, everything is pointing towards it being a means-tested benefit.

[NikLR 13,227]

Depends on the state.  If it's for pregnancy then some states cover the mother and that isn't a means tested benefit.  Some states cover an unborn baby and that's not a mean tested benefit.  It depends on the state. 

If it was a normal ob/gyn appointment for a pap smear etc, then that's preventative care and should have been covered by insurance fully.   Unless she went in for an issue, then that's probably not covered. 

[JeanneAdil 6,491]

14 hours ago, Kerri and Myles said:

We went forward and got the benefit taken off and are going to pay the full price of the appointment.  Better safe than sorry with this, everything is pointing towards it being a means-tested benefit.

No,   don't pay full amount

it is an adjustment made  with an agreement between  insurance company and the provider (in this case the OB/GYN)

my bills read like this

amount charged 

network discount (taken off by the agreement)

insurance paid

your share

 

all insurance companies have a agreement with providers / only difference being sometimes you must go to in -network and out of network you will pay more for the appointment

 

always good to check list of in network providers for any policy

always call dr offices and ask if they accept the insurance 

some put signs up in waiting room saying things like "medicare advantage plan not accepted here"  I saw that recently

and i know you're not getting medicare / that was just an example of what to look for and ask about

 

Edited November 14, 2020 by JeanneAdil

[WaterLeaf 200]

Just as JeanneAdil said, it is normal for insurance to cover some stuff and doesn't cover some other stuff.

 

But however you will notice if you sign up for public benefit - you read the papers and signed them. If you were reading the papers and asking what does what mean, they will tell you. I had not came across a public benefit in the health care system myself - or yet, but I don't recall hearing about it. Some payment of certain places in the health industry will give you a discount if you pay full up front asap with a payment card.

[JFH 12,190]

Sounds like a normal doctor invoice to me. All healthcare establishments over-inflate the prices, the insurance companies then respond with their price, the insurance pays their part and the patient pays theirs. You would know if you applied for a public benefit. The forms she filled out sound like the normal forms you fill out at an OB/GYN appointment (consent to treatment, insurance details for payment, consent to pay your part, medical history, etc). 

[Lemonslice 4,836]

5 hours ago, JFH said:

Sounds like a normal doctor invoice to me. All healthcare establishments over-inflate the prices, the insurance companies then respond with their price, the insurance pays their part and the patient pays theirs. You would know if you applied for a public benefit. The forms she filled out sound like the normal forms you fill out at an OB/GYN appointment (consent to treatment, insurance details for payment, consent to pay your part, medical history, etc). 

I've never been asked for my income though...  Not sure why OP chose to pay the full amount, they only needed to check what was signed.

[JFH 12,190]

38 minutes ago, Lemonslice said:

I've never been asked for my income though...  Not sure why OP chose to pay the full amount, they only needed to check what was signed.

At the medical center where I go, they have a “goodwill” program where if your household income is below a certain level you immediately qualify for a 25% discount on your part of the bill. It’s not a public benefit, just a goodwill gesture from the clinic.