CBS 5 Advocate

Push back when health providers want payment upfront

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Marie Merrifield paid $296 upfront for a colonoscopy but then found out it was covered in full by her insurance and has waited months for a refund. (Source: 3TV/CBS 5) Marie Merrifield paid $296 upfront for a colonoscopy but then found out it was covered in full by her insurance and has waited months for a refund. (Source: 3TV/CBS 5)
PHOENIX (3TV/CBS 5) -

A Phoenix woman says she overpaid upfront for medical care and has waited months for a simple refund. It's a good lesson for any patient who's asked to pay in advance.

Medical providers want to collect upfront for treatments because they think they know how much you will owe after your insurance processes the claim. But no matter what they say, they can't know for sure. That's why you should always fight to pay later.

Marie Merrifield scheduled a colonoscopy with Desert Ridge Gastroenterology. She wanted to wait until her insurer processed the claim before paying, but she says the practice told her otherwise.

"You have to pay your part of the payment in full, prior to the procedure. They would not do the procedure unless you paid," Merrifield said.

Merrifield paid $296 and days after a successful procedure she received the explanation of benefits from insurance. Turns out her plan covered everything; she owed nothing. Desert Ridge Gastroenterology acknowledged that they owed her a refund, but Merrifield says three months later she still doesn't have it.

"Why is it such a hard time to cut a check and send it back. It's just very frustrating when you have to make six to seven calls," Merrifield said.

Many medical practices use outside billing companies. Red tape and delays are common with refunds. They're quick to take your money but can be slow to give it back. Merrifield says she's heard one excuse after another.

"'They're cutting a check this week and as soon as I get it, I will send it on to you. I will give you a call when I have it in hand.' I haven't heard another thing," Merrifield said.

Merrifield has learned that patients should push back when told they need to pay estimates in advance. It's better to be exact.

"Wait until the insurance sends you their explanation of benefits and then pay what they say you owe," Merrifield said.

As long as you use in-network providers, waiting to pay should be an option. Negotiate to pay little or nothing upfront. Many providers will agree to charge you nothing until insurance settles the claim; but only if you fight and insist.

CBS 5 News talked to the doctor at Desert Ridge Gastroenterology and the owner of the billing company they use. Both apologized for the delay and a check was issued to Merrifield immediately. CBS 5 News thanks both the doctor and the billing company for quickly resolving this matter after we brought it to their attention.

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