Sara submitted this great tip:
We compare every medical bill we receive it to the Explanation of Benefits (EOB) from our health insurance company. We make sure the billed amount is the actual “Patient Responsibility” amount per our health insurance, as well as ensuring all services are listed as “In Network”. If there is a discrepancy, we first call our health insurance, then we contact the medical facility.
We have saved over $800 in the past four years simply verifying the bill was done correctly. According to All You Magazine (April 2011), 85% of medical bills have errors. You can find your EOB online or your health insurance company will mail it to you after the service is submitted by your doctor. Always check before you pay! -Sara
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{ 90 comments }
I wish ours had had errors! The NICU charged $42 every time they checked our daughter’s blood sugar levels with the One Touch. That is 8-10 times per day for 5 days. Ridiculous. And my SIL doesn’t pay a dime going to the hospital b/c they are on food stamps.
Just to clarify, receiving Food Stamps doesn’t mean you don’t pay for medical care. After all, FS is for food. However, if she’s income eligible for FS, she may also be eligible for some form of Medicaid, which provides medical care.
That is probably what she meant. I know here, based off income qualifications, if you are eligible for FS then you are eligible for Medicaid.
We have a $100 copay and I have some pretty significant health issues and there are many times I don’t go to the ER when I probably should just because of that. *sigh* that’s life though, right? =\
With my husband’s new high deductible plan, the insurance lady said not to go to the ER unless we had cut off a limb! They won’t pay the claim.
Often times people are eligible for programs run through the hospital even if they have insurance, to cover the costs if they are eligible based on income. The hospital bills insurance, but then writes off the rest.
To add to this, always, always, always ask if you can get a discount for paying your bill in full. Although we had insurance, my oldest son needed 4 operations in a 12 month period. Our insurance was had a $500 deductible and $2000 out-of-pocket limit (which of course, we had to pay twice over the course of the 12 months). The children’s hospital was wonderful. Our portion of the hospital bill was still over $1200 and each time they gave us a 25% discount for paying in full. This was such a blessing to us with a husband in seminary full time and a toddler, one on the way, and me working full-time as a teacher! However, the hospital I had gave birth in wouldn’t do it. Still, it never, ever hurts to ask!
I’m sorry that is what I meant. Yes, there is a tier system. Didn’t mean it was a direct result of being on food stamps. She’s on food stamps and medicaid.
Doctor’s bills are the WORST for having mistakes. I feel like it’s a full time job keeping track of each one. I am on the phone with someones billing every week it seems. Anyone have a great tip for keeping track of individual dr bills? I find it hard to keep track of the EOBs and each different dr bill. When you have children it’s very difficult to keep track of each bill each child has as different dr offices.
UGGG!
I kept a 3-ring binder when I was pregnant with our first daughter, as I was being seen weekly for u/s, and being sent to different locations depending on who was looking at her (the cardiologist or the perinatologist). I would match up all the EOB’s with the dr’s bills and make sure they matched if it was one I had to pay. If it was one covered by the hospital, I didn’t care so much if they messed up. (Our low income made us eligible for a program through one of the hospitals where they covered any remaining parts of the bill after insurance paid.)
I buy the $1 file dividers at the dollar store (plastic, larger but similar to the ones used to sort coupons or checks) and have one set up for each different doctors office. I have been dealing with multiple special needs children for 10 years, organization is key! Just today I called because I caught a $520 error an office was trying to bill me for, that was already paid by the insurance company.
I used different colored highlighter when my twins were born. Orange for me, Blue for my son and Pink for my daughter. I still use hightlighters my yougest is Yellow.
Sadly, it’s not jut mistakes. A lot of times it’s padding! Love seeing vaseline being a line item at $12, when they sell a giant jar in the gift shop for $2. THIS is the type of thing that healthcare reform should have been focusing on!
I went to the pediatrician with my youngest for her 18 month check up. Should have been covered at 100% for preventive care. Suddenly I get a bill. I call the insurance company to find out what happened, they said it was billed as a “diagnostic” visit and to call the dr. When I called them they said there was one $110 bill for the check up that was covered 100%. Then an additional $110 bill for a diagnostic visit. It turned out, during the course of the checkup the dr mentioned tht my DD had dry skin and wrote a prescription for a pecial cream. THAT was the diagnosis!! I was responsbile for $6 and told them that I wouldnot pay that under any circumstances, because I didn’t need someone with a degree to tell me my kid’s skin was dry. DUH!!! They never asked for that money again!
I need to start keeping better track of all of this. Guess I will start using that filing cabinet sitting under a pile of junk in the garage LOL!
Make sure you use the drawers and not just put stuff *on* it
LOL!! Can I just shove it in the drawers unorganized? =P
I would agree that this is a major money saver!!! We were being billed for $500 and when I called the office to ask why the bill was so hi, they said that they were showing our daughter was not covered. Funny because it was the first bill that this was a problem….they spelled her name wrong by one letter. Needless to say it went down to $100.
A similar thing happened to us once because a FastCare Clinic (sort of like one of those minute clinics in CVS stores but one run specifically through my employer) had entered my daughter’s date of birth incorrectly. When the EOB came, it stated that the service was not covered because the date of birth does not match. I had to make several phone calls to get it all straigthened out, which took a bit of time, all because the nurse practitioner at the clinic entered the wrong information. It was so frustrating to have to deal with because none of it was my fault, yet I was the one who had to make it right or else I would have been billed by the clinic when my insurance denied their claim. Such a pain!!
A good doctor’s office/clinic will help you fix the problem. Being billed because of a clerical error does not make you responsible for the charge. It’s a headache fixing it though!
I keep track of my doctor bills for the kids. Good thing to because I got a bill from the a Lab for my daughter’s lead test. Come tofind out they never billed my insurance company at all. I had to call them more then once to get it taken care of. the reason they said I got a bill is because the insurance is in my husband’s name but the bill came in my name. That is so stupid we are all on the same policy it’s just under my husband name because he has it thru his work.
When I was admitted to the hospital for possible gall stones, I found out I was pregnant at the time. During the ultrasound they found blood around the sack (I was about 7 weeks along and did not know, I had moved a couple weeks earlier). The hospital’s GYN came in and asked if I had an OB/GYN and I said I did, she said she was not going to do an exam since I was already going through so much and had blood in the sack and was spotting. She said she would check on me again during my (4 day) hospital stay.
Weeks later, I got a bill for $250 for an exam, that they never bothered to bill to my insurance company either. I was so shocked and REALLY angry. I wrote a scathing letter, stating that I would not submit the bill to my insurance and would not pay the bill since a five minute conversation does not constitute an EXAM. Never heard a word about it again!
I received a bill in the mail for a critical stay that my 16 month old had. It was 2.2 MILIION dollars. Yes, he was critically ill and we were there for almost a month, but that’s a lot of money. We had insurance, but were out of our “network”. Most people would stop and accept the 10 or 20% co-pay that they were liable for, but for me, that was still WAY to much! I spent two years fighting the insurance companies and have learned the hard in and outs of insurance billing/patient advocacy the hard way. We ended up paying just a few hundred dollars. Now, I know how the elderly and others end up being taken advantage off. I have earned the title “Insurance Guru” and now help anyone I can!
That’s a fantastic reduction. You should write a post about this!
My husband was in a car accident once out of town. He was taken by ambulance to the ER and spent several weeks in the hospital. Well, no one bothered to tell us until AFTER his stay that they didn’t accept our insurance plan AT ALL! However, there was a hospital about 2 miles down the road that DID and he could have been transferred there at any time. I spent over a year fighting it and ended up still paying an insane amount of money OOP. I was young and had no idea this was something that could have been a problem. I had insurance, and my husband was seriously injured, not once did it occur to me that this could have happened.
I homeschool my kids and it will DEFINITELY be a lesson when they are high school aged how to handle insurance!
Unfortunately, the hospital CANNOT tell you they do not accept your insurance unless you ask them. This is because you could then sue them for giving you less than stellar care upon finding out they don’t accept your insurance. Same reason why when you go to the ER now they don’t ask for your insurance as people who do not have insurance have complained that they get lesser care because they have no insurance.
It’s a messy system.
My father went into the hospital in January and they asked him up front in the ER if he had insurance and asked for his copay right there. Sad to say that he went in with chest pains b/c he had recently had a triple bypass. They did me the same way a couple years ago. We have always been asked up front for our insurance card & copay.
Last year my oral surgeon mistakenly billed my wisdom teeth extraction as a dental charge, so my medical insurance refused to pay, even though my medical insurance covers wisdom teeth extraction. After SIX MONTHS of phone calls to the oral surgeon, they finally put the claim through properly as a medical claim and the insurance payed it. Those six months were infuriating, but saved me $1500!
Same thing happened to us in December. Thankfully, it only took one phone call to fix.
Yeah, wisdom teeth are crazy nowadays. You need to be really careful because they charge you individually for TOP and BOTTOM. It’s considered two surgeries or procedures and most insurance companies only pay for ONE of these. So lame.
Also, when I had my daughter we delayed the Hep B until we left the hospital, but they charged us for it on her birthday AND the day we left. Simple mistakes like that slip through and are really easy to find. Pay attention to when they offer you things like tylenol because once they offered and didn’t give it to me and I was charged anyway.
We saved $100′s by calling and asking for a discount if we paid in full. We did this with my hospital bills when I delivered my son and when my son was in the hospital for a 3 day stay at 6 months. We saved 15% each time off our out of pocket. It’s doesn’t hurt to ask!
This happens often without a phone call (but not all the time). On both of my c-sections, I was offered a “pay in full by 30 days” discount on my initial bill that covered my portion after insurances. But it is always smart to call first to see if it is offered.
I’m curious, do you get the discount after it has been sent through insurance on what is left as your responsibility? Or do you get the discount by paying in full without involving insurance at all? I just had a baby and have a high deductible plan, I’m about to send off all of the payments, but saving some money would be nice!
I have done this as well. When I had my second daughter I saved 15% from the hospital bill. Then, months later, she was in the hospital for a week. I called again, expecting a 15% discount. Instead, they said that to avoid accounts from going into “a monthly billing payment” they were offering a 25% discount. This saved us $1,000!
I just saved us over $1,000 by doing this! My husband had surgery & we’d met our deductible & co-insurance but the insurance ran the hospital bill under my name rather than his! So we were getting hit with my deductible instead of it going towards his. So our responsibility for the hospital bill went from over $1,500 to right about $500!
You have to watch out for stuff like that. My newborn got ran under my husbands name so the insurance could charge a deductible. So I have paid mine now and his has been paid under our family plan. He just had surgery so we are waiting to see if they try to charge him again for his deductible even though they said we had already paid all deductibles this year.
I was let go last school year from my position at the local school. My husband picked me up on his insurance through the school system and we are paying over $600 a month on insurance. Couple with the medical bills as a result of having a baby and we are paying a lot out of pocket. I was so mad to get some of the hospital bills because I was charged upwards of $60 for Motrin after delivery and had a prescription filled before I left the hospital for $4. Not only that but our hospital allows the parents to keep the baby in their room after delivery rather than the nursery and the nursery nurses are on standby if you need them. for the 3 nights I was at the hospital, the baby was with me 24/7 unless she had to go the nursey to be checked on by the pediatrician. Her nursery charges were around $2000. Still not sure how considering I did all the work and had to pay the pediatrician on top of all that too.
Our baby isn’t “paid for” yet because of those silly/stupid prices they put on simple things that I could get close to free. 90 prescription cost me $12.00, but hospital charged nearly $10.00 per pill! And all the pain meds I got I could have done without because they didn’t work anyway and they were over the counter meds which cost less per bottle than they charged per pill… Next time I go, I will not stay longer than one night. If that.
I will definitely start taking a closer look on things more often. One my son’s bills had listed a fertility procedure!!! Good grief…
Next time, consider a homebirth
One reason that hospitals charge so much for medications is because a nurse must administer the medication. The cost of any medication given to you in a hospital by a nurse has an included “administration charge”. Not only are you paying for the medication itself, you are basically paying for the nurse to obtain the medication, give you the medication, and document. Next time, see if your medical facility will allow you to use your own medications from home. You can ask your doctor to write an order for you to take your own medications from home. These will need to be in their original containers and sent to the pharmacy for verification. That may help you save on “cost per pill” in the hospital if you are giving the medications to yourself instead of having a nurse administer them. Always check with your doctor before doing this!
Signed,
A Medical-Surgical RN
Thanks for the tip! I would never have thought of this but it makes a lot of sense. Thank you.
Emily, I have to ask, are you all in Texas? I taught and we were covered under my insurance and we paid around $650 with $500 and $2000 out of pocket limit. I had two c-sections under this plan and it irked me to no end that I had to pay a nightly deductible for a baby that stayed in the room with me.
With my third child, my husband worked for a hospital system and we paid $1250–that’s IT! I couldn’t believe it and I must have called back to ask 12 times before the delivery.
I live in Wichita, KS. I had a c-section, so we were in the hospital for 3 days. My daughter’s hospital bill was $3000 when she stayed in my room the entire time! I never knew I had the option to send her to the nursery. I just couldn’t believe that I had to pay that much just to care for my ow child. The 3K was for her deductible and coinsurance. She turns 2 on the 27th, and I have about 2 more payments to ” pay” for my daughter.
last year i had a horrible ingrown toe nail, i went to a general doctor and he looked at it and said the whole toe nail needed to b removed, ive had many ingrowns before and they never removed the toe nail, i refused to let him do that, i instead went to a real toe doctor then. but that first doctor billed my insurance sayin he did infact remove my toe nail. i called my insurance company and they didnt’ care, they told me to call doctor and handle it. come to find out they were a lousy insurance company anyways. after seeing the real toe doctor a few times for check ups and ingrown toe nail removal and surgery to make sure it dont come back i find out i owe the doctor 200 dollars…y? because my insurance company tops out at payin ONE THOUSAND dollars a year. yes, i paid my 300 dollar deductible, they forked over 700 dollars for bills, then called it quits. i dropped them soon as i found that out.
I have a fun medical error for you. When my kids were little they were goofing around with their little tykes cars. One was on top of his car roof when the other rammed it. The resulting situation was a trip the ER and stitches. I had to fight with the insurance company over it because whoever originally put the “accident” in the system at the hospital referred to it as a car accident. My insurance wanted an accident report and to be sure the other driver wasn’t responsible.
Now that’s just funny
hahahaha!
haha!!! That made me chuckle! Too funny.
Really, almost any trip to the ER is going to result in a form from the insurance to determine if it was an accident that they can charge to someone else. My daughter has a chronic terminal illness and we still get them almost every time we have to go.
I completely agree. It’s worth every minute of time and effort. We’ve definitely saved over $1000 by doing this.
I check every bill and almost every one is incorrect. I feel like I have to tell the insurance company what my plan covers. It takes a lot of time but usually comes out in my favor thankfully. My son had a cranial band which they originally diagnosed his condition as plagiocephaly or flattening from external pressure. However, through a lot of work of mine, we found out that he actually has mild craniosynostosis, which is where two of his plates are fused causing the head shape problem. The change in diagnosis caused the insurance to pay 100% instead of nothing. Saved us $1500.
My husband also was being charged over $50 a month after insurance for a CPAP machine that he should have owned since he had it so long. I called and they removed the charges.
Now here’s a reader tip I like! We just got a bill for my appendectomy and for a 40 minute procedure cost $20,000. Our copay was $50, but it was still shocking to see that amount.
My husband ALWAYS asks if there is any discount for paying the bill in full as soon as we receive it. Sometimes the answer is no but sometimes the answer is a 20% off break.
I had heard of people asking for a discount for paying medical bills in full but never tried it until last month. My husband went through 5 weeks of radiation, and after insurance, our responsibility was about $5,000. I called to ask about payment options, since we didn’t have $5,000 to spare, and was told that they’d knock off 20% if we paid in full. I accepted (saving $1,000!), took the money out of our emergency fund, paid the bill, and returned that amount to the emergency fund when my husband got his bonus this month. Now we will be asking for a discount whenever we get a medical bill.
I save about 75 dollars a month just by hang drying my clothes. I do one load every day and hang it on hangers on the shower rod. I also have a drying rack. I either do the laundry early in the morning and hang it all day or do at night and hang it before bed and it’s usually dry by morning.
I am on the budget plan that allows you to pay the same price every month based on your average usage. Since I’ve been hanging my clothes for the past four months, my plan was adjusted to 74.89 less per month. $$$$75 TIMES 12 is 900 a YEAR!!$$$
Drying a load of laundry in an electric dryer uses about 5 kilowatt-hours of energy, which costs less than $1 (we pay almost $0.16 per kwh; many people pay less). Even though we’re a family of six, I don’t do enough laundry to save $75 per month…more like $35.
I had received an explanation of benefits under my daughter’s name for having a C-section. Problem was, she was only two days old at the time! I thought maybe they mixed it up with my name when she was born, but I didn’t have a C-section!
i wish i had been more diligent about wisdom teeth, 2 c-sections, gallbladder surgery, and tons of tests….i bet we could have saved a lot. we paid them all in full so even a discount for that would have been good to ask for. the parts that most confuse me is deductibles. i don’t know how to figure all that out with 4 family members. and that sounds like one area that gets messed up often. thanks for making us think about this!
It’s pretty sad that we have to think of this as a way to “save” money when, in fact, reviewing medical bills is just a way to make sure we’re not being ripped off by the insurance companies!
I totally agree.
My twins were over 12 weeks premature so we’ve had lots of experience with hospital bills and specialist bills. I’ve seen lots of errors!
Yesterday, we got a bill for my younger daughter. She has a form of arthritis and had seen her rheum. For some reason the tax ids had gotten mixed up and it was billed as her seeing a dentist that was out of network. We got it straightened out- the difference was about $275! If I hadn’t looked at it carefully, I would have just thought it was part of her deductible!
Definitely check those bills with your medical contract. When I had my son, the hospital and insurance billed me for an amnio and an “in patient” charge. Under my insurance contract, there was no mention of any “in patient” charge (just a charge for the amnio). I disputed the charge with my insurance company and won (I made copies of the actual contract and sent them in with my dispute form). This saved me somewhere around $400.
When I delivered my third child I wanted to have an all natural birth-but being 41 weeks preggers I got induced. When I started getting bills for my delivery (we are self pay for insurance because we have our own business) I was shocked that insurance wasnt covering anything. We pay a pretty penny for our premiums, let alone them not covering this delivery! After making a zillion calls I found out the dr had billed me high risk because this was my third pregnancy and my insurance had no documentation that I was, so they werent covering it! But I was never high risk! So after several months and another board of drs looking at my records they found the dr error. If I had just paid the bills it would of been over $10,000 for less then 24 hour vaginal birth without an epidural. Pay attention! I ended up paying about $4000-but a lot less for looking.
It’s true–medical bills need to be scrutinized carefully. My husband’s dental bill seemed a little high last month, so we logged in to our account on the dental insurance website. The dentist’s medical biller had neglected to deduct an insurance “write off” of $90. My husband pointed it out to the dentist and consequently saved $90. It seems so tedious to have to do this each time we receive a medical bill, but it is necessary. I worry about senior citizens who are not so savvy.
I work at a medical office and I know from experience how true this is…sadly…
I also save hundreds of dollars each year by doing this! I write a letter of appeal to almost every large bill that isn’t paid in full by my insurance. They almost always give me a significant break in the cost.
How do you do this? Do you write to the provider or the insurance company?
We’ve had a few increased medical bills. My FI had to go to urgent care for strep over the holidays and a few months back we got a bill for the full amount (after our $50! copay…who said teacher’s have great health insurance…) Luckily, I was able to straighten it out by calling billing, and it was relatively pain-free, but I’m glad I thought to check it out instead of paying it right out.
My husband was laid off on Dec 29, 2009. Before we took our 2-yr-old to the doctor in Jan, we called our insurance (from his work) to verify that we still were covered. We were. The dr’s office also verified it when we went in. A few weeks later the insurance company actually PAID the bill. Then, MONTHS later, they *changed* their mind and took their money back from the dr, resulting in us getting billed. We qualified for Medicaid at the time since my husband was unemployed and I’m a stay-at-home mom but since it was so far past the appt date, Medicaid wouldn’t pay it. We are STILL fighting the insurance company on this one. It’s a headache but so worth the fight.
Unfortunately, I don’t think you’ll be able to win this one. The insurance company only is obligated to cover until the end of the month of employment.
We’ll see! I’m trying to think positively! =) It seems like since they told us twice that we WERE still covered and then proceeded to pay the bill…that they would be obligated to pay it. If they had told us yes but then refused to pay once they realized their mistake, it would be different because we could have then billed it to Medicaid. Since they waited so long, we’re unable to do that. *sigh* Again, I guess we’ll see! =)
After my son was born, we received a handful of bills from different providers: hospital, doctors, etc. I was pretty sure those charges should have been covered by our insurance at the time. I called the providers and asked why I received a bill. Each time I was told I should not have received a bill and I could disregard it. Apparently the bill was sent to me before it was submitted to insurance. Those few phone calls saved me hundreds.
Last year our daughter had a small procedure done at the hospital but after insurance the bill was almost $1300. Our hospital has a note at the bottom of all bills that if paid in full within 30 days then you can take off 10%. I called the hospital to see if there was anything better than 10% off and was told no, very quickly. I mentioned to the lady that in these economic times, I was surpised that the hospital was not willing to work with patients. Did I have the money? Yes! But did I like the quick response not willing to work with me? No! She said she’d talk to her manager to see if there was anything she could do but doubted it. A few days later I got a call and we received 50% off the bill! Over $600 savings by just calling your hospital!
I have don this several times with both of our girls birthing bills at another hospital where I got 15% off our first girl and 25% off the second girl. Both of those times, the hospitals actually offered those discounts to me just to paid in full!
Please, please, please folks if you have the money available, call your doctor or hospital and see if they will give you a discount.
What’s great about each is we knew all these bills were coming so when we didn’t need the extra money, it went right back into savings!!!
I struggled with our insurance company which refused to pay for my allergy testing (around $1500) but was paying for the weekly shots which I wouldn’t have needed unless the allergy test said I did. After a year of being pushed around the system, I called my husband’s employer and complained. I found out that his employer has an insurance advocate and that person is paid to deal with the insurance company!! I was told that anytime I have a problem to contact this advocate and to NOT deal directly with the insurance company. Needless to say, they fixed the problem with one telephone call and I have never had a problem since.
I strongly suggest you check and see if there is a person in your company that does this, too. I feel sure that insurance companies automatically decline to pay thinking people will “give up” and go ahead and send a check. When they realize that they are dealing with an employer that may take their business elsewhere, they have a different outlook.
To add to this, insurance plans work in two ways:
1) Fully funded plans-these plans have to follow STATE and federal guidelines.
2) Self-Funded plans–These plans only have to follow federal guidelines and procedures that are not “covered” are the the will of the employer that provides the insurance.
For example, my son has autism. My husband’s plan is a self-funded plan (as are most plans in the private sector. They are cheaper, especially since they don’t have to follow state mandates, just federal). Insurance would not pay for a second pair of eyeglasses in a year (he was 2, got glasses and then had to upgrade to bi-focals because of an eye condition). I spoke to the benefits advocate at my husband’s employer’s office. They agreed to cover them and called the insurance company and told them to do it. However, when we wanted them to pay for ABA therapy, they would not pay even after three appeals, letters, medical data, and a doctor-to-doctor. (Praise God though, as He has provided for this in other wonderful and unexpected ways).
I agree with this!!! I handle all the Human Resource aspects for the company I work for (which includes all the employee benefits). I encourage all my employees to contact me when they are not sure if a bill is correct. Because I really understand all the ins and out of our insurance plan, it is very easy for me to figure out if the bill is correct and if it is not, I have direct contacts with the ins. company to get the issue resolved very quickly. Most issues are resolved within 7 days and it only took me sending a quick email to our customer service rep with the bill attached.
So definitely utilize your benefit rep at your company!!
I went to my gynecologist for a regular visit and because I have infertility, one time they put that for the diagnosis and the insurance didn’t want to pay b/c they don’t cover infertility treatments. This might help someone else to double check your diagnosis when checking out of your visit.
My husband had surgery last year…Until that time I had never even considered “shopping” for a surgery center…Well after I got the quote for our portion being $1800 for his surgery from the same place that I had the same surgery( gall bladder removal) two years prior and I paid $640…I was shocked at the crazy increase…Started calling different surgery centers…our out of pocket went from $1800 to $900…The first place was charging double what most others were…Crazy…
Reading all of these comments makes me really wonder how many of these were actually “mistakes” and how many were more like “purposeful carelessness” on the part of the doctors/heath insurance. The more difficult they make it for the individual to understand and get corrected the more likely the person is to just give up and work on paying it, especially since medical issues usually go hand in hand with stress and being less able to spend time and effort correcting the mistakes.
I just got us $240 back on prescriptions. I thought we had a deductible (which I found out we actually don’t), so when I picked up the first prescription, I didn’t think anything of the cost. When I picked up the second prescription and found that we were now paying over $250 for 2 (when I thought our deductible was only $150), I knew something was wrong. Found out 1) we don’t have a deductible, 2) the pharmacy was told we needed pre-authorization, so they charged us full price, but no pre-auth was actually needed. Now I have to submit a claim form to get reimbursed, but at least I get the money back. There’s no way anyone would have caught that and refunded us our money.
I haven’t had a chance to read everyone’s reply but it definately pays to know your rights as well. A few years ago, I ended up in the emergency room and then off to surgery to have my appendix removed (I never wanted surgery more in my life . . . way, way, WAY worse than labor).
Anyway, our insurance at the time was a $500 and $2000 out-of-pocket limit (per person) so we expected to pay $2500 to cover my portion of the surgery (we had it saved up). So, you can imagine my surprise (and not a small amount of anger) when I got the bill for the surgeon, which was over $3000 (just his bill, that did not include hospital, medications, etc, etc). I called the insurance company and questioned this. I was told that because the surgeon was “out of network,” I would have to pay out of network pricing. I was stunned. I asked, “Just to be clear, next time I end up have EMERGENCY surgery, I need to ask everyone in the room if they are in-network.” It was the most ridiculous thing I had ever heard and, more than that, it just didn’t make sense!
Now, here’s where insurance companies expect most people would stop. Most people would call up, speak to an (un-informed) customer service rep who tells me sorry and then leave it alone.
I am not one of those people.
I took out my insurance benefit handbook and read it front to back and then back to front. And, lo and behold, there’s this little law call the Prudient Layperson Law. (Look it up, I believe every state has one). It says that if a normal, everyday person can look at you and say, “You need to go to the emergency room and get help because it’s an EMERGENCY,” then no matter where you are and who is or isn’t in network, your insurance has to treat it as in-network.
I called the insurance company back up and read this section of the handbook to customer service rep, verbatem. She was quiet for a moment, then asked to put me on hold, and came back a solid 5 minutes later and told me it was all taken care of.
I don’t blame the customer service reps. I believe insurance companies purposely keep them in the dark about things like these so that they don’t offer the information up. Therefore, many people won’t deal with the arguing, they’d just pay.
So, definately do your research; it definately pays!
This can happen with ambulance rides, too. My son got a head injury at school but he didn’t have any side affects from it until later that night. We took him to an urgent care center. When we were there the urgent care center said he had to go by ambulance to the hospital’s emergency room, We didn’t call the ambulance, the urgent care center did and it was the local volunteer one. Our insurance refused to cover the ambulance service because it was out-of-network. We appealed and finally got it covered.
When you have an emergency, the last thing you are thinking about is whether the ambulance company is in network or out-of-network. You get whatever company is the first responder in your area, usually a volunteer crew.
I am not one of those people either! Thanks so much for the info. about the Prudient Layperson Law; I am going to look at our handbook right now. You are so awesome – thanks again!!
I spelled prudent wrong–but if you google Prudent Layperson several links pop up. Hope it helps you out!
When my dad was in the hospital and then 6 weeks died. The bills were still coming in I started calling the offices of the doctors doing the billing and talked to them, most if the bills that were $30 or less said don’t pay it. We have write-offs for those small amounts and then apologized for my loss. That was a great blessing not to have use all of his money left in the checking account or to have to dip into our money.
As someone who works for an Insurance Comapny, I always tell my customers to make sure they understand why something was covered or not covered and also to make sure your provider is charging what they should (example: a provider can’t charge you for something that is a “write off” amount as part of their network fee schedule). Also, don’t be afraid to appeal a decision if you feel you didn’t get your max benefit. And if that appeal is rejected, appeal again! You have certain rights as an insured and you need to make sure you are getting your max benefit.
Also, if the insurance company ends up paying your claim BUT you feel your provider is charging too much for the service, let the provider know you think their fees are outrageous. I have a HSA account as part of my own insurance so every dollar really matters to me. When a provider saw me for 45 seconds to check to see if I needed sticthes and then dismissed my cut but charged me $225 for “surgery,” I became the “squeaky wheel” at the place of service until they re-billed my claim and billed it correctly.
I have re-coup hundreds of dollars nearly every year by paying attention to medical EOB’s and bills. Clinics, hospitals, and insc. co. make mistakes all the time and they won’t notify you if they have. You have to bring it to their attention. Don’t be afraid to show them their mistakes and get a correction and or refund – it is your money and nobody cares more about it than you!
My insurance company keeps refusing coverage on my family physician visits and labwork because they classify them as “mental health” because one of my symptoms is depression. We’ve been doing the visits and labs because my other symptoms are indicative of a underlying physiological cause such as thyroid disorder. In the meantime, I am taking antidepressants to ease the depression (I have tried alternative meds and those haven’t worked). Yet, they aren’t even following their own rules. Mental health is supposed to be covered 50%, but they are only paying $25 a visit as if this is a therapy visit. I’m so frustrated and swamped with bills right now. I just want to get better!
We’ve got my husband’s HR person involved (insurance is through him) after unsuccessfully trying to hash it out with the doctor’s office and insurance (who keep blaming each other) and she says that the insurance company shouldn’t be looking at the doctor’s notes, just billing codes. Is this true? She’s fought a battle or two for us, but this keeps happening. I’m at my wits end and this is all so confusing to me. Is there someplace I can go to learn more about the insurance process? I’ve tried reading our benefits booklet but that’s like reading a forgein language.
Wonderful tip! I guess I need to start doing this asap.
It is SOO important to review medical bills in their entirety. I found this out the hard way. Our daughter was 10 weeks premature and the last thing I was worried about was looking over bills with a magnifying glass. For the first couple sleepless months I was just writing checks for whatever came in the mail because I simply just expected the costs exorbitant amount of money . It turned out the hospital was sending our bills to an insurance provider that I had cancelled SIX years prior- and they were paying!!! What a headache that was to sort out, the “group” we were part of didn’t even exist anymore!! In addition to that, they had us in the system as “uninsured” for 3 days during her 4 week stay, I have NO idea how that could have happened, but do you have any idea how expensive just 3 days in the NICU is?! When all was said and done we ended up receiving money back- but it took many many long hours on the phone. I swear next time I have a baby I’m not just bringing my insurance card- I’m bringing the whole filing cabinet!!
Does anyone else smell a rat here? I wonder if the rampant sloppiness in billing ever favors the patient? This area is worthy of investigation, big time.
I would like to reply to the reader who saved money on her medical
bills by reading her EOB’s. I work for in medical billing for a large
medical office. We would love it if out patients would read their
EOB’s. We welcome questions about the bill after you have read the
EOB, it is also good to call your insurance company if you don’t
understand why or how a charge has paid. Great tip.