ANA Discussion Forum
General Category => Insurance => Topic started by: lawmama on March 23, 2010, 11:55:06 am
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My insurance is just finally getting around to paying my claims because they decided to do a (very slow) pre-existing condition review before paying anything. Now that bills are finally being paid, I'm STILL getting bills. Apparently many of my doctors and clinics and other departments are sending me bills for amounts above what insurance would pay. I am supposed to have an out-of-pocket limit with my insurance, which I have already met and paid. Did this happen to anyone else? I'm not sure if I should start with the insurance company or the people who are billing me or what to do, or if I am just out of luck. I've never had claims this substantial before, so I have no idea if this is normal.
Thanks again!
Lyn
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Lyn,
If all of your hospitals and providers are "in network" or "participating providers" or whatever your policy calls them, then they agreed to take whatever the insurance company pays as payment in full and you aren't responsible for the difference. I'd start with calling the insurance company to see what they say. Sometimes it's something as simple as them not having something they need to process the claim properly. I went around and around with my hospital and insurance company for over a year over the same issue that resulted from one billing code being keyed in incorrectly. What took so long is that medical billing at the hospital would not even entertain the thought that they could have made a mistake and kept sending me on a wild goose chase to find who did.
Ultimately, it took a call to the hospital administrator to straighten it out.
Even if you are responsible for some charges, there should be an out of pocket limit, or catastrophic cap, but you should have been informed of that before you agreed to the surgery.
Good luck! It's frustrating!
Lori
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Rule #1 of health insurance coverage -- send all bills to the insurance company first, let them tell you what they cover and what is your responsibility, not the doctors billing staff. I still have times when the doctors staff tries to get something out of me like, 'we know this is the amount not covered.' I respond that they should send the bill to the insurance company or bill me and I will send it. I don't pay anything until I see an EOB (explanation of benefits) that shows: billed amount, adjusted amount, amount paid, and amount you may owe.(and other stuff like deductible remaining, out of pocket max, etc.)
I had one bill after my surgery from some doctor that I did not know for a few hundred bucks. My EOB showed it as something like 'coded procedure not covered.' I figured the doc put the wrong code in and wasn't getting paid because of this. I kept forwarding the bills to the insurance company and they responded accordingly. Eventually the doctors billing staff fixed their error and got paid. (not from me).
Like what was said previously, if you are using an in-network doctor or facility they are bound to accept the adjusted amounts set by the plan. If it is out-of-network remember your out-of-pocket maximum may be different than for in-network.
Good luck
Neal
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Yep Neal, I agree! Doctors' offices (dentists, ophthalmologists, etc) are famous (infamous?) for sending monthly statements out that usually have charges for which they have not received payment. It's just what the office staff does all he time.
I always wait till the next statement to allow time for them to get paid by insurance. And, as you say, the EOB should show the breakdown ...... also, your account on the insurance company's website will show your claim info.
Greg
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I agree with Neal as well-I found that my insurance company was more than willing to duke it out with the hospital/physical group etc over incorrect charges-I was completely shocked that they did that! Also, don't be afraid to call and challenge the bills with the provider themselves as well. I have learned that mistakes are made all the time on theses bills. Good luck Lyn!
Erin
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When I had my first child, The insurance paid the bill and I was sent the balance. I paid the balance right away so as not to get hounded by the hospital. Some weeks later the insurance company made an adjustment and paid the hospital more money. I called the hospital to get my money back and they told me when this happens they get to keep the extra money! Lesson learned. I don't pay any medical bills now until they threaten collection.
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Send the doctor's office copies of your EOBs. Highlight the parts that say "patient is not responsible for discount" or whatever wording your insurance company uses.
It may be necessary to do this more than once.
Jan
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Lyn .... good advice from Jan and Rupert! Wait till at least the second statement comes to you .... and even then, scruitnize and question the numbers.
The docs don't really know what's transpiring between you, them and the ins co, and the office folks that mail you the statement are only doing paperwork. So there's plenty of time to sit back, relax and breathe deeply. ;D
Greg