Do you follow up on your medical billings?

[Mulligan]

This just happened to me. It is the only time I have ever paid for a procedure at a hospital and I already feel like I was getting ripped off. Now keep in mind this was only a small amount of just over $50 but still... I went for an annual checkup which for me is about every 3-4 years. I was then sent down for blood work. The lady took my insurance card and ran it through and said I owed $108. So I wrote the check, as that is what they told me it cost. Fast forward 4 months, I get a quarterly statement from my
Insurance company and it had the breakdown of savings, insurance payment, and patients responsibility. There the line said $51.99. Well I certainly remembered I did not pay $51.
So after calling several people who finally routed me to the person I needed to talk to, he said indeed that I had a credit for over $50 and change. I asked if I was going to ever receive a refund, he said no we would just use it to reduce any other future bills I may have. Well, I probably won't be back for 3 more years and if I did I may not have used their services anyways. He said I had to request the refund which I in turn did. I asked him in a polite way as I know it is not his fault, "So if I was short that amount, you would have just waited until I needed services again to make up the difference?" Of course, his response was no. I can not believe that the hospital would not notify me of overpayment and refund me the difference. If I had not looked at my quarterly health statement I would not have known, as BCBS certainly didn't know how much I paid the hospital. I wonder if this stuff goes on all the time, or if I was just the unfortunate one?

[bo_knows]

In this day and age, I still cannot believe that medical establishments cannot tell me exactly what I owe at the time of service. You have a computer, you have my exact medical plan, you have a connection to the medical plan's database... why can't you tell me how much you owe?

I almost never pay on the spot. I tell them to bill me. Terribly inefficient, but it prevents overpayment.

[Amethyst]

Having to deal with 3 separate insurances for health, dental, and vision...each has its own issues. For example, the dental bills have to go through the health insurance (and get turned down) first, then the "turn-down" goes to the dental insurance. Since my co-pay is based on rates negotiated between the dental practice and the secondary insurance, I often get billed for months for the "difference" between my rightful co-pay, and what the dental office charges uninsured patients. Many times it has gone all the way to collection agency threats before I am able to get it sorted.

Much depends on the wit, or lack thereof, in a particular medical office. Some of the worst problems resulted from a stupid person in the billing office who kept "losing" the first insurance company's statements or forgetting to forward them to the secondary insurance. While never admitting fault, she informed me it would be best if I did the forwarding myself! There is someone marginally more competent in the office now, although her command of English is limited.

The health and vision insurances have their own issues. Bottom line is that I have to know up front what my co-pays are SUPPOSED to be from year to year, and bring the pre-negotiated list of charges to every visit.

Amethyst

[braumeister]

I've maintained a spreadsheet for years that deals with medical bills. It's very simple, and I've found it has saved me a few bucks from time to time.

Every time I get a bill, I scan it and save the PDF. Then I enter the details in my spreadsheet. Same for EOB forms. Takes almost no time, and I like having the information at my fingertips.

[Meadbh]

This is one reason why a single payer system appeals to me. Procedure goes something like this:

1. Pay income taxes
2. Use healthcare system as required

Much less stress for the consumer!

[Mulligan]

Quote:

Originally Posted by Amethyst Having to deal with 3 separate insurances for health, dental, and vision...each has its own issues. For example, the dental bills have to go through the health insurance (and get turned down) first, then the "turn-down" goes to the dental insurance. Since my co-pay is based on rates negotiated between the dental practice and the secondary insurance, I often get billed for months for the "difference" between my rightful co-pay, and what the dental office charges uninsured patients. Many times it has gone all the way to collection agency threats before I am able to get it sorted. Much depends on the wit, or lack thereof, in a particular medical office. Some of the worst problems resulted from a stupid person in the billing office who kept "losing" the first insurance company's statements or forgetting to forward them to the secondary insurance. While never admitting fault, she informed me it would be best if I did the forwarding myself! There is someone marginally more competent in the office now, although her command of English is limited. The health and vision insurances have their own issues. Bottom line is that I have to know up front what my co-pays are SUPPOSED to be from year to year, and bring the pre-negotiated list of charges to every visit. Amethyst

I guess I am not the only one then. I guess I am a simple man,but you would think they could just look at the insurance card and then it would tell you exactly what you owe based on the contract with carrier and co-payment amount. I just pay cash on dental and they give me 15% discount off the top and it's done, so I get to miss all the billing fun with dental.

[calmloki]

Bear in mind my user name, calm low key.

Had a little issue that required various amblampce rides and hospital stays and some subcutaneous hardware. Billing goes like this: Calmloki, you owe $2400 for the ride. "no, I have insurance"

OK, insurance, you owe $2650 for Calmloki's ride (hunh? where'd the extra $250 come from).

"Bamblance company, we being an insurance company, will pay you $850 and you will take it and smile".

Bamblance. "ok".

As an extra added enhancement I had the sheer effrontery to have an issue not in my home state - sure, my insurance company has business there, but it's maybe like asking one McDonalds to refund for a bad hamburger from another McDonalds? So all the billing goes to other state insurance, gets rejected, sent to me, back to them 'cause we signed up down there ASAP after the event, and then up to my local insurance company. Getting 2-5 letters per day either dunning me or explaining that the insurance has paid, but the provider isn't aware yet, or asking me where I am, presumably so they can repossess the thread and hardware. The doctors never did decide what my whole keeling over issue was about; should I do so again I know where to point my bony finger.

[Rich_by_the_Bay]

It's a mess and does not get easier after Medicare kicks in - in some cases it is even more bizarre. I have dealt with this as a provider (pure chaos) and as a patient, soon to be Medicare.

My advice is not to capitulate - inform yourself of every "line item," wait until insurance/MC acts before paying off any balances. If you have a Health Savings Account, take full advantage; remember you can use it to pay past claims even if you paid them off out of pocket and later identify an error. You can even use the HSA to pay MC premiums down the road.

There is at least a hope that future health care reimbursement will become simpler under OCare at least a couple of years into it.

Lastly, don't let the frustration cause you to not take care of things that need taking care of. It's bad, but better to be well cared-for first, then arguing a bill for months or years.

[harley]

Quote:

Originally Posted by Rich_by_the_Bay There is at least a hope that future health care reimbursement will become simpler under OCare at least a couple of years into it.

Not taking that bet.

Quote:

Lastly, don't let the frustration cause you to not take care of things that need taking care of. It's bad, but better to be well cared-for first, then arguing a bill for months or years.

Good point! Even better, live a long healthy life and let them argue with your estate.

[Bram]

Medical billing can be such a mystery!

My dh had major surgery last fall. The hospital sent a bill to the insurance for just over $50k & insurance declined to pay. Turned out it should have been sent to Medicare first. I check the online Medicare pay'ts frequently. That bill, nor nothing in that ballpark, has ever shown up as having been re-submitted to Medicare, nor to the secondary, nor more importantly to us. It's been 10 months! Medicare sometimes pays very promptly if the bill is submitted promptly. I don't know why providers don't jump on getting their bills submitted.

We've had other similar situations where bills are submitted erroneously to 2nd insur. before Medicare, but nothing like that high $$$ amount. I find things rather confusing in regards to Medicare payments & have learned just to let things take their course. When I get a bill that I shouldn't, I call the provider & straighten things out. The last call, just recently, was precipitated because the provider had not submitted the Medicare EOB along with the bill to the 2nd, who denied pay't. Simple solution, but really... why wasn't that just done automatically? The 2nd ALWAYS wants the Medicare EOB along with the bill.

The Medicare/insur. situation seems quite gobbed up to me. But I've learned just to roll with the flow, because ultimately our out of pocket is very minimal.

[jollystomper]

Quote:

Originally Posted by Mulligan I wonder if this stuff goes on all the time, or if I was just the unfortunate one?

I have seen this happen more than a few times to us. I always review the statements since any co-pay I apply to our Flexible Spending Account. We reported one doctor to the insurance company because it happened frequently with his office.

The one good thing is that we can access the info as soon as the insurance company mails out the reimbursement statement.

Fortunately our family doctor is very good about this, they even caught a mistake over a year old that even the insurance folks missed and sent us back the money with interest and a note of apology.

[savory]

While I do not understand everything, I ask the doctor/hospital/office about how they plan to code the procedure. With the code, I know I can have a direct conversation with the insurance company.

I also do not trust my doctor anymore in terms of the test ordered. I alwasy question them in my mind and with the Doc. The tests will not do any harm (and in some cases you absolutely need them) but the Doc will suggest tests that help with their insurance but not my health. I understand this is a fine line sometimes but my experience has not been positive. My latest example is the Doc would not provide a refill prescription after 6 months for a prostate medicine, that I have taken for many years, without an office visit. I went into the office. She greeted me. Asked me how I was doing. And wrote the prescription. I at least wanted the doc to have the displeasure of checking my prostate. But no such luck on this visit. That was the last visit to this doc.

During another visit for my physical, my iron was a bit low. The Doc suggested taking iron and coming back in 3 months to retest. I knew I felt better after taking the iron since I was not falling asleep nearly every afternoon. In this case, I decided to donate blood where they measure your iron for free. They even give you cookies and juice. So, I may have saved someones life with my blood donation, ate a cookie, and saved what I expect was about $125.

[JOHNNIE36]

You have to check everything and then check it again. I remember from years ago to never pay a medical bill until you have heard from the insurance company, you know, the Explanation of Benefits statement (EOB). Even then, I wait to receive the bill from the provider. My recent hospital experiences have indicated that the hospitals will offer a discount to pay your copay or deductible upfront and I don't mind doing that for a couple hundred bucks savings. I know what my copay is and the hospital will tell you up front what it is and if they don't offer a discount, ask for one. Other than that, I never pay up front.

[imoldernu]

Quote:

Originally Posted by JOHNNIE36 You have to check everything and then check it again. I remember from years ago to never pay a medical bill until you have heard from the insurance company, you know, the Explanation of Benefits statement (EOB). Even then, I wait to receive the bill from the provider. My recent hospital experiences have indicated that the hospitals will offer a discount to pay your copay or deductible upfront and I don't mind doing that for a couple hundred bucks savings. I know what my copay is and the hospital will tell you up front what it is and if they don't offer a discount, ask for one. Other than that, I never pay up front.

+1
Since we went on to Medicare 13 years ago, almost no problems with either the service or our supplement. About the only problems that we've ever had have come from clinics, doctors or hospitals. We pay all of our bills immediately on receipt EXCEPT for those three, where we wait for two months, or until we get the first threat. In almost every case where the bill doesn't seem right, the doctor etc, has gone back to the insurer and it has been straightened out. The few times we paid early, it was like pulling teeth to get the overbilling back.

[MooreBonds]

Quote:

Originally Posted by bo_knows In this day and age, I still cannot believe that medical establishments cannot tell me exactly what I owe at the time of service. You have a computer, you have my exact medical plan, you have a connection to the medical plan's database... why can't you tell me how much you owe? I almost never pay on the spot. I tell them to bill me. Terribly inefficient, but it prevents overpayment.

In all fairness, some of it is probably because they don't want to be left holding the bag in the event of mistakes/fraud.

Just like with auto insurance, just because you have a medical insurance card doesn't prove to the doctor/hospital that it is your bonafide insurance plan, or even that it's currently in-effect at time of service (you could have cancelled it several months ago).

Imagine if you were in a car accident, and you had to settle up with the person at the scene of the accident for their deductible. Would you simply take their word for it that they have a $250 deductible, and that their insurance company will make good on the remaining $3,485 in repairs that it will likely cost to repair your vehicle over and above their deductible?

[katherinejones24]

Quote:

Originally Posted by braumeister I've maintained a spreadsheet for years that deals with medical bills. It's very simple, and I've found it has saved me a few bucks from time to time. Every time I get a bill, I scan it and save the PDF. Then I enter the details in my spreadsheet. Same for EOB forms. Takes almost no time, and I like having the information at my fingertips.

I do the same thing. There were a few times that I found unusual billing to my health care statement. I am with Blue cross blue shield. I am not sure who's fault it is so from then on I kept a spreadsheet for myself to reference to.

[NW-Bound]

Quote:

Originally Posted by MooreBonds In all fairness, some of it is probably because they don't want to be left holding the bag in the event of mistakes/fraud. Just like with auto insurance, just because you have a medical insurance card doesn't prove to the doctor/hospital that it is your bonafide insurance plan, or even that it's currently in-effect at time of service (you could have cancelled it several months ago)...

Or in my case with a $10K deductible policy, the health providers called my insurance, and learned that my expenses had not been anywhere near that limit. They then demanded a big chunk of it, if not all of it, in cash. My long-time doctor does not do that because I am a repeat customer and the charge is small, but a hospital wanted several grands up front for a surgery.

So, if you buy a high-deductible plan, make sure you can cough that up immediately when disaster strikes, though I am sure most people here who manage to ER would not have a problem with that.

About tracking expenses and reimbursements, my secretary/wife has been doing that very diligently, leaving me much time to make posts here.

[Alan]

I've had what happened to the OP occur 3 times.

1st time was back in 1990 when DW went in for overnight surgery, and was released on a Saturday morning. To get her released they insisted I pay $5,050 which was 20% co-insurnace. I told them I had reached the max deductible for the year as I had back surgery a few months earlier. They called the insurance company but it was a Saturday so not open for business. I had to pay up to get her out. When I get the EOB a few weeks later I see that the bill was paid in full so I called the hospital and they confirmed that I was in credit by $5,050 and they hadn't planned to send out a refund to me, expected it to sit there until we used their services again.

Last time was the most bizarre, about 8 years ago. I obviously hadn't been doing a good job of tracking all the EOB's because I received a letter from the Doctor's office saying that my account had been in credit for $75 for well over 2 years and they had refunded the charge (for a tetanus shot) to the credit card I used at the time. I had cancelled that card shortly after and had to dig out old statements, that I fortunately had kept, to find my old account number. I called the CC company and they confirmed I was in credit by $75, but were not planning on sending me a check, even though I had no means of using that $75. (they did send me a check once I formally requested a refund)

[bo_knows]

Quote:

Originally Posted by MooreBonds In all fairness, some of it is probably because they don't want to be left holding the bag in the event of mistakes/fraud. Just like with auto insurance, just because you have a medical insurance card doesn't prove to the doctor/hospital that it is your bonafide insurance plan, or even that it's currently in-effect at time of service (you could have cancelled it several months ago). Imagine if you were in a car accident, and you had to settle up with the person at the scene of the accident for their deductible. Would you simply take their word for it that they have a $250 deductible, and that their insurance company will make good on the remaining $3,485 in repairs that it will likely cost to repair your vehicle over and above their deductible?

Yeah, but your analogy fails by the fact that medical practitioners have computers at their fingertips that supposedly have access to the insurance companies database. They should be able to readily verify, card or not, that you have a specific insurance plan and what your deductible is.

[Gatordoc50]

Quote:

Originally Posted by bo_knows Yeah, but your analogy fails by the fact that medical practitioners have computers at their fingertips that supposedly have access to the insurance companies database. They should be able to readily verify, card or not, that you have a specific insurance plan and what your deductible is.

The insurance company also has computers, so using your logic, should pay at exact time of service. And yet, they take weeks to months to pay.