Medical Bill Payment

[TromboneAl]

The following seems to be happening a lot recently. We'll get some medical bill, pay it, and then later get a check from that company for a portion of the payment. No explanation.

My guess is that the insurance is paying more than they originally expected, so we end up with an overpayment. Perhaps we should delay payment, and call before paying.

Anyone know what's going on?

[MichaelB]

Quote:

Originally Posted by TromboneAl The following seems to be happening a lot recently. We'll get some medical bill, pay it, and then later get a check from that company for a portion of the payment. No explanation. My guess is that the insurance is paying more than they originally expected, so we end up with an overpayment. Perhaps we should delay payment, and call before paying. Anyone know what's going on?

Perhaps the price you are being charged is greater than the fee agreement the provider has with the insurance company. Calling probably won't help but delaying payment until the insurance company determines how much is owed may.

[FUEGO]

Not sure what is happening in your case, but we sometimes have the insurance company revise their payment of bills. This happened recently with a bill from April. I think we owed an extra buck or two (our 20% of some steeply discounted amount for a lab test). We didn't fight it and just paid it at the next visit.

Our experience is that we usually get a small bill after the visit. We pay the $25 copay, but then none of the lab work or tests/procedures are included in the $25 that covers just the office visit examination. So then we get the bill for something like $3 or $10 (or rather they ask for this at the next visit). This is usually a $400 lab test/procedure that the ins co says they pay $50 for normally, and they pay their $40 (80%) and we pay our $10 (20%). I always have to check the ins co's website to review the explanation of benefits (EOB) to verify what/why we are being charged.

I would recommend checking the EOBs against what you paid and what you were billed. Surprisingly, doctors don't always get their billing and coordination with insurance companies 100% accurate.

[kaneohe]

Why so quick on the draw? I have Medicare and a supplement and I let them go first. Sometimes a whole year goes by before the whole cycle is complete so you have to keep good records of when you pay or you risk double paying if the others don't keep good records.

[Katsmeow]

Agree it is better to wait (if the provider will allow it) until you see what the insurer pays. I was annoyed today to get a bill from a radiologist for a procedure in July. Insurer had paid its part, provider had written down part of it (as per agreed rates with insurer) and I was left owing about $33. That part was fine. What was annoying was that the invoice had a stamp saying past due. This was annoying since it was the first bill received....

[toofrugalformycat]

Ditto, best to wait. I always try to leave the office paying as little as they will let me, because I never know how much the insurance will pay (even though I do my best to find out ahead of time). Then I wait until the bill arrives from the doctor, and wait until it is due, to pay it. I've even had doctor's offices ask me to wait longer, because they would rather not have to deal with refunding me.

[easysurfer]

I have BCBS (hsa) and let this process through first. Nice to get service, show the card and initially no payment, then get a processed bill.

[marylandcrab]

I own a medical billing business. Sometimes months later the insurance company will refigure the fee paid, sometimes lower, sometimes higher. Sometimes they initially deny and say it's deductible, copay, not a covered service, and we bill the patient - then months later they reverse the decision and we pay the patient a refund.
Sometimes our billing system won't function perfectly and will grab some bill by date of service bills and will say they're late when patient didn't pay the first one. Not all the time, but it has happened before.
Sometimes one of my people makes an honest mistake.

[braumeister]

My doctor is great, but the people who do his billing are incompetent.
Wrong coding, bill the secondary before the primary, etc. And even after they finally straighten out all their mistakes (sometimes with my help), there is always some amount left over that I'm responsible for, but they never bill me for it.

I've mentioned this to the doc several times over the last few years, and he always just rolls his eyes and agrees they could do a lot better.

[TromboneAl]

If I wait before paying, and things are revised, can I expect to get a revised bill?

[MichaelB]

We get a bill from the service provider for the original amount (list price), then an explanation of benefits from the insurer showing 1) the original amount billed, 2) the corrected rate, 3) the disallowed amount, 4) the amount the insurance company will pay, and 5) the amount we are liable for. The service provider then bills us again, this time the corrected amount, and asks for immediate payment. When the billing coed and such are correct this usually takes 45 days. When there is an error in the billing code it could take 3-4 months.

[REWahoo]

Quote:

Originally Posted by MichaelB We get a bill from the service provider for the original amount (list price), then an explanation of benefits from the insurer showing 1) the original amount billed, 2) the corrected rate, 3) the disallowed amount, 4) the amount the insurance company will pay, and 5) the amount we are liable for. The service provider then bills us again, this time the corrected amount, and asks for immediate payment. When the billing coed and such are correct this usually takes 45 days. When there is an error in the billing code it could take 3-4 months.

This is exactly how our plan works.

I do not pay the bill until after I receive the EOB from our insurance company. Most of the time the provider doesn't even send us a bill until after the insurer has told them what they will allow/pay.

[JakeBrake]

Quote:

Originally Posted by REWahoo This is exactly how our plan works. I do not pay the bill until after I receive the EOB from our insurance company. Most of the time the provider doesn't even send us a bill until after the insurer has told them what they will allow/pay.

This is my policy also. I'm on traditional Medicare with a Megacorp retiree supplement, which adds an additional time delay.

However, after a recent major encounter with the Medical Establishment, one of those unknown/faceless (to me) providers that came out of the woodwork, forwarded my bill for their services to a collection agency.

I have no idea how this affected my credit score and I really don't care since I have no plans to borrow money, apply for a job. or get a security clearance.

[Alan]

Quote:

Originally Posted by MichaelB We get a bill from the service provider for the original amount (list price), then an explanation of benefits from the insurer showing 1) the original amount billed, 2) the corrected rate, 3) the disallowed amount, 4) the amount the insurance company will pay, and 5) the amount we are liable for. The service provider then bills us again, this time the corrected amount, and asks for immediate payment. When the billing coed and such are correct this usually takes 45 days. When there is an error in the billing code it could take 3-4 months.

Quote:

Originally Posted by REWahoo This is exactly how our plan works. I do not pay the bill until after I receive the EOB from our insurance company. Most of the time the provider doesn't even send us a bill until after the insurer has told them what they will allow/pay.

Same here. I usually get the bill from the provider first but I wait until I get the EOB to see how much I owe. Sometimes, a month later I will get a second bill bill from the provider before I get an EOB. Then it is time spent on the phone with BC/BS trying to find out if they received the bill, and if so why they haven't paid it. A real PITA.

In October I went for a check-up and had to go to the lab for a blood test ahead of time. My insurance number had changed Jan 1st, and I watched the receptionist at the lab correct the number on my details form from my new card. A few weeks later I get a bill saying that BC/BS had rejected the claim and I had to pay in full. I then marked up the bill with my new number and mailed it back to them. Last week I get a new bill from them where BC/BS has paid the contracted price.

[TromboneAl]

Today we got our first bill for the parathyroid surgery at UCSF.

Before I tell you how much it is for, I'll let you know that when we first saw a doc about this, I asked whether we'd reach Lena's $5,000 deductible for the year.

The bill is for $33,249.98. No problem filling the deductible. If I understand everything, we will pay our $7,500 max out of pocket for the year.

But, at the bottom, it says "PAY THIS AMOUNT 0.00." So my guess is that they are telling us not to pay this now, and wait for the insurance company to be billed.

[REWahoo]

Quote:

Originally Posted by TromboneAl But, at the bottom, it says "PAY THIS AMOUNT 0.00." So my guess is that they are telling us not to pay this now, and wait for the insurance company to be billed.

+1

I'll be interested to hear the numbers after the insurance company massages the bill.

[braumeister]

Don't be surprised if you have to write a check to them for $0.00 to clear their record.

[MichaelB]

Quote:

Originally Posted by REWahoo +1 I'll be interested to hear the numbers after the insurance company massages the bill.

+1

[TromboneAl]

Quote:

Originally Posted by REWahoo +1 I'll be interested to hear the numbers after the insurance company massages the bill.

I am hoping that my understanding of the term "max out of pocket" is correct. That is, I won't pay more than $7,500 for the year without a major fight. Do you think there is any fine print or loopholes here? We've already spent $4,236 so far.

[MichaelB]

Quote:

Originally Posted by TromboneAl I am hoping that my understanding of the term "max out of pocket" is correct. That is, I won't pay more than $7,500 for the year without a major fight. Do you think there is any fine print or loopholes here? We've already spent $4,236 so far.

There shouldn't be any loopholes, but the $7.5K MOOP covers eligible expenses.