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Does your medical insurance plan issue EOBs (ie Explanation of Benefits)?
I regularly review these together will the actual bills to determine if I am being billed in a way that is compliant with my health insurance.
Good point. In Medicare, the medicare equivalent can be used to beat the perpetrators.
In fall of 2020 I went to a Dermatologist. First time. When I was leaving, I asked if I owe anything, knowing I had a little bit of deductible left to pay. They said no, we will bill you for it. Fine.
The Medicare MSN, or whatever it is called, showed Medicare paid them 2 weeks after I was there, and my Medigap Plan paid a week after that. Only my remaining deductible to be paid by me.
The months go by, no word from Dr office. Finally, 6 months later, I get a bill from a billing company working for the DR office. The $ amount for me to pay is way too high! and I can't figure out how they could have arrived at that number! I rapidly seemed to sense that this was a rinky-dink billing company, and they were many states away from me. The person who answered the phone said that they would refer it to the person who reviews it, and my bill would be put on "hold". I told them that I would be VERY unhappy if it was sent to a collections company!
Over 2 weeks go by, no word from them, I call again. This starts a loop that repeats each time I call them every 2 -3 weeks hence. The person who answers says, after a pause (probably to look what the present date is), that my bill just went for review on date "X", which is ALWAYS the day BEFORE I called in. Sure, uh-huh.
This loop happens a few more times that I call after no action, each time they say the same (the day before I called it went in to be looked at!), each time I warn them about no going to collections!
Finally, I call and won't let the person go. I'm fed up. They are wasting my time and my life. If they ever hope to get even a dollar out of me, they better listen. I have all the Medicare paperwork, and I tell her when, by who, and how much for what was paid to the Drs office for each item. I strongly suggest that she write them down. She asks me what those numbers were again, and I go through them very slowly, slowly explaining the whole process as she writes them down. Then she tells me all the dollar amounts, dates and items that THEY said they were paid by Medicare and Medigap Plan. They were all really low-balled. I sensed fraud by the billing company.
Another 2 weeks goes by, I call again, reminding the person all the dates and $ amounts that I went through last time that was all supposed to be "passed on".
She tells me it's out of billing, and I should get it via email soon. "When did it go out, I ask?". And she says, after a pause... it went out yesterday!. Um-hmm, sure. Days later, I get the email, the dollar amount I owe is exactly what I calculated.
The story doesn't end there. I was supposed to pay via their payment part of their website. It didn't work. I had to call again to get it set right. I demanded that they U.S. MAIL me a statement showing then that I was fully paid up. I did get that.
My suspicion - That the Drs office was using some really low-cost "processor" that was people working in their homes spread over who knows where. I am thinking that they were making up reimbursement $ amounts that were low, and would just figure that most people would just pay the increased bill, and that those who griped, they would wait them out. I think they decided that they had a shark on the line that would bite them, and decided to cut me loose. I suspect that the $$ they created and skimmed stayed with them, that the Drs office wasn't a part of it and didn't know. [Soapbox item, Drs SHOULD know what goes on in their own office, and any company that they hire to do things for them! It's basic management!]
History - Once at a Megacorp, they hired an in-between that would handle billing through the company health plan. They promised to save the company $$$ (okay, anyone with a brain, what's wrong with this idea?). The dollar amounts they billed were almost always high and wrong, and most people gave up trying to straighten it out, they just wore down and paid. Any employee who squawked, it just fell on deaf ears in Megacorp's benefits department.
Finally, one company director was squawking in an email about it to a fellow employee. But this director accidentally hit "all", and it went out all over the company to every single person! Oh what a great morning that was!!! Thousands of responses agreeing! Crashed the internal e-mail system! Red hiding faces in HR, the in-between company was dropped shortly thereafter.
