Just a quick reminder that you should review your insurance “statement of benefits” and bills to ensure they are classified and paid properly. You can’t rely on the doctor’s staff to submit the bills to your insurance properly, and you also can’t trust the insurance company to handle the claim properly every time.
Whether it’s incompetence, “fat fingers”, confusion, neglect or overwork, both accounting offices are prone to make errors on your bill that could end up costing you hundreds on a single visit or even thousands over a year. One such error just happened to us.
Since changing to a lower coverage medical plan (90% vs 100%) this year, I’ve been logging into my insurance carrier’s website to validate how they were handling my claims for my recent back problems. This past week, I noticed that they finally processed the claim for the MRI I received on December 31st, and not surprisingly, they didn’t process it at 100% reimbursement. They were charging me over $300 for the procedure! The submitted amount was about $1200, but they applied a $300 discount. My share of the remaining amount was supposedly about $310.
I had to wait over the MLK Jr. holiday to get through to the carrier’s billing department to rectify the issue. Originally, since they didn’t process the claim until the new year, I thought that they had processed it under the new medical plan (same carrier, same plan number, different coverage). The agent informed me, instead, that the claim was billed under out-of-network coverage!
I had to second-guess whether I had looked up the Radiology center properly and whether they really were in-network. However, a quick reply from the agent indicated that the claim was placed through the doctor’s name, not the business’ name. I had looked up the business, not the doctor, so I hoped that was the problem.
I jumped over to the insurance carrier’s site, used their find a doc tool, and found the Radiology center showed as in-network on my plan. Great! I confirmed that the company was in-network and it was a simply billing error. I called the Radiology center, spoke to their billing office and she almost immediately recognized the error when she looked at my records. Apparently, they outsource the actual claims submissions to a contractor, and the contractor goofed. She said she would contact the contractor immediately and get the bill resubmitted. Whew!
When we were under a 100% coverage plan, we never bothered to even look at how much the doctors were submitted to billing, and how much our insurance company was actually paying. Now that we are responsible for 10% (plus deductible) of our bills, we’re much more vigilant. And that’s why our premium on this plan is $2500 less per year than the 100% coverage plan!
- Understand your insurance plans: medical, dental, prescription, auto, homeowners, umbrella, etc.
- Review your insurance Statement of Benefits when they arrive.
- Be proactive to catch errors. You can’t rely on someone else noticing the error and fixing it on your behalf. Personally, I log in to the insurance carrier’s website to be proactive, but the carriers are pretty good about mailing the paper copies to you soon after they finalize in the system.
- Don’t be afraid to point out errors. Some people, maybe even you, are worried about “complaining” because you’re afraid of confrontation. This isn’t complaining or arguing; it’s fixing a minor problem that has a big consequence for your wallet. Most companies really aren’t malicious, so it’s probably just a goof, not intentional.
- Along the lines of #1, review your insurance policies to see if you could really be saving money by “downgrading” your coverage. We determined that even if we hit the deductibles and out-of-pocket maximums this year, we would still save money over the difference in premiums of the two plans. Also check how much you could save by increasing your auto deductible up to $500 or $1000, or your home deductible to $1000 or higher.
Basically, the lesson is to learn where your money is going!
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