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Nov
15
Insurance. No small gift. As I mentioned in my previous post, I have been hanging out in hospitals and doctor offices quite a bit recently. I have been shocked at the cost of the tests I have had done, and grateful beyond measure that my husband has good insurance. I know it happens to many, many, many people, but for the first time, I realized that without our insurance, this little health glitch I am experiencing could have financially devastated us. No, I take that back. My health care bills would never financially devastate us, because I would choose to not see a doctor or have tests done. Not for myself. Thankfully, I don’t have to make that decision, but I feel for everyone that does.
I am one of those people who kind of skips along, assuming that most people are honest and doing what is right. I am occasionally wrong. We have Blue Cross insurance and a supplemental dental insurance to help with the orthodontist bills. Most of the providers we see are very familiar with both our primary and secondary insurance, so I never give it a second thought. My sons’ dentist office took a couple of times to actually submit the claims to the primary first, but they got it figured out, so I assumed all was fine.
I got a bill from my kids’ dentist earlier this fall, and for some reason I just thought how can we owe almost $160 for just part of the year, when we have two insurance policies paying on these claims? My first thought was that they submitted the claims incorrectly again, so I made a phone call to the dentists office. First, I do like the dentist my kids see. Second, there is no other pediatric dentist on both of our insurance provider lists, so its a good thing I like her. Anyway, I called her office, spoke with the staff member that answered the phone and questioned the bill I had received. She quickly told me that they did file the claims correctly and the bill was correct. Sigh. So I called each insurance company to try to figure out why I was being charged so much for simple cleanings.
I spent 3 hours on the phone that morning, back and forth with the insurance companies. To their credit, they were all very helpful and tried to find an explanation for the bill. Finally, someone walked through the bills with me line by line, date by date, for the past year. I learned that as a preferred provider, my dentist can charge whatever she wants, but the insurance company has set a cap for how much she will actually get paid for each service – and I am not responsible for the difference. We discovered that the dentist office had been billing me for that difference for at least the past year, probably longer.
After three hours on the phone, I was slightly irritated. The insurance representative told me exactly what to say to the dentists office, and to let them know that if we could not resolve this, then Blue Cross would send a patient rep out to visit with the dentist. I was happy to pass that along. This time when I called, I specifically asked to speak with the person responsible for filing the insurance. The person that answered the phone said that she did it, which I’m pretty sure is not true. But I explained my 3 hours on the phone, what I learned, and what the Blue Cross rep said. Instead of any apology or even acknowledgment that something might be wrong, I was told that she would pass the message along (to who, isn’t she the responsible one?) and someone would get back to me. Very anticlimactic. And more than a little rude.
I waited a week for a return call from the dentist but finally called them back. After I repeated most of the previous conversation that I had with them, I was then told that amazingly enough, the bill in question had been adjusted! Instead of me owing almost $160, I actually had a credit of about $50 on our account. Again, no mention of why the amount was adjusted, no apology, nothing. Which is fine, because being billed correctly was the goal, but you’d think if they want to keep long time patients, they might show some common courtesy when they screw up.
No, I don’t really think it was a screw up on their part. They’ve been in business too long not to know about the cap on charges. I screwed up, by not examining the Explanation of Benefits statements closer and questioning amounts that didn’t make sense. I screwed up by trusting that it would all be handled correctly and honestly. It was a necessary lesson, because now, no EOB goes unexamined.
Because of that incident with the dentist office, when I got a bill for one of my recent tests that said I owed over $600, I immediately called Blue Cross. That time it was a simple coding error. The rep fixed it right when I called and my balance dropped to zero.
I’m sure everyone else is diligent about combing over EOBs, checking and double checking. I’m new to this world of medical expenses. Routine doctor visit co-pays have been the extent of my experience up until recently, so I haven’t had to worry about it. I can tell you though, since I started spending so much time as a patient, I will never take insurance for granted again.
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2 Responses to “Grace in small things – the medical bills version”
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Some Lucky Dog on November 15th, 2009 5:15 pm
You’ve learned and passed on some valuable information. I learned a long time ago that it is important to understand your insurance benefits and how they are determined. Preferred providers and non-preferred seem to be one of the biggest areas that is misunderstood. My hubby and I chose to go to a non-preferred dentist. We also have Blue Cross (federal employee BC), but they pay so little that our dentist won’t contract with them thus he is non-preferred. As a result we pay almost all the bill out of pocket. So many people don’t realize this and wonder why they pay so much! In your case, it sounds to me like the office really did bill you incorrectly or inadvertantly. Good for you for questioning it and making it a learning experience! I keep a separate medical file for each family member where I put all the EOBs and bills I get. Then I match them up and can see exactly what’s been paid and what’s owed.
Sheri on November 16th, 2009 3:09 am
Keeping a separate file for each family member is a great idea! I’m not very organized with it yet, I just go through the EOBs as I get them, but I do need to get organized. That’s partly why I wasn’t very diligent before – the EOBs would get tossed before I had a chance to check them! That meant I had to order back EOBs from BCBS and wait for them to mail them, so now I am saving everything. Wouldn’t it be nice if everything was online