Friday, March 07, 2008

Insurance Woes

Sharon from the Frugal Duchess had a great post about checking your medical bills for errors. I wanted to add my own experience to this.

If you get an unexpected bill, make sure you call and confirm:
1. who sent the bill
2. what services you're being billed for
3. whether your insurance was billed or not

If you get notice that your insurance has denied coverage, make sure you call your insurance company to find out why!

Recently I went in for a routine medical visit and had some routine tests done. I received two unexpected bills. The first was from some billing office that my doctor used. When I first mentioned that I received a bill and I thought my insurance was going to cover it, the person I spoke to said that maybe I needed to get a pre-authorization in order for the visit to be covered. I didn't think that was the case since it clearly states on my insurance card that no pre-auth is required. Once she checked the billing record, she found out that they never even sent it to my insurance!

Next I got an invoice from the testing company saying that my insurance had denied coverage. I called the testing company to get more info, but I didn't get very far besides learning when the claim was submitted. Instead they suggested that I call my insurance company. I was able to get some information from the automated system that said one test had been reimbursed and the other was denied. Of course I waited to talk to a rep about why my claim was denied. I found out that it was mis-coded in the system! It was funny that when I called the testing company, they told me that they hadn't received payment for either test when my insurance had already wired the money for one test. I'm guessing that it takes a few days to update payment status.

I can't believe a routine doctor's visit for someone with good insurance turned out to be such a pain!

Here's what I learned:

1. Sometimes doctors will bill you instead of the insurance because they forgot to bill the insurance (I know some doctors that make you do all the insurance reimbursements - what a headache!)
2. Sometimes a company will send you a bill even though your insurance has already paid the claim - call your insurance company to see if they paid
3. Things get miscoded, which could be a reason for denial
4. Insurance companies pay way less than what is billed! I was billed for two tests that cost over $200 together. The insurance company paid half that!