This past November, my wife had to see a doctor at our local Urgent Care. Unfortunately, when the bill showed up the claim had been denied. The reason? Out of network. The problem? It wasn’t out of network! It’s supposed to be a $20 co-pay with the rest going to insurance. So… I called the Urgent Care billing office on December 15th. They confirmed that it should’ve been covered, and promised to re-submit the claim. Fast forward to this week…
We just got another bill from Urgent Care. Same deal — they want the full balance. This time, however, it seems that our insurance company decided to split the difference and apply it to our deductible instead of flat-out denying the claim, or paying it like they’re supposed to. When I called the Urgent Care billing office, they weren’t sure what went wrong, but promised to re-file the claim. Again.
Instead of waiting another month to see if the problem was still there, I decided to call Blue Cross & Blue Shield directly. After a bit of noodling around, the CSR seems to have figured out the problem. It seems that the doctor filed the claim using his own taxpayer identification number (TIN) instead of the TIN for the Urgent Care clinic. She further stated that whenever this happens, they have to go in and override it by hand. Whatever.
The bottom line here is that a less persistent person would’ve assumed that the insurance company knew what they were talking about, or perhaps lost track of the situation entirely and ended up paying the bill. Always double-check your medical bills. And always appeal your health insurance denials.
Amazing. This is precisely what happened to me just yesterday with a ophthalmologist. After reviewing my claim at A****, I noticed I was going to be billed the full amount even though I called the day before my appointment to confirm if the visiting doctor was ‘in network’ They hemmed and hawed saying that he was but gave me transposed digits as to which address where he was covered. The ‘doctor’ was listed as being ‘in network’ on the insurance company’s website.
I called the ophthalmologist’s and they said ‘we warned you’. But they didn’t tell me that this visiting ‘doctor’ was going to use a different tax ID to bill (gets more cash that way). The insurance company is reviewing the case.
Now I read from others here that this ‘in network’ ‘out of network’ shell game is becoming common.
A pox on both their houses!
It is absolutely imperative that you get an itemized list of billing as it will shed light on obvious fraud, I was relieved of a $68,000 dollar bill because I proved blatant fraud by getting this itemized bill. I promptly backed my truck to the hospital dock and instructed the administrator to load the improperly charged items onto my truck and I stated that if I am going to pay for these pieces of equipment that was on my bill, I wanted possession of it and that is when they decided they should rethink the bill. A BIG FAT ZERO!
My wife and I have run into similar problems, lately. And, a lot of them. One of the problems had to do with our child’s birthdate recorded incorrectly in the computer. That problem stemmed from my employer (its side of the computer system). The other problems have had to do with the doctor’s office incorrectly billing. My wife and I truely believe that these ‘medical errors’ are a scam created by the industry, to dupe careless, naive customers into paying twice.
I always review any doctor/dentist bills that I recieve. I ran into one incident about 3 months ago where the insurance tried to only pay half of my chiropractic bill claiming the chiropracter charged more than was usual for my services. I always call the insurance company directly instead of dealing with the doctor’s office. Luckily, my situation only took one call to resolve.
The whole medical / insurance billing process is truly a fiasco. It’s really no wonder that insurance rates keep going up. Recently, my wife had a 2 minute “free consultation” with a dental specialist. Turns out that it wasn’t truly free — they charged the insurance company $60. For a 2 minute non-contact “consultation” on whether to have actual treatment performed. If we’d known they were going to pull that, we would have thought twice about even doing it.
The lack of transparency in medical billing is quite disturbing.
I have found errors with insurance billing too many times to detail. It takes way too much time to fix, but I always do it because I’m too tight with money to let them get away with such things!
The worst problem I ever had to fix was when my husband and I switched jobs/ insurance/ states when I was heavily pregnant with our second. I went in for my final OB apt with that provider on my last day of work.
When that provider billed my insurance, the entire charge for services up to that point are billed as of that last appointment day $2500?). My insurance denied it because I was no longer eligible. ??
Turns out my employer told them my last day was the DAY BEFORE my real last day. It took about four months to get everything straighted out. By then, I was almost done dealing with the billing problems from the birth!
My friend is getting fertility shots…well, his wife is…and they got a bill for about $6,000 a few weeks ago. Turns out their insurance had them marked as out of network incorrectly.
Now, that huge bill was definitely a tipoff. Really, it’s the little things that are hard to pick out.
For us, we have 100% coverage, no deductibles and small copays, so I only care about the bill if we have to pay more than $20 or $40 (specialist)
Very true. Just this weekend, we went out for pizza. Of course, I always tabulate stuff in my head, and the total at the counter seemed to high. When I got the receipt, they had charged us for three kids drinks when I had asked for water. After that, we went to Target my wife caught them double scanning a package of Pull-Ups that we were buying (along with other things).
A common problem, it seems, is how the provider identifies itself to the insurer. You may have access to both Blue Shield or Blue Cross providers, but the provider might mistakenly bill through one of which he is not a preferred provider.
I’ve had to deal with this and it’s extremely frustrating. The provider often isn’t aware of the proper billing procedure and address, the insurance won’t budge, and you’re expected to pay deductibles.
This is REALLY important. It took me over a year to get an erroneous $1400 charge off my hospital bill when I gave birth to my second child. I had to call, write letters and finally had to call their PR department and threaten a letter to the L.A. Times on their shoddy billing practices before I finally got the charge removed!
Even after all that, they failed to record the payment i did make (for the only amount I owed – $250 copay – which i paid in advance of the birth of my child). They insisted they never received it, even though I paid it in person. I had to go to a lot of trouble to get the cancelled check back from my bank before they fixed the bill. I wrote a steamed letter to the president of the hospital – and this is the most prestigious one in Los Angeles! Who knows how many people would’ve just paid, either in ignorance or to avoid the frustration?
I concur with Jim – this advice applies to all bills (and don’t forget purchases). The assumption is all those scanners are correct, but people input the prices and they do make mistakes…
I think it’s important to double check all of your bills, medical ones especially, because people make mistakes – and medical mistakes are costly.