Mar 30, 2011

Call Before You Pay (Janssen)

I have a secret theory that some companies send out bills without a lot of detail or add on extra charges, hoping that you'll pay them without noticing or bothering to find out what exactly you're paying.

A couple of weeks ago, a friend asked me how much we'd paid out of pocket for our daughter's birth. I told her (probably with no small degree of smugness) that it'd been completely covered by insurance.

Then, of course, THAT AFTERNOON I walked to the mailbox and pulled out a bill from the hospital for the sum of $700. My baby was eight months old! What could I possibly owe? Also, goodbye tax return.

I went home and called the hospital to ask what this $700 bill was for (you might have guessed that the bill made no mention of WHAT I might owe $700 for, just that I owed it and ought to pay it quickly before it went to collections).

They told me that $200 of it was my co-pay and $500 was my co-insurance. (I have no idea what co-insurance is). They did rush to assure me that the insurance company had already paid $15,000 for her birth, and had only bumped back this very small $700 charge. This did not make me feel better.

I felt certain that everything we'd read about the health insurance plan insisted that a birth would be completely covered and there would be no copay at all. So I called my health insurance company and asked how come they hadn't paid it.

The answer? They'd listed my delivery as being out of network. Was it? Of course not, and as soon as they looked up the hospital where she was born and my plan, it was clear that she was born right smack in the middle of the network and that I certainly did not owe $700 and they would cover it.

But if I hadn't called, I would never have known, and I also would have been $700 poorer. On Monday, I got a form from the insurance company indicating that they had increased the amount they paid and I now owed nothing.

If I wasn't already convinced that you shouldn't call about any bills you think you don't owe, I certainly am now.


Anonymous said...

So true, but especially true for medical bills. I'm not exaggerating when I say that 80% of my medical bills are incorrect. Frequently, I have to get on the phone with the provider and the insurance company (sometimes on a conference call) to get them all straightened out. Over the last 10 years, I estimate that I've saved close to $3,000.

Katie Rich said...

I should have Joey read this post. We just got a bill for a hospital procedure that we paid a $100 down-payment on, but the bill does not mention that down-payment anywhere. The price might still be correct, but I want to know for sure before we pay.

Miriam said...

We had a similar thing happen when Chelsea was born. We called the insurance company and it turned out the denial we'd recieved was from an employee who had been fired because of all the mistakes he'd made! We were covered :)

Miss Creativity said...

Found your lovely blog via tea and crumpets and oh dear it makes me so glad we have the NHS we may grumble and complain but at least we do not fear the postman. I hope you sort it out and if you ever fancy a virtual coffee and sympathy then you are always welcome at my place.
Take care, keep safe, be happy

Nathan Pralle said...

I hate, HATE medical bills and the medical billing process. It pays to call because 99% of the time, even the folks doing the billing don't have a firm grasp on what they're doing.

Co-pay is what you pay up front, before the deductible kicks in at all. Co-insurance is present when your plan says that after you hit your deductible but before your out-of-pocket max you have to pay a percentage of the total cost. EG:

$0 to $DEDUCTIBLE = You pay all.

$DEDUCTIBLE to $OOP MAX = You pay whatever percentage the insurance does not. Some plans (like mine) are 100%, so you pay nothing. But my old plan was 70% coverage, so I had to pay 30% of the cost.

$OOP MAX to $LIFETIME MAX = Insurance pays all.

It's a crazy system. What you ran into is that some insurance plans if you're IN network, you don't have co-insurance. But if you're out of network, suddenly you'll have a co-insurance.

Jennie said...

I think what frustrates me more than anything is not the act of calling or having the conversation but how IMPOSSIBLE insurance companies or just general customer service reps makes it to call. Lines are busy, wait times are insane, the calls get mysteriously disconnected. They make it so hard for anyone (but, especially people with busy schedules and small windows of time to make these calls) to deal with this stuff.

I'm not saying anything newsworthy, of course, but it's just so hard to be responsible at that's just so frustrating.

Karina said...

Medical bills are ALWAYS wrong.

But $15,000?! What the...?! Did something go wrong during delivery? I thought Laela was expensive at $2,800 with the midwife. Avery was only $1,800 with a midwife.

Nathan Pralle said...

My son's birth was just over $67,000 with a C-sec. So yeah...I see $15K as pretty cheap. :)

Anonymous said...

Why are medical costs soaring?