If It’s More Than A Copay, Call Before You Pay

Paying for health care is complicated, and having health insurance doesn’t always help. Mr. PoP and I each have health insurance through our respective employers, but our health plans are very different from one another. Between the HSA, PPO, flex savings account, in-network, out-of-network – not to mention having the car insurance company involved for a claim there – it can be a nightmare to keep it all straight.


With that many moving parts involved, and the potential for some big bills, I’ve finally just adopted a pretty straightforward strategy for medical bills.

If it’s more than a copay, call before you pay. (Click to Tweet this!)


This Saved Us $86 This Week

About six months ago, I had a respiratory infection from hell. At one of the (too many) doctor’s appointments while trying to fend it off, my (in-network) physician took some blood to make sure that my immune systems was doing its job properly. (It was, thanks for worrying.)

Well, six months later, I get a bill in the mail for $102 from a medical lab across the state. It didn’t take too long to figure out that it was the blood tests done when I was sick. But why wasn’t there any mention of any insurance coverage on it? My doctor was in-network, and he took the blood – shouldn’t it have been covered under my copay that day?

So I called my insurance company. And a lovely lady named Alma helped me out. Yes, the doctor was in-network, but the lab he used is out-of-network, so they have the right to bill you. But wait! They were sent an EOB. (That’s Explanation of Benefits for those of you not up on the healthcare lingo.) Sweet Alma told me that my bill should be $16 based on the EOB, not $102. And best of all, she was going to straighten this out for me right then.

I held on the line while Alma called and sure enough, 10 minutes later she had confirmed with the medical lab that the my bill should be $16. What happened? A “clerical error” where the EOB wasn’t noted on my file.

So what would have happened if I hadn’t called? In all likelihood, I would have paid the $102 and never been any wiser. It’s doubtful that the lab would have ever realized the error, and even more doubtful they would have sent me a check to refund the difference. So that 20 minute phone call really did save us $86.

As pessimistic as people can be about the health care system, I have found that if you call and are sweet and nice, the customer service and billing reps on the other end of the phone go out of their way to help you. And sometimes their help and advice is worth a LOT more than $86.

Get to Know the Billing Department

A year ago a friend’s infant spent over a month in PICU (pediatric intensive care unit) and had major surgery (he’s fine now!). Even with their insurance coverage, their bills were astronomical. They made too much money to qualify for grants, but the bills were big enough that they would basically be paying the equivalent of this kid’s college education when he was still in diapers.

While they were in the hospital, a nurse told them the hospital ran pay-in-full forgiveness programs occasionally, but they would need to work with the billing department to work it out. Basically my friend arranged to pay minimum monthly payments to the hospital, while calling every few weeks to see if the forgiveness program was active. Before too long, a 50% pay-in-full program was activated. They then paid 50% of the remaining balance on their bill, and the other 50% was forgiven.

This persistence, inside knowledge, and many many phone calls saved that family tens of thousands of dollars.


Challenge Any Denials

Almost everyone I know has had a claim or reimbursement denied or only partially paid at one time or another. I’ve seen $20K tests initially denied coverage, only to have it covered after a formally contesting the denial of coverage. Too often I’ve had Flex Benefits claims denied, but when I call and explain what the receipt is for, the answer is – handwrite that on the receipt and send it back in.  Then it’s approved.  Our denials of coverage or reimbursement haven’t been in the $20K range so far, but calling and questioning the denials almost always gets advice on what you can do to get the treatment covered.


When In Doubt Call

Serisously. The regular customer service at our insurance company is great for the smaller things like we’ve experienced, but they also have an entire department of advocates on staff to help their insured navigate the system and negotiate payments when it gets really complicated – like the case of my friend and her baby’s month-long stay in intensive care. So running the risk of being redundant…

If it’s more than a copay, call before you pay. (Click to Tweet this!)

Were you able to find errors, successfully challenge claim denials, or otherwise reduce the amount you were initially billed by a medical provider? Please share your stories and advice so everyone can benefit from them.


****Author’s Note: None of this is meant as a commentary on any political policy, nor is it intended to spark any debate on health insurance in America. 



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