And... More Insurance

I just got a bill for x-rays that I think should be covered.

My old insurance from years ago I used to have a copay. Go to visit/copay/BE DONE WITH IT.

Now I have a share, which is fine. Problem is I get a bill and I have no idea if that is my shar or the whole bill. I have to research it and then either wait or fill out paperwork and resumit it and WAIT to see if I still owe them any money and again figure out if it is correct or not.

IT SUCKS.

I don't like to be late with my bills but how the F can I pay them if I'm not sure they accutraly reflect what I owe?

Hi Dexter...

I have insurance that works the same way. There's no co-pay, but I have to pay a part of the bill.

If yours is like mine, what should happen is...

- the doctor submits the bill to the insurance company.

- If the insurance company is slow to respond, the doctor may send you the whole bill. I've found that this is just a formality. If I call the doctor's office, they usually tell me that they've submitted it to insurance, and not to pay the bill yet... to wait for insurance to reply.

- At some point, insurance will process it. When they do, they will generate an "explanation of benefits". They should send you a coy of this, but you may be able to access it online before the physical copy reaches you. It should show what the doctor billed, what the negotiated rate is (i.e. if the doctor bills $1000 for an xray, but is in network, they may have a negotiated rate with the insurance company of only $200 for the same xray. You are paying the negotiated rate, not the full rate), whether you've met your deductible, and if so, how much the insurance company has paid and how much you'll need to pay.

- You *should* get another bill from the doctor, showing what you owe. In a perfect world, this should match your explanation of benefits.

If you're nervous about this you could...
a) call the doctor's office and ask if they've billed insurance yet.
b) go online and check your insurance to see if a claim was filed, and if it's been processed yet.

I hope that helps. Dealing with insurance and doctor bills is such a huge pain. I'm still struggling to get a receipt showing what I paid for a procedure back in November. It's very frustrating. I hope you're able to get this all sorted out without too much stress. (And, forgive me if I misunderstood something and just typed a whole lot of useless info at you!) Good luck.

I've found that the "explanation of benefits" letter I get from the insurance is often incomplete/premature so I have to wait for a second one to see what is or isn't covered. In the interim I get another bill from the lab or doctors office with a different amount but it isn't the final amount. If I simply wait I get a final bill that is lower. It is almost as if they are trying to trick me to see if I'll pay a higher amount.

At first I was going to the insurance site to check the status of claims but that has stopped working. Either it won't load the claims page or the numbers there are severely out-of-whack and I can't make them match up to received bills. That's what happened last year when it was showing that I had paid over twice as much as I actually paid for prescriptions putting me way over my max, yet I was still being charged for prescriptions that should have been free. I got the charges fixed but not the inflated "cost". I thought it was taken care of but I think that's the source of the check I just received that I posted I think in another thread.

Thanks guilloche it's no way to run a system.