I have health insurance through work, and I always choose the plan with the lowest deductible (which is $1,000). Most years, I barely even touch my deductible. 2018 has been a different story!
I’ve already racked up over $500 in medical expenses this year, and I’m sure I’ll max out my deductible by the end of 2018.
Over the past several months, I’ve woken up in the middle of the night a few times with excruciating abdominal pain, back pain, and vomiting. Since it always happened after eating a high fat meal, my doctor suggested getting my gall bladder evaluated.
It turns out that I have gall stones. I had some other lab work that came back abnormal, so I need to follow-up with a specialist to make sure everything is good to go before I have surgery.
Dealing with health issues is never fun, and it’s even more stressful when you see the bills.
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I’ve incurred over $500 in medical expenses this month, and the worst part is that ALL of these expenses could have been avoided. Here’s why this happened – and what you can do to make sure this never happens to you!
Clinic is In-Network, but the Doc Isn’t
Who even knew this was a thing?! I sure didn’t.
When I found out I needed a gall bladder ultrasound, I talked to the billing coordinator at my doctor’s office to get the CPT (current procedural terminology) code for the ultrasound.
The two of us sat together in her office and called the insurance company. We confirmed with the customer service rep that the procedure was covered and that the clinic was in-network.
The guy told me that the procedure was 100% covered and I wouldn’t have to pay a cent out of pocket.
Flash forward a few weeks later and I received a bill for $250 – the entire cost of the ultrasound. When I furiously called up the insurance company, the rep told me that the clinic is in-network but the radiologist who reviewed the scan is not.
I had never been told the radiologist’s name and I hadn’t even met him.
I had never heard of this before, but apparently it is actually common. If you ever need to have a test done (like an MRI), make sure that the radiologist is in-network!
If you’re having surgery, verify that the hospital, surgeon, anesthesiologist, and any other relevant doctors are in-network as well.
Exclusions No One Mentions
According to the insurance plan documents I received during open enrollment at work, lab work is 100% covered and does NOT go to my deductible. Imagine my surprise when I got a bill for 100% of the cost of lab work.
After numerous conversations with different customer service reps (who all gave me incorrect information), I finally talked to someone who know what he was doing.
It turns out that there is an exclusion that no one (including most of the customer service reps) seems to know about. Lab work is 100% covered UNLESS the clinic sends the lab work out to a hospital for it to be processed.
In that case, the entire cost goes toward my $1,000 deductible.
Billing Errors
In addition to the many rules, nuances, and exceptions described above, my insurance company also screws up my bills. On more than one occasion, I’ve been erroneously charged a specialist visit copay instead of a primary care visit copay.
One would think that this would be a relatively easy thing to fix, but of course, it isn’t.
Each time, I call the insurance company and the doctor’s office numerous times until I finally reach someone who knows how to do their job. Basically, each party tries to blame the other and neither will do anything to resolve the situation.
By the time I FINALLY talk to someone who will actually fix it, I’ve spent hours of my life trying to save $25 and questioning whether or not it’s even worth it.
I’ve considered changing insurance companies, but I get my insurance through work, and getting it anywhere else would be insanely expensive.
If you’re ever thinking about getting Humana for medical insurance, I strongly encourage you to look elsewhere.
Lessons Learned
While dealing with unexpected expenses (and insurance companies!) is never fun, I’ve learned a lot from these experiences, like:
- It’s not enough to make sure that the clinic or hospital is in-network. Make sure the doctor is too!
- Don’t believe everything that insurance customer service reps tell you.
- Even if something is generally covered, there may be exclusions or exceptions.
- If something looks incorrect on a bill, it probably is!
- Don’t give up when trying to fight an incorrect bill. Eventually you might talk to someone who knows what they’re doing and will help. (If not, insurance companies have an appeal/grievance process).
Have you ever had any unexpected medical expenses?
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Healthcare many times feels like a game – there are rules, different players and it so often you feel like you’ve lost instead of won! Having worked for a company that fought the insurance company for proper payment (you’d be surprised how many ‘mistakes’ are made), I can’t stress enough that doing your homework is crucial. First, read your plan (as boring as it may be) to figure out how it works. What’s your deductible, what’s your co-pay, what does in network look like vs out of network. Second, always inquire of a doctor’s office to make sure they accept your insurance – and great call on checking to make sure certain services or doctors are covered too – you’d hate to be surprised!
I also whole-heartedly agree with checking your bill – if something looks off or fishy – definitely call to inquire. Mistakes could have been made on either the doctor’s side or on the insurance company. Simple mistakes on their side could mean major pain on your end!
I couldn’t agree more!
This may not apply to you but I work for a small company so we change insurance companies every year or two to get the best rates. It’s a huge hassle for my family since my oldest son is diabetic and every time we change we have to go through the process of getting him approved for all his diabetic supplies. We have always had a contact person through our insurance broker though that is basically a liaison for us to the insurance company if we’re not getting results with an insurance issue. Might be worth checking out to see if you have someone similar.
Sorry to hear that it’s been such a hassle for you! I will definitely look into that. Thanks for sharing!
I’m glad your health is on the road to improvement. What happened with your radiology report is not cool. I work in insurance and it’s a customer service business. I would say that given your denial after the preapproval you should call them back, indicate you were proceeding on their advice and in good faith, and insist they cover at least 50%. Good luck!
Thanks! I did that and they promised to review the claim. A few weeks later, I received a letter simply stating that the original processing of the claim was correct. I could file an appeal, but at this point, I don’t feel like it’s worth the time (it if were for a larger amount of money, I definitely would).