So far, we've had very few problems with the bills and insurance. The doctor's offices know how to submit proper bills and Connecticare has been paying them promptly. That doesn't mean that mistakes don't happen, so it's important to review everything before you pay it. Here's one problem I recently uncovered.
Two weeks ago, the radiologist's office sent us a $279 bill for a July visit. This surprised me: why would I receive a bill 5 months after the service was rendered? I know Connecticare paid the bill--I reviewed it last year, around the time I did my first financial post.
Moreover, I couldn't understand the charges on the bill itself: the debits and credits netted out to zero, yet the bill showed a balance due. Where did the charges come from?
Connecticare's website provides a complete claim history, so I compared the bill I'd received to their transaction history. Tracing the history, it looks like Connecticare paid the claim and later denied it (perhaps on an audit review?); it was then resubmitted and paid by Connecticare. Somewhere in the process, the radiologist's office generated our bill for a "phantom" balance of portions of the charges.
I called radiologist's billing office and the clerk quickly reviewed the bill, told me it was an error and not to pay it. I'm glad I called! Had I paid the bill, I would have had a credit-balance with the radiologist until they eventually reconciled their books and refunded my money. Right now, I need the use of that $279a lot more than the radiologist does.
Always, always, review your bills and make sure you understand them before you pay!
2 comments:
Sandy that billing error may be the first of many. I speak from experience with medical bills for our relatives and especially ones getting complex treatments and surgical procedures.
I would like to suggest to Joe that he deal with this exclusively and not even tell you about it. I have spent hours and hours trying to deal with insurance and medical billing problems. It is maddening. I used to work in that field so I know all the facts and get the rules about billing codes and insurance coverage etc. I feel a great number of errors are being made due to non-trained staff = ignorance of policy or else maybe sheer stupidity or even sometimes staff being careless and not thinking of the impact on people. It can get REALLY stressful to deal with the billing errors.
The last thing Sandy needs is to know of these issues. Sandy consider not even looking at those bills. Sandy you have enough stress and worry and need to concentrate on healing not dealing with administrative errors.
Insurance companies sometimes play tricks too. One example is someone had a colonoscopy under anethesia in a surgical center. The doctors and center were participating with the insurnce. A giant bill was received from the anesthesia office asking patient to pay it. Dr. office = anesthesiologist said "we are not participating with that insurance plan so you have to pay the balance they didn't pay". Insurance said "they are not in our plan so we didn't pay the full amount and patient has to pay". However since the patient has no say at all in who the anesthesiologist is the ins. has to pay the full amount as an 'exception'. You see the anesthesiologists hate the low reimbursement of the HMOs and ins. companies so some of them refuse to sign contracts with any of them to be participating. So with one call saying the right things the insurance company admitted they must make an 'exception' to pay 'as if in network' and the patient was let off the hook.
Also we are still getting bills for Cancer treatments for a relative that were rendered over 18 months ago...still dealing with those...
And also recently a doctor's office didn't bill the patient for something that was applied to dedictible, it was a current bill not past due, but the patient was sent to collection agency! After I got involved the error was admitted, it was paid, and I made sure it didn't get put onto the credit report for the patient as it was not even late!
Thanks Christine! Joe is actually a data base analyst for the medical auditing portion of his company, so he's pretty thorough with our bills. He knows the billing codes and standard practices. Our insurance company has actually been very good about payments; Joe has been auditing everything along the way!
Post a Comment