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Keep a Close Eye on Your Medical Bills

February 15, 2009 | Healthcare | My Ramblings | No Comments

Like many of us, I used to go to the doctor or dentist and then receive insurance statements and doctor bills.  For the statements, I would quickly scan them and file them away.  I would then pay the bill.  A few years later, I learned the hard way that I should have been paying closer attention because it was costing me money.

I found out by accident that my dentist, who I went to for years, was ripping me off.  As a result, they ended up having to refund me a few hundred dollars.  What my dentist did was bill my insurance company and have me pay the difference.  For example, the dentist would bill the insurance company $200; the insurance company would pay via the contracted rate of $120 and determine my out of pocket cost of $20.

However, the dentist would bill me the difference of the full amount ($200) and the contracted rate ($120) which was $80.  So I ended paying $60 more than I should I have paid.  This went on for a few years until I caught on.  Looking back, I should have reported them because I’m certain they were doing the same to other patients as well.

Below are some other things I’ve learned over the years to keep a close eye on:

Make sure your medical provider is in network. A couple of years ago, I went to a dentist for a cleaning.  When I made the appointment I asked if they took Aetna.  They said yes.  The cleaning was 100% covered by Aetna.  A few weeks later I got a bill from the dentist.  When I called the dentist office I was told they accepted Aetna but they weren’t in Aetna’s network.  I refused to pay the bill because they didn’t tell me they were out of network.  They ended up cancelling the charge.

Make sure you know what’s covered by your insurance company. A few years ago, I went to a dentist for teeth cleaning which was 100% covered by my insurance company.  At the end of the cleaning, I was given a fluoride treatment which I didn’t request.  The fluoride treatment wasn’t covered and as a result I was billed by the dentist.  I felt this was a gimmick by the dentist just to earn more money.  The fluoride treatment wasn’t necessary.  However, in the future I made sure to pay attention to things like this!

Make sure your procedure will be covered by your insurance company. If you are having a medical procedure that’s out of the norm, make sure your insurance company will cover it.  Many doctor offices will do this for you, but some won’t.  You do not want any surprises.  Make sure that when you call the insurance company, you document everything, especially who you spoke to. Also, have them send you documentation.  You may speak to one customer service rep that tells you something is covered and when you call back, the 2nd customer service rep will tell you it’s not covered.  This has happened to me; see below!

Don’t hesitate to dispute a claim in writing. About a year ago my doctor recommended that I have a colonoscopy to check for colon cancer since a close family member had polyps found during their colonoscopy.  I called Aetna to see if the procedure would be covered.  They said yes, it would be 100% covered.  To my surprise, Aetna didn’t cover the procedure.  When I called, the customer service rep said it wasn’t covered.  I explained to her that when I first called I was told it would be covered, but I had no evidence of this.  I didn’t even have the name of the rep I initially spoke to.

I then decided to dispute the claim in writing.  Aetna responded by letter a couple weeks later that the procedure was indeed covered 100%.  However, Aetna ended only paying 1 of the 3 bills.  So I wrote a 2nd dispute letter, which, they never responded to.  A couple months later the 2nd bill was paid and just recently after me calling them again (7 months later), they paid the 3rd bill.  Unbelievable!

Never pay the doctor bill until the claim is processed by the insurance company.
Many medical providers will send out bills before the claim is processed.  Sometimes, they’ll send a bill for the entire amount, which makes no sense.  Sometimes, they’ll estimate what the insurance company will pay and your out of pocket cost.  However, you should never pay the bill until the claim is processed because the insurance company will determine the contracted rate and your out of pocket cost.  Always pay by what the insurance company determines and not the medical provider.

Shop around and compare prices. I must admit that I rarely do this; however, I have in the past for dental procedures which saved me hundreds of dollars.  Of course when it comes to your health you want the best care even if you have to pay more for it.  It’s unfortunate that doctors don’t list their prices and most patients never ask.  But shopping around to compare prices is a great way to save money!

If a claim is denied, investigate it. It may be a mistake.  Insurance companies make mistakes, too.





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