lurker with an insurance billing question

[pinktulip]

I don't know or understand a lot about insurance, so I thought this would be a good place to ask I hope this makes sense:

A few weeks ago I called to get an IUD. My doctor's office told me that since IUD's are so expensive, they need to call my insurance company and determine how much the IUD will cost and I will have to pay for it in full before insertion. I gave them my insurance information and I got a call back saying that the insurance company said my IUD was 100% covered, so I made an appointment and got my IUD soon thereafter.

Yesterday I got a $480 bill in the mail for my IUD. I called my doctor's office this morning and they told me to call the insurance company to see if there was a mistake in billing. I called the insurance company and they said that in my plan, for an IUD I had to pay my $400 deductible and then 20% after that. They said in my notes, they see when the doctor's office called and that was the information they gave them.

So, I called the doctor's office back and told them what the insurance company said. They said in their notes that the insurance representative originally said I would have to pay my deductible, but then changed her mind and said that it would be covered 100%. But she said that the new healthcare act was confusing?

The insurance company said I could appeal the claim since I was told one thing and billed another. My doctor's office is sending me their notes so I can send it in to appeal it, but this is going to end up falling on me, isn't it? Is there anything I can do?

[jenny1223]

I've had good luck pushing back on insurance to cover stuff that I was told would be covered and then wasn't.

[pinktulip]

how did you deal with them? appeal the claim?

[jenny1223]

The couple times I've done it, I just called in and the rep I talked to fixed the claim over the phone and arranged it to be paid. I may have had to have the doctor's office resubmit the claim to insurance. I've learned to keep meticulous notes every time I talk to insurance.

[LoveTrains]

Here's the thing - at the end of the day, you are responsible for knowing what your insurance covers. I don't know, I would probably fight it since the insurance company did tell your doctor that it was covered, but I don't know how hard I would fight it. Do you have an FSA account? I would probably just pay it from my FSA and chalk it up to lessons learned.

[pinktulip]

No FSA, but we do have plenty in savings to cover it. It's just annoying because it was an expense we weren't counting on. A few months ago, before I even called my doctor's office about it I called the insurance company to see if IUD's were covered and I was told at the most, I would be billed $200. I was a little surprised to hear it was 100% covered but just being told it wouldn't cost much I figured that was true. Lesson learned I suppose.

[Deleted]

Can you call insurance back and talk to a new person about it being at 100% w/ the new healthcare act if that's where they thought the communication goof was?

I had issues with my IUD cost too. The clinic gave me one price (device and insertion fee), so I budgeted on 20% of that and then at the end of the day there were STD tests and a $34 pregnancy test among other things they tacked on that the billing specialist neglected to tell me about. I also had to go back 3 weeks later for the OB to double check placement and I got charged for an office visit for that too.

Sometimes you just can't do anything right.

[LoveTrains]

Oct 10, 2012 12:34:44 GMT -5 pinktulip said:

No FSA, but we do have plenty in savings to cover it. It's just annoying because it was an expense we weren't counting on. A few months ago, before I even called my doctor's office about it I called the insurance company to see if IUD's were covered and I was told at the most, I would be billed $200. I was a little surprised to hear it was 100% covered but just being told it wouldn't cost much I figured that was true. Lesson learned I suppose.

This is what I would then push back on, not what they told the doctor's office. If you have the date/time/name of whom you spoke with to verify coverage, I would absolutely push the issue.

[definitelyO]

I would push back on the fact that you were told one thing and then charged another. the 100% coverage doesn't go into effect until 1/1/13 and not all plans have to comply with that directive (grandfathered plans are exempt). the MD office may have gotten it wrong -but I hihgly doubt they would give you your money back.

[mrs.spunky]

Oct 10, 2012 14:08:38 GMT -5 definitelyO said:

I would push back on the fact that you were told one thing and then charged another. the 100% coverage doesn't go into effect until 1/1/13 and not all plans have to comply with that directive (grandfathered plans are exempt). the MD office may have gotten it wrong -but I hihgly doubt they would give you your money back.

This isn't correct. The law went into effect during the summer but companies aren't required to comply until their next renewal (unless of course they are grandfathered and don't have to comply at all).

[definitelyO]

Oct 10, 2012 14:22:58 GMT -5 mrs.spunky said:

Oct 10, 2012 14:08:38 GMT -5 definitelyO said:

I would push back on the fact that you were told one thing and then charged another. the 100% coverage doesn't go into effect until 1/1/13 and not all plans have to comply with that directive (grandfathered plans are exempt). the MD office may have gotten it wrong -but I hihgly doubt they would give you your money back.

This isn't correct. The law went into effect during the summer but companies aren't required to comply until their next renewal (unless of course they are grandfathered and don't have to comply at all).

thanks! my head is on our Jan 1 renewal. sorry - she's right - it went into effect for plans that renewed after 08/01/12.

[pinktulip]

Oct 10, 2012 14:04:40 GMT -5 LoveTrains said:

Oct 10, 2012 12:34:44 GMT -5 pinktulip said:

No FSA, but we do have plenty in savings to cover it. It's just annoying because it was an expense we weren't counting on. A few months ago, before I even called my doctor's office about it I called the insurance company to see if IUD's were covered and I was told at the most, I would be billed $200. I was a little surprised to hear it was 100% covered but just being told it wouldn't cost much I figured that was true. Lesson learned I suppose.

This is what I would then push back on, not what they told the doctor's office. If you have the date/time/name of whom you spoke with to verify coverage, I would absolutely push the issue.

I have the date and the time, but not the name of the rep. Is it reliable without her name or not?

[pinktulip]

Oct 10, 2012 14:30:15 GMT -5 definitelyO said:

Oct 10, 2012 14:22:58 GMT -5 mrs.spunky said:

This isn't correct. The law went into effect during the summer but companies aren't required to comply until their next renewal (unless of course they are grandfathered and don't have to comply at all).

thanks! my head is on our Jan 1 renewal. sorry - she's right - it went into effect for plans that renewed after 08/01/12.

Thank you ladies! All the heathcare laws are confusing to me and I obviously don't keep up with them enough I will definitely look into that with my plan.

[mrs.spunky]

Oct 10, 2012 14:34:39 GMT -5 pinktulip said:

Oct 10, 2012 14:04:40 GMT -5 LoveTrains said:

This is what I would then push back on, not what they told the doctor's office. If you have the date/time/name of whom you spoke with to verify coverage, I would absolutely push the issue.

I have the date and the time, but not the name of the rep. Is it reliable without her name or not?

I always get a confirmation number. Usually that will work in place of a name.

[kershnic]

Definitely do the appeal, I think you have a good shot of it working if the doctor's office notes clearly reflect what you were told.

I'm dealing with infertility and insurance coverage and "knowing what your plan covers" is literally impossible sometimes. The written documents contradict each other. I call one phone number and they don't know and direct me to another place who doesn't know and I end up going in circles. Sometimes the only choice is to trust the doctor's billing office interpretation and then follow the appeals process if something goes wrong.