Within six months of getting married, I had been to an emergency room two times. The first visit was for me and the second visit was for my wife. For both visits the hospital was in-network for my insurance and we paid the full deductible. At this point we were both recent graduates, and until we received our degrees both of us were still on the health plans of our parents. This meant that up until those two visits, neither of us had any experience with using our own health insurance.
I was surprised in the weeks that followed when I started receiving bills for these emergency room visits. As a property insurance agent, when I think of paying a deductible as an insured I put it into the context of a homeowners policy, where you typically never pay a dime above your deductible for a covered loss. Since I went to an in-network hospital both times and paid the deductible, I did not expect to be receiving any additional bills. I asked a few peers at work about this and they advised me that this is perfectly normal; that bills come in for emergency room visits all the time even if you pay the deductible, and the insured is required to pay them. At this point in the story the grand total was three bills adding up to a sum of $201.00. This wasn’t exactly a heavy amount, but it’s still a lot to pay when you never budgeted for it.
Newly enlightened to this system, I resigned myself to having to pay these extra bills. Luckily for my wallet and I, my wife’s stubbornness held out slightly longer than my own and she told me to reach out to our health insurer to find out how to avoid these costs for future visits. I sent an email to my insurer through their website, advising them of the two visits and subsequent bills. I inquired into why I needed to pay beyond the deductible, and received a startling response. After further research they found that in all three cases these bills were the result of the physician billing my insurance company separately from the lab, with the lab having already been paid for these same services. In other words, my insurer was being billed twice for the same work, with the second bill being sent to me. My insurance company advised that I wasn’t responsible for any of the bills, and has since settled all three claims.
I wish I could say that this was my only experience with being incorrectly billed, but that isn’t the case. After my daughter was born I anxiously waited for weeks for the bills to arrive. Every new parent hears horror stories about how much you can be charged for the birth of a child. Even a birth with no complications can be very expensive. I was careful to make sure that I knew the coverage limits and out of pocket max for my plan to try and prevent any surprises, so you can imagine my shock when the bills arrived and the total tally was for about a thousand dollars more than my insurance’s maximum out of pocket expense for my family!
After getting past the initial panic attack I started reading through the bills and matching insurance claims. I quickly discovered that the bills were so high because I was being charged in full for every bill related to the doctor who attended to my daughter between her birth and us leaving the hospital. According to the denied claim, the doctor was not participating in-the network for my insurance plan. This made absolutely no sense to me, since I made sure that the hospital we used was in network. I called the hospital and was provided with the following explanation: the doctor was being contracted by the hospital and was not an official hospital employee, therefore even though this hospital was in-network, that didn’t necessarily include the doctor.
This loophole infuriated me, and felt like an underhanded way for my insurer to avoid paying for a covered hospital visit. I immediately reached out to my healthcare provider to express my dissatisfaction. That was when the customer service representative that I spoke to advised me that my health insurance plan included a provision that covers out-of-network contracted doctors as long as we receive their services through an in-network hospital. Therefore, that extra grand of claims would be covered after all! I was told that those claims would be re-processed, and I never had to pay those bills either. Subsequent hospital and doctor visits went through the same process: the claim would be initially denied because the doctor wasn’t a true hospital employee, I would get billed in full and would then call my insurer to re-process the claim and pay the bill. Every time this happened I was the one who had to remind my insurer of the provision in my plan that covers these scenarios.
These episodes taught me something very important: that I should always question my healthcare provider about all claims and additional costs that come through to me, and that a failure to do so can result in me essentially giving away my money. While I’m sure there are going to be legitimate bills sent to me in the future for various reasons, verifying each one will protect me from being wasteful. I can only hope that none of my co-workers, the ones who advised me that getting additional bills is a normal part of the process, have been paying bills that should have already been covered. One thing is for sure, I will never take the hospital, doctor or insurer at their word that I owe money, and will second guess every health bill that I receive from here on out.