I agree that the title of this week’s blog post is pretty corny.  It gets even cornier when the staff here at AdviCare say it around the office and we put our hands up like a police officer stopping traffic.  But corniness aside, it is great advice that we share with consumers all the time.

Know when to pay and when to say NO WAY_STOPOne of the first questions we ask people when we talk about our services is, “What do you do when you get a bill from your doctor or an explanation of benefits from your health plan?”  The most common answer we hear is, “I pay the amount they tell me to pay.”  Our advice to those people is to stop and make sure they actually owe that amount before paying that bill.  Billing mistakes are made by doctors’ offices and hospitals and claims are processed incorrectly by health plans.  Here is an example that happened to me just within the past few weeks.

My daughter saw an allergist, a doctor who is considered a specialist, for the first time about two months ago.  During that visit, she underwent an allergy test. I made sure before taking her to that doctor that the doctor was in-network with our health plan.

Two weeks ago I received the bill from the doctor for that visit.  The bill said that my responsibility after my health plan processed and paid the claim was $3,900.   I thought this was outrageous since I went to an in-network doctor so I took a closer look at the bill.  The total charge for the allergy test was $540.  The total charge for the doctor’s “initial consultation,” which means the first visit between my daughter and this doctor, was $13,500.  My health plan apparently didn’t question the doctor’s charge of $13,500 for this initial visit and they processed and paid the claim, applying $3,900 of their $8,000 allowed amount to my deductible.

The first thing I did when I saw this bill was to call the doctor’s office to ask them to take a look at this bill because clearly no one reviewed it before it went to my health plan.  The woman on the other end of the phone agreed that something “didn’t look right” so she was going to review it further.  A few days later I received a call from that woman who said they agreed that the amount charged was incorrect and that a corrected bill was being submitted to my health plan to be reprocessed.

In this case, both my doctor’s office and my health plan made a mistake and it was up to me to find the mistake and fix it.  While this was an obvious mistake which would cost me $3,900, mistakes are also made which only cost us $20 or $25.  But given the amount that we already pay in health insurance premiums and in co-pays and deductibles, why should we pay extra because of mistakes made by providers or health plans?

So, when you receive a bill from your medical provider or an explanation of benefits from your health plan, take a few minutes and review what they are saying you owe.  If you don’t understand all of the codes on the bill or how they determined how much you owe, call your provider’s office or your health plan and ask them questions.  If something is wrong, your provider or your health plan will fix it.  But it takes you and your review to know when to pay and when to say NO WAY!