or... maybe why not.
Today I got my insurance statement in the mail. It's basically an explanation of benefits for the past 2 weeks worth of claims. The total amount that WE owe on it is $3,381. The last three statements have together totaled $733. This means that within 10 weeks we have had enough 'medical charges' to be billed $4,114. This isn't SO bad, because we know that from here on out our deductible is met and our insurance will be picking up 100% of all in network activity on our account. And better yet, we shouldn't see a bill for $75 of the 'extra' which was applied to our out-of-network deductible because we see that provider through CMS. They cover whatever insurance doesn't, thankfully.
But wait... our Super High deductible is still only $4,000... and then there's $75 for the out of network doctor... so what is the other $39 from?
Oh, I loved to learn this. My OB doctor sends out his labs. To an out of network provider. Oh yeah, and so does our hospital. Seriously.
Right now that is $39. Not a huge deal. Not even a big deal really. Money that we'd much rather not pay out, of course, but not money that will keep us from buying groceries or from getting gas in the car to go to school or work.
But. But my OB will continue seeing me every 4 weeks until the last trimester where he'll see me sooner. And if he needs any more lab work, up goes the cost. And the hospital, well, thankfully I don't generally do the kids' labwork at our hospital because I take them to a children's hospital (but this claim was a urinalysis, not necessary to go to a children's hospital an hour away for that one...). In 5 1/2 months I will be giving birth in that hospital, though. Myself and our new child will likely both have lab work done. Billed to this out of network provider. And there's probably nothing I can do about that.
Oh, and just for fun, labwork doesn't even go toward an out of network deductible, which I won't mention the amount of that number because I don't want you to spit your coffee onto the screen. Lab work is only considered part of the plan if it's done by an in network provider.
Looks like I'll be on the phone tomorrow. I don't want $39 to gain any zeros during the year.
We have a love/hate relationship now, us and our insurance. SO GLAD we have it at all because they will eventually pay out something. But YIKES that it's only March and we have over $4k in bills...
I totally don't get insurance, usually leave it to my husband. However, this is just some info that may or maynot help.
ReplyDeleteMy OB has a sign in her office that says "we send all lab work to ****". The office will however, send to a different lab. . .if you ask for it to be done. In my case her choice was out of network for me, but by simply asking we pay $0 for lab work.
Not sure how the hospital portion would work, but you could always ask them.
Meredith -
ReplyDeleteOh my---I can't STAND dealing with insurance companies. I will share with you that I have dealt with this issue MANY times and EVERY time the insurance company has agreed to cover it. YOU, as the customer, can't help that the DOCTOR or the HOSPITAL sends the labs out to a non-network provider. YOU are doing your part in going to an in-network provider. YOU stand firm in this....explain what I just wrote. More than likely they will understand your view and will say "okay". What gets me every time is that it takes TIME to make these calls...you're on hold forever, and you have to pay such CLOSE attention to these statements - can't tell you how many mistakes I find ALL of the time!!!!
Blessings,
Kathy
My hubby had the same thing happen with our insurance. He called them and they waived the fee except for what we would have paid in-network. It might be worth a phone call since you will be dealing with this for several months!! Good luck.
ReplyDeleteUgh. I've been battling our insurance since my company changed carriers this year. However, I'm pretty ready to forgive them the HOURS I've spent on the phone since they are going to cover Dima's speech therapy, which is almost unheard of to have covered. I almost didn't call them yesterday to have them reprocess a claim they did wrong...almost. ;)
ReplyDeleteI am sending this to my DH who works in health insurance to see if him or his cronies have a way around this....that is just crazy.
ReplyDeleteOK, so the DH and his co-workers say the hospital situation will be covered because you do not have a choice in who does the bloodwork (as long as the hospital is in-network).
ReplyDeleteAs for the OB appt. you would need to request they send to an in-network lab or give you a script to get it done yourself at an in-network lab.
I hope that makes sense if you have any questions you can email me at stessieb3@yahoo.com and I will forward whatever to my DH.