Courtesy Cassandra Cloutier
- I get health insurance through my employer, but have still received large medical bills.
- I've learned a few ways to reduce charges, like checking a prescription against the bill.
- I also stayed on top of my insurance company for reimbursements.
I became an accidental expert at investigating medical bills — and getting them reduced — during a few years of doctor's visits for a chronic condition. I get health insurance through my employer, but I was still being asked to pay dozens of large charges myself. Luckily, by doing three things, I didn't have to pay over $4,000 that I was going to be billed for.
Check the order from your physician against the services you were billed for
I recently received a $699 bill for a scan I hadn't been prescribed and didn't know I was receiving.
My doctor referred me to go for imaging, and to avoid any unwanted charges, I called my insurance ahead of time to make sure that the prescribed scan would be covered. They confirmed that the scan listed on the referral would be fully covered, and that the coverage would kick in before I met my deductible (which was great since it had just reset for the year).
Sure enough, my insurance portal showed that I owed $0 for the prescribed scan, but I was also being charged for a mysterious second service I didn't recognize. I called the provider, thinking I must have been charged by accident, but they informed me that the other test was a complementary study they always performed alongside the one I'd gone in for. The test took place simultaneously in the same machine, so I had no idea I was receiving it.
A look back at my doctor's referral confirmed that she'd only ordered one scan, so I decided to dispute the bill: I'd scheduled one service, submitted the proper referral for it, and confirmed coverage with my insurance.
Since I had that referral as proof of my doctor's order, the provider acknowledged the discrepancy, and the charge was reduced to zero.
Tip: Trying to compare referrals, bills, and insurance claims can be confusing when they all name services differently, so be sure to check the "CPT" billing code for each service.
Check whether you're being reimbursed properly by your insurance company
By staying on top of my insurance provider, I received $3,151.55 in reimbursement checks that likely never would have been paid if I hadn't followed up.
I was seeing a specialist who didn't accept insurance, but my policy allowed me to self-pay and submit claims for reimbursement. While I submitted the claims every month, I received reimbursement checks sporadically, covering anywhere from a few visits to several months of treatment. Plus, I had to keep emailing about the same unpaid claims until they were resolved, so my online insurance portal was full of duplicate claims and out-of-date information.
The key was to stay organized. I documented every claim I submitted, held on to all of the mail I received from the insurance company, and emailed when payments were missing. A handful of checks were paid without me having to follow up on them, but I'm glad I kept track of everything because I discovered thousands of dollars in payments that were accidentally mailed to the provider (who I'd already paid) instead of to me. It took three months of calls and emails to get them re-issued and sent to me.
Tip: To figure out which services have been reimbursed, pay attention to not only when you receive the checks, but the dates of service listed on your explanation of benefits. While I received some timely reimbursements, one January claim wasn't paid until July.
Confirm that your physician correctly billed your insurance
Before you pay a medical bill, make sure to confirm whether your insurance company was billed properly, even if you think your provider has all of your correct information.
I recently received a $455 bill for a routine physical. I'd found the doctor through my insurance portal and confirmed my insurance information with them before the visit, so I knew I was covered. When I called the billing department, they had the wrong insurance information on file. They'd sent the bill straight to me instead of submitting it to my insurance company.
Once I gave them my correct information, they processed the bill through insurance, and I was fully covered.
My final tip: Don't assume you're responsible for a payment just because you received a bill.
My initial reaction to large medical bills has often been embarrassment, thinking I must not have selected a good insurance policy or properly confirmed that my doctors or services were covered. I've had the urge to just pay a bill immediately, even if it seemed outrageous, so I could get it over with. However, by staying calm and asking questions, I've saved myself thousands of dollars.