$144 Medical Bill - should I fight it?

[Pleasedeletethis]

Looking for some guidance on dealing with a medical bill, and I'm sure some of you folks have-real life experience you'd be willing to share.  Can you help?

Here's the situation:  Back in September I saw the local family practice doctor for an infection in my elbow.  After the initial visit, a follow up visit, a blood test, and an X-ray, I got the bill: I still owe $144 even after health insurance paid their part.

Should I pay it or fight it?  I mean, $144 is a lot less than some of the gigantic medical bills you hear about, but I still feel like I'm getting shafted because I have insurance and I just saw the family doc for two short visits.

Secondly, if I fight it, what's the best course of action?

Thanks in advance!

[johnny847]

Just because you got a bill doesn't mean they're trying to overcharge you. When they provide you with a cost estimate at the beginning, that's all it is. A cost estimate. They tell you your cost based on their prediction of what the insurance company is going to pay them. Someitmes the insurance company doesn't pay out as much as they thought.

It may be that you need to talk to the insurance company, not to the doctor's office.

[LeRainDrop]

Did your insurance company pay the correct portion of the medical claim?  If so, I'd pay the balance.  Though it can't hurt to call the doctor's office to ask if they would reduce the cost to you.  If they feel that they've been paid enough by the insurer already, they may be willing to eat some of the balance.

[zephyr911]

It's hard to answer this without knowing what kind of policy you have and what kind of charge is being passed on to you. Do you have a deductible? A catastrophic cap? Did you hit one or both? Is this a co-pay?

More info would elicit better answers.

[redcedar]

I do not ever trust a medical bill. Too many errors over the years and they rarely give you the full picture and often no picture of what has happened.

Get your EOB, explanation of benefits, from your health insurance provider. If a big company, I am sure that they have a member portal that you can log into and see your EOB online. You will see exactly what services the doctor provided, what the doctor attempted to charge, what the insurance company set as the allowed or negotiated charge, what the insurance company paid on your behalf, what you may have paid upfront, and what you still owe at the time of EOB (this part can get out of sync if you have paid any or all since the EOB was published).

Take time to really read the EOB and then question anything and everything that seems out of line. You can question the doctor and the insurance company. Sometimes you have to do both to get the full picture.

In the end, you may find, as others have said here, that the charges are legitimate (which is different from you like them). If legitimate, you need to pay it and learn from this. You can spend time researching costs up-front so that you do not face surprises in the future. Now, I will warn you that this is not yet as easy as it should be but researching cost and value upfront is a growing trend and it is getting better each year so get used to doing it now.

[Pleasedeletethis]

Just because you got a bill doesn't mean they're trying to overcharge you. When they provide you with a cost estimate at the beginning, that's all it is. A cost estimate. They tell you your cost based on their prediction of what the insurance company is going to pay them. Someitmes the insurance company doesn't pay out as much as they thought.

It may be that you need to talk to the insurance company, not to the doctor's office.

I do not ever trust a medical bill. Too many errors over the years and they rarely give you the full picture and often no picture of what has happened.

Get your EOB, explanation of benefits, from your health insurance provider. If a big company, I am sure that they have a member portal that you can log into and see your EOB online. You will see exactly what services the doctor provided, what the doctor attempted to charge, what the insurance company set as the allowed or negotiated charge, what the insurance company paid on your behalf, what you may have paid upfront, and what you still owe at the time of EOB (this part can get out of sync if you have paid any or all since the EOB was published).

Take time to really read the EOB and then question anything and everything that seems out of line. You can question the doctor and the insurance company. Sometimes you have to do both to get the full picture.

In the end, you may find, as others have said here, that the charges are legitimate (which is different from you like them). If legitimate, you need to pay it and learn from this. You can spend time researching costs up-front so that you do not face surprises in the future. Now, I will warn you that this is not yet as easy as it should be but researching cost and value upfront is a growing trend and it is getting better each year so get used to doing it now.

Good news, and big props to both of you!  Here's what happened:   

I just got off the phone with the insurance company.... Turns out that due to something slipping through the cracks, one of the items on the bill - a $116 charge - wasn't even processed.  As a result, the insurance customer service agent offered to re-process that item, so hopefully that brings that charge down substantially.

If not for you, I would have paid the whole thing, saying "Oh, well, I guess I can't win..."  But thanks to your guidance, it sounds like I may come out better than I expected due to some kind of administrative glitch I caught.

Big thanks!

[Pleasedeletethis]

Did your insurance company pay the correct portion of the medical claim?  If so, I'd pay the balance.  Though it can't hurt to call the doctor's office to ask if they would reduce the cost to you.  If they feel that they've been paid enough by the insurer already, they may be willing to eat some of the balance.

Turns out that the insurance company didn't pay their portion - some kind of "processing error" caused one of the charges to not be processed, and so they're re-processing that charge.  Hopefully it brings that line item down a lot. 

Thanks for the suggestion! 

My experience talking to the doctor's office (or dentist) is that their typical go-to line is to get you to set up a payment plan, when really what I want to do is to question the actual charges.

The "Holy Crap!  $116 just to be seen for a puffy elbow!?!?!  And then tests on top of that!?!?!"-factor definitely is what starts it - in the future, I'll be sure to discuss costs up front with the physician because these kinds of surprises always happen when I go see a doctor or dentist.

[FerrumB5]

We were charged 6.5k hospital (WTF!?!???!) + $800 ambulance when my daughter was taken to ER. No scans, no Xrays, no medications, no shots, nothing. All were dropped after 2 calls to insurance. Having a 2-yr old means no HSA with high deductible
(rant on: WTF do the doctors do in ER for $6500 / 30 min of just visual and hand checks??????)

[johnny847]

Just because you got a bill doesn't mean they're trying to overcharge you. When they provide you with a cost estimate at the beginning, that's all it is. A cost estimate. They tell you your cost based on their prediction of what the insurance company is going to pay them. Someitmes the insurance company doesn't pay out as much as they thought.

It may be that you need to talk to the insurance company, not to the doctor's office.

I do not ever trust a medical bill. Too many errors over the years and they rarely give you the full picture and often no picture of what has happened.

Get your EOB, explanation of benefits, from your health insurance provider. If a big company, I am sure that they have a member portal that you can log into and see your EOB online. You will see exactly what services the doctor provided, what the doctor attempted to charge, what the insurance company set as the allowed or negotiated charge, what the insurance company paid on your behalf, what you may have paid upfront, and what you still owe at the time of EOB (this part can get out of sync if you have paid any or all since the EOB was published).

Take time to really read the EOB and then question anything and everything that seems out of line. You can question the doctor and the insurance company. Sometimes you have to do both to get the full picture.

In the end, you may find, as others have said here, that the charges are legitimate (which is different from you like them). If legitimate, you need to pay it and learn from this. You can spend time researching costs up-front so that you do not face surprises in the future. Now, I will warn you that this is not yet as easy as it should be but researching cost and value upfront is a growing trend and it is getting better each year so get used to doing it now.

Good news, and big props to both of you!  Here's what happened:   

I just got off the phone with the insurance company.... Turns out that due to something slipping through the cracks, one of the items on the bill - a $116 charge - wasn't even processed.  As a result, the insurance customer service agent offered to re-process that item, so hopefully that brings that charge down substantially.

If not for you, I would have paid the whole thing, saying "Oh, well, I guess I can't win..."  But thanks to your guidance, it sounds like I may come out better than I expected due to some kind of administrative glitch I caught.

Big thanks!

Glad to hear it.

I'd also keep the doctor's office in the loop if you haven't already. You don't want them complaining about a "late payment" when the money should be coming soon from the insurance company.

[Pleasedeletethis]

We were charged 6.5k hospital (WTF!?!???!) + $800 ambulance when my daughter was taken to ER. No scans, no Xrays, no medications, no shots, nothing. All were dropped after 2 calls to insurance. Having a 2-yr old means no HSA with high deductible
(rant on: WTF do the doctors do in ER for $6500 / 30 min of just visual and hand checks??????)

That's actually insane...   But awesome that it was taken care of.

What did you say to the insurance company to get them to take care of it?

[FerrumB5]

Hospital did not have ins info on file (which is very strange given we've been there before) - insurance called them while I was on the phone with insurance (o_O doesn't happen often does it?).
Ambulance - same story. Ambulance was city-owned, not hospital one. Hospital didn't have it and could not give ambulance any legal info anyways.
My HMO covers ambulance 100%

But 6.5k for a visual check?

[Jack]

Turns out that the insurance company didn't pay their portion - some kind of "processing error" caused one of the charges to not be processed

<cynicism>It's the "processing error" called "deny everything the first time regardless of whether it's legitimate or not, and a substantial portion of our victims marks customers will let us get away with profit we don't deserve."</cynicism>

[thingamabobs]

We were charged 6.5k hospital (WTF!?!???!) + $800 ambulance when my daughter was taken to ER. No scans, no Xrays, no medications, no shots, nothing. All were dropped after 2 calls to insurance. Having a 2-yr old means no HSA with high deductible
(rant on: WTF do the doctors do in ER for $6500 / 30 min of just visual and hand checks??????)

So you thought there was something serious going on with your daughter and needed emergency transport to the nearest ED for her to be evaluated. Ambulances aren't free, neither is keeping  an entire ED staffed, lights on, equipped. Care to elaborate on what was going on? Did you at least pay for your full service cab ride?

[FerrumB5]

Wasn't me - my wife. Daughter fell 3ft down on her head into the basement window-well due to ass-cheap covers in someone's house while I was at work. Since insurance covered everything except the co-pay and daughter was just fine (albeit a swelling on her little head) I didn't press any charges and just let it go. Shit happens

[thingamabobs]

Here's the situation:  Back in September I saw the local family practice doctor for an infection in my elbow.  After the initial visit, a follow up visit, a blood test, and an X-ray, I got the bill: I still owe $144 even after health insurance paid their part.

Should I pay it or fight it?  I mean, $144 is a lot less than some of the gigantic medical bills you hear about, but I still feel like I'm getting shafted because I have insurance and I just saw the family doc for two short visits.

First, I'm glad you got this sorted out. I always check my medical bills against my insurance EOB to make sure it has been properly processed.

I once fought Quest and my insurance for an entire year because the insurance kept claiming not to have received the bill to be processed. I sent it three times myself before it was processed. The bill went from $150 to $35.

I wonder why you felt like you were "getting shafted" and you "just saw the family doc". That family doc spent 4 years in college, 4 years in med school, 3 years in residency, just so they can take care of you. Honestly, xrays (big machines, a tech to take the pictures, a radiologist to interpret the images), labs work (phlebotomist to draw, transporter to move the samples, tech to process the samples on big machines), 2 visits (office staff, rent, lights) for $144 is not a bad deal.