It sounds like what you have is a medical plan that has a $1250 deductible per person. That means you are responsible for everything up to $1250 before BCBS will pay anything. After you have paid your deductible of $1250, they will pay 80% of the bill and you have to pay the other 20%. You will pay 20% until you have reached $5000 and then they will pay 100%.
Now, I don't know all the benefits BCBS offers but that is usually how benefits and deductibles work.
YOU have to keep track of how much you have already paid out. If you have already paid $1250, you have to be vigilant about making sure BCBS pays their 80% AND making sure the hospital and doctors understand that you've already paid your deductible. The portion you should pay would now be 20%.
Go over your bills that come in, and before you pay a cent out, make sure BCBS has paid their portion. Make sure you understand what is covered and what is not even if you have to call a bajillion times. Sometimes it takes a while for records to get updated. I know it is alot, especially when you are trying to get DH better, but if you are not vigilant, you will get screwed. Good luck, hope DH heals fast.
I agree with all of this.
It's too late now (I'm talking about for me and DH, here, not you, it's not too late for you at all!!!) for the really difficult stuff, but in the last year I've finally developed a system. Bought some cheapie binders in last year's back to school sales, got a 3 hole punch, and some dividers. Space for Explanation of Benefits, Bills, and then EOB+Bill+Receipts. I also have a printer/copier.
When I get notice that an EOB has come in electronically, I open it and make a copy. If it has more than one appointment on it, I make two, and highlight the relevant one on each page. Put those in the binder. When I get a bill, I match it up. When it's paid and I get a receipt, I staple them (also got a stapler!) together and put them in the back divider area. Keep it current for the insurance year. End of insurance year, I put all FINISHED things into a bigger binder, and start over.
I also have an accounting sort of pad with columns and rows, and I write it all out as it happens. Amount charged, what they paid, what we owe, and a check mark once we pay it with the date. That's at the front of the binder.
That's how I keep myself organized. That system might not work for you, but you need to figure out your OWN system, and quickly.
Yes, sometimes providers don't use the right billing code. I would definitley call BCBS and ask why it got denied--maybe it's a billing code issue and you can get the doctor to bill it differently.
Yep.
It sounds like your DH's hospitalizations were fairly recent. Don't be in a hurry to pay the hospitals or doctors. Many times it takes a few months for the insurance payments to be posted. Keep excellent records of your phone conversations/emails. Question every charge on the billing. You may need to request an itemized billing from the hospital. Most of the hospital bills are a summary billings only.
If a claim is denied, contact the provider (hospital or doctor) and ask for a review and re-submission of the claim. Many claims are denied due to billing coding errors.
I agree with it all!
Just make sure to set up a plan and stick with the due dates. If you can't make one, call and let them know.
Absolutely! You could be paying on something for a year, and if you miss one due date they might send you to collections. So keep up with the plan you set up with them.
Our dr. will charge about $45 if you have no insurance and pay cash that day but will routinely bill our insurance over $200for an office visit. Where is the logic in that?
In most states, you can't really offer a separate plan for insured and noninsured, but you can offer a discount to whomever you want.
When they charge insurance $200, they are very likely getting the same $45 that they might offer as a discount to someone...plus a bit extra to pay the people who do the insurance forms for them.
I'm a retired chiropractor. When I was practicing 10 years ago, the reimbursement for an office visit was around $30. That was also often the copay for insurance plans at that time (at least the ones my practice members told me about). So I just charged that amount, cash, made a "super bill" for them to send in if they wanted "credit" for deductibles, and we were all happy.
We have Aetna, and we see a chiro who is a preferred provider with them. Aetna now reimburses at a rate of something like $23 per office visit. In 10 years, it's gone DOWN. The chiro charges 62.60 for a normal visit, in order to get $23 from the insurance company, and then we pay 10% of the allowed charge, which is around $26, so we pay about 2.60 per visit once we hit the deductible.
The insurance process has caused this, and it's the reason I never became a preferred provider or played the insurance game. I charged what I charged and then I was done. I didn't want to deal with charging more to get what I felt I needed.
Your DH is so lucky he has you! Our crisis involved ME as the patient, and I'm the only one in the household who understands insurance. So I was dealing with what had happened, dealing with other things, and trying to comprehend the insurance stuff. My state and DH's lack of understanding of it caused us problems, and it took 5+ years to get out from under the bills (which were far less than yours).
I know you are dealing with your own emotions about all this, but you're not also the one with the physical problems, so it allows a small buffer that enables you to deal with the insurance people and office people better. He is so lucky to have you!
Get your own system, so that you're organized. Make copies of EOBs with multiple charges on it so you can match it up exactly. If you have questions, ask.
Get ONE notebook that you keep with all the bills and EOBs and receipts and your checkbook register (or however you keep track of your money). Date the pages, write down who you are talking to, what they say, what they'll do, when to contact them back, what YOU need to do. Keep yourself organized!
DS got an ambulance ride after a fall, and the ambulance was the first to bill insurance, but the LAST to bill us. It took months and months to finally get someone at the insurance company to notice that since the ambulance had billed first, they were reimbursing based on a NON emergent ambulance ride. If the hospital bill had come in first, the ambulance reimbursement would have automatically been done correctly. I kept taking notes, but kept losing the notes, so I couldn't be definitive about my conversations with people, and I got accused of lying a few times (thanks, Rural Metro Ambulance company!!!).
Organization will help you a great deal!
Good luck, take care of yourself, and I hope your hubby heals up fast!
to everyone going through something similar. I'll post again when I get some more news.
