Here come the medical bills. Advice needed

Jessa1404 · May 2015

Hey everyone,

I got an unwelcome shock this week when I received a very expensive medical bill in the mail. I'm just looking to see if anyone has advice on how/if I should handle it because I have very little experience in this arena. I thought I had decent insurance. I pay a lot for it through my employer, and I haven't had a real problem in the past (although this is my first pregnancy). Since January, I've been paying little bills here and there, nothing amounting to too much. My biggest was probably a little over $100. This week, I got a bill for almost $700 from a medical lab for what I thought was a routine blood panel, and it was for tests they did back in January! My husband asked why I thought I needed some of the expensive individual tests (for example cystic fibrosis costs almost $1000 alone and we don't have risk factors), and I said I didn't think about it. My doctor gave me a prescription to have blood drawn for the blood work I needed, and I just did.

I'm of course grateful my baby and I are healthy. But this is just a lot of money for us, and I'm dreading there will be other "surprises" from February, March, etc that they haven't even billed to the insurance, yet. I have a deductible, but even after I meet it, my insurance only covers 80%. I feel like something about this bill isn't right, but I don't know how to go about it. Should I call my insurance or doctor or the lab? I don't even know what to ask. Any thoughts or advice are much appreciated. Thanks in advance!

chshannon · May 2015

I would call my insurance company to check first. I was billed $189 for an ultrasound that the insurance didn't cover I called them and they suggested calling the dr and the dr recoded it and now the insurance company is covering it. I would start with the insurance co first though.

irohspupil · May 2015

Here is the link to the thread posted just a few days ago that may help you out: https://forums.thebump.com/discussion/12572571/unexpected-baby-bill

I suggest calling your insurance to find out exactly what they do or do not cover. If insurance will not cover the bill, it doesn't hurt to talk to both your doctor and the lab about the cost of the work being done. You may be able to get the cost lowered or even be offered a monthly payment plan.

J&D2007 · May 2015

Don't pay it for now and research your options. You need to make a call to the biller at your doctors office and to the insurance company. Most times, things can be recoded and rebilled.

Jessa1404 · May 2015

Thanks for your responses! I saw that thread from a few days ago, but my situation is a little different. That's why I posted again. That OP's bill was for an extra gender reveal test. I haven't done anything extra. This is just from a blood panel that they prescribe for all of their patients. That's why I feel like something is wrong here, but I just don't know what to say to my insurance when I get someone on the line.

Perfect Sonnet · May 2015

I would call your insurance. I am not sure if they could do anything about it, but if anything they could give you a better expectation of what's to come and what will or will not be covered as far as the normal future pregnancy stuff goes. Also, when your doctor prescribes you tests or such in the future, try to get a better understanding with him/her of how this works with the insurance you have. Or try to call your insurance before you get it done.

irohspupil · May 2015

Jessa1404 said:
Thanks for your responses! I saw that thread from a few days ago, but my situation is a little different. That's why I posted again. That OP's bill was for an extra gender reveal test. I haven't done anything extra. This is just from a blood panel that they prescribe for all of their patients. That's why I feel like something is wrong here, but I just don't know what to say to my insurance when I get someone on the line.

My lab was also routine with my OB's office. At least, that is how it was explained to me at the time. My OB orders this same lab work for all of her patients.

Did you get a legit bill or just an explanation of benefits? When you call your insurance, tell them you received a bill in the mail for a blood panel that you thought would be covered. Tell them you aren't sure why it isn't, and the rep should be able to give you an answer. As others have said, it is probably just the way the doctor worded it when he/she submitted it to the company. It may just need to be recoded.

Don't be scared to talk to them! They are very much used to getting these kinds of calls.

They know what you want to know.

Jessa1404 · May 2015

Thank you for your help and encouragement! Between pregnancy hormones, exhaustion, and inexperience with this, I feel badly equipped to "fight" with an insurance company like some people say they have to. At least now I have some things to say to get the conversation started without looking completely clueless

emmacake08 · May 2015

Since you probably won't get out of the bill, you should call your insurance company just to ask what the deductible and the max out of pocket is. I'm surprised your OB didn't spell that out for you. Mine gives me a print out at my first appointment based on the plan I have. Also make sure you're using in network providers. My husband has a great job for a top oil company but our max out of pocket is still $3000. When you aren't having babies and healthy, there really aren't any bills. Having a baby means you will pay the max.

Unfortunately too, if you have a baby that needs to be hospitalized for a condition separate from birth, they might also meet the max out of pocket. When I had my twins, I payed $3000 for me and $3000 for each of them, $9000 total. I know all the money is overwhelming but it's good that you're planning ahead. Some hospitals will do payment plans but a lot of OBs won't. It just depends.

lap018 · May 2015

The only way a chart can be "re-coded" is if it was coded incorrectly in the first place. You can't just "re-code" and "re-bill" an account and assign diagnosis and procedure codes based on what a persons insurance will cover, that is called fraud. Sincerely, your friendly neighborhood medical coder

CaliforniaDream87 · May 2015

Call your insurance company. They are the only ones that can tell you why a certain test wasn't fully covered, ect.

Miz_Liz · May 2015

FYI, at my Dr's CF was an optional test that I was told isn't covered by most insurance companies and typically runs $800+. I was given a separate form though saying that the test was explained to me and I had to sign it acknowledging that it was reviewed with me and I was choosing not to have it done (it also went into details on the cost). I am not sure if this is standard procedure or not, but worth asking why they ran that test if that is what is driving the bill and you did not say you wanted it done.

jesselayne8 · May 2015

Did the lab enter your insurance correctly? I paid a $788 lab bill because the hospital billed the wrong insurance company which obviously denied my claim. Turns out once they billed the correct company, I owed $0 so they credited my account.

J&D2007 · May 2015

lap018 said:
The only way a chart can be "re-coded" is if it was coded incorrectly in the first place. You can't just "re-code" and "re-bill" an account and assign diagnosis and procedure codes based on what a persons insurance will cover, that is called fraud. Sincerely, your friendly neighborhood medical coder

Sorry if I didn't explain what I meant when I posted that it can be rebilled. I am a physician and I undertaken that things can't be randomly recoded. But, as we all know, things get entered incorrectly all of the time and many times it can be fixed within the limits of the law.

lap018 · May 2015

@J&D2007 this is true, that is what all of our lovely audits are for! I know MDs typically don't just LOVE coders (queries, missing documents, and signatures)

but anywho I just wanted to clarify that it can be re coded and or re billed if there was a mistake made initially. But coding cannot be used to fit the preference of the insurance company or patient depending on what is or is not covered. Which I'm sure you know all about, but maybe not everyone else on here.

babywhaley17 · May 2015

Have you met your deductible yet? My company pays my insurance, but we have a $5000 deductible. So I have to pay all bills until that's met. Then it's 80/20 deal until the federal out of pocket max of $6350. With delivery, i know we will easily hit that amount.

Lalala2326 · May 2015

I would actually call the lab first and make sure they have even billed your insurance. 99% of the time I get a statement from my insurance company (whether they covered or denied it) BEFORE I get an actual bill from the provider/lab/etc... If you got the bill first there is a good chance they haven't billed your insurance yet. This is how I usually know I have phonecalls to make. I just had that happen actually but with an ultrasound. I called the radiology place that read the ultrasound that was billing me, and they said they didn't get my insurance info from the hospital. I gave it to them, they billed it, and my bill went from $170 to $14. If your deductible is not met yet though, and this is bloodwork, most likely you will have to pay it, but at least it will apply towards your deductible. Also just by having insurance a lot of times there is a cheaper negotiated rate that you would have to pay rather than the original amount billed even if insurance doesn't cover any of it as it applies to the deductible. If they don't bill your insurance (again, you should be getting statements from your insurance every time they are billed for something), then you won't get credit for it.

JNOVA2015 · May 2015

I think you've gotten great answers.

At my high school we had to take a mandatory class called consumer economics where we learned about things like health insurance, how to get a mortgage, how to buy a car, balancing a checkbook, how to do your income taxes, and how a 401k works. I didn't realize at the time that this isn't a normal class nationwide, but it should be. Too many people don't know how to deal with these kinds of things (which isn't their fault, because most of them are completely non-intuitive), and it's so easy to be taken advantage of by insurance companies, doctors, etc. It's really sad how much time we spend learning calculus and how little time we spend on basic financial education. It's one of the only non-honors classes I took, and probably the class I use most since graduating.

tarheelgirl8 · May 2015

Did you get a legit bill or just an explanation of benefits? When you call your insurance, tell them you received a bill in the mail for a blood panel that you thought would be covered. Tell them you aren't sure why it isn't, and the rep should be able to give you an answer. As others have said, it is probably just the way the doctor worded it when he/she submitted it to the company. It may just need to be recoded.

micshi said:
This exactly. I received a bill from my hospital in early February and had a pregnancy brain moment and paid it without comparing it to my EOB. Turns out the reason that the hospital had sent me the bill is because the hospital had submitted the claim incorrectly to my insurance. So insurance had "denied" it, saying that it should be resubmitted as "X". Once the hospital resubmitted, it was covered and I got a refund. So, make sure to compare the bill to the EOB that you receive from your insurance provider. And if you still have questions, call you insurance and ask. It never hurts to ask.

ETA: the comment in italics above is mine. I have no idea why it looks like it's by another poster, and can't figure out how to fix it. Epic fail. Sorry!

shmarpler · May 2015

Any time I get a bill that I think is off I call my insurance company. I ask what was billed to them and what they covered and what my responsibility is. If you are being charged more than your insurance company says you owe, call your doctor's office. If the amounts differ, you should be able to see where the problem is and figure out how it can be fixed. Good luck!

deviduke412 · May 2015

You probably didn't meet your deductible yet. I got a bill for $840 for my anatomy scan that insurance didn't cover. It was because I hadn't met my ded yet. Now that it's met, they will cover 90% of all future bills this year.

destinysmith94 · May 2015

You should call the place that billed you and set up a billing plan, that's what I've been doing. I pay $100 a month. As long as you're paying on it, it shouldn't be a problem! But sometimes if you don't start paying on it, it'll go on your credit Hun

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