Dealing with health insurance

This is a bit of a venting post as I’ve been trying to figure out bills and what the insurance pays and what applies to the deductible and what the health provider is allowed to charge me. Don’t get me wrong, I am so glad I have good health insurance, but trying to negotiate this maze is frustrating to say the least! I know that certain providers sign a contract with the insurance company and agree to accept the insurance company’s payment schedule. But when the provider is billing $5,000 and the insurance company agrees to pay $750; how is that provider meeting their bills, especially when I’m only paying a $30 co-pay?

I have a large deductible on my insurance – $5,000 – and I have no idea how I’m going to pay half of that (I will get reimbursed for half). We have savings that could get wiped out by this, but at least we have savings. In addition to that, I’m paying $60/week in co-pays – sometimes more. That adds up in a hurry. And on January 1st, the $5,000 deductible starts over – but so does the $2,500 reimbursement.

It may be a shock with these bills, but how do people manage without health insurance? I’ve seen how much all these charges are and can well understand how people can go bankrupt and lose everything while trying to pay medical bills.

Today was the day I tried to get organized with all the Explanation of Benefits or EOBs from the insurance company. I have also had a long conversation with one of the hospitals that sent me a statement – no detail on it at all – to find out why their amounts didn’t match the EOB.

So here’s how this works with my insurance: an EOB is posted for every provider at some point after they have billed my insurance. The EOB shows provider, procedure, charges, what they allow, what they won’t pay, what the provider is allowed to bill me. So if the bill I get doesn’t match, I want to know why.

The person I spoke with in the provider’s billing office said they don’t normally send itemized bills just a statement. If I’m having to pay some $4,000+ I want to know what I’m paying for. She did agree that was reasonable and said she would send an itemized bill. The other concern I had with the bill is it only gives 7 days to pay – now who has $4,000 on hand in their bank account? I know I don’t have to pay it all at once; that I can make payment arrangements, but that is still a lot of money. Do people really pay from statements that don’t give a date of service or name of procedure? How do they know that the billing is correct?

So my EOBs and bills are somewhat organized, so that’s something.

6 thoughts on “Dealing with health insurance

  1. Ugh and yuck. I got a headache just reading what you have to go through! This is ridiculous, not only the ambiguity and exorbitant costs, but that people who are already facing daily challenges and struggles just trying to survive physically, also have to muster the energy and brain-power to navigate all these twists and turns of a ridiculous system. We are so lucky here in Canada with our health-care system. One of my brother’s pre-autologous transplant drugs cost several thousand dollars per treatment (and he needed six)…because of his amazing work insurance, he only paid $4.00 for it! But we both wondered what people do who don’t have insurance. It’s frightening and sad that people have to worry about all of this when all of their energy should be focused on healing.

    My rant’s over now. I’m sorry you have to deal with all of this. I can’t imagine being able to.

  2. Yes, you’re lucky. Every time someone tries to reform health care here, it devolves into name calling and worse. It’s painted as socialism at best, and communism at worst. I get so tired of the political garbage of it all.

  3. This post definitely strikes a nerve with me. Navigating health insurance is stressful at any time, but especially so when dealing with massive health issues. The last thing you want to think about when dealing with a health crisis is red tape.

  4. This caught my eye: “…when the provider is billing $5,000 and the insurance company agrees to pay $750; how is that provider meeting their bills, especially when I’m only paying a $30 co-pay?”

    Allow me to offer a story. Years ago, I needed a hysterectomy. It was to be a laser procedure, which meant at most an overnight stay at the hospital. The cost was to be $6000. At the time, I had no insurance, and told the nice lady in the hospital billing department that there was no way I could afford such a thing. “Can you pay cash?” she asked. “What?” says me. “I don’t have that kind of cash.”

    As it turned out, credit was the same as cash, and if I put it on a credit card, the cost would be $1,500.

    So. What the provider is billing may be more a function of what insurance will pay that a reflection of actual cost to the provider.

    Now, as to that business of not having insurance. I went for years and years with no medical insurance, and when things like the hysterectomy came up, I discovered some creative ways to deal with it. My surgeon was also one of my customers. (I think you know I varnish boats for a living.) We struck a deal – a year’s worth of varnish maintenance in exchange for his surgeon’s fees. What a deal! Just like paying the preacher with chickens and pies in the old days!

Ruth passed away from cancer. Please remove from list

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