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.

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