Windfall!

I got $135 from my dentist last month, and just received $20 from the EMG doctor.  Last October, I got $1,000 back from my son’s orthodontist.  Every time, it’s because I read the Explanation of Benefits sent by my insurance company.  Read your EOB!

Keep Track
I keep a running list of all medical appointments for my family. I know the date of the visit, and I enter the date that I receive an EOB; a few weeks later I enter the date that the provider’s bill arrives. Keeping track of the EOBs that have arrived means we are never surprised by unexpected bills.

Ask Questions
Once a claim was denied and I subsequently received a bill from the doctor’s office. Since I had read my EOB (and my plan booklet), I phoned the insurance company to ask why the claim was denied. Turns out that someone’s fingers were working a little too quickly and they’d entered the wrong code. As easily as that, the claim was approved.

Appeal
Sometimes “no” just means, “ask a different way.” If you read your plan booklet and believe that the claim falls within what is covered under your plan, write a letter of appeal. Sometimes your doctor will write a letter on your behalf (ask nicely; it’s something extra, and time for which the doctor doesn’t get paid). I have appealed two claims (in addition to the wrong-code mentioned above), and both times the claim was approved.

Know What You Owe
If you read your EOB’s, you’ll only pay what the insurance company says you owe. Different doctors set up their billings system differently. Some medical practices automatically bill you right away, expecting you to deduct what your insurance covers when you send in your payment. If you happen to overpay, some doctors’ offices will in let you know that there is a credit on your account. But not all do. I remember being appalled upon reading a story from someone whose boss would not allow her to inform a patient of nearly $400 in overpayments on that person’s account. I thought it couldn’t possibly be true.

It does happen, though. My son’s orthodontist keeps overpayments. Our insurance covered $500 toward braces. Since braces cost more than ten times that amount, we had to pay the remainder up-front. A year and a half later, our insurance company increased the benefit to $1,500. That will save us money on future orthodontia, but I didn’t dream it would be applied retroactively. It was, and the insurance company sent the extra money to the orthodontist – money that had had already been paid! The only way that I knew about this is because I read my EOBs. I waited, and waited, and waited. Finally I phoned the orthodontist, and learned that checks are only sent to patients who request them! The orthodontist’s office is decorated like a palace. The man drives a hummer. He takes his entire staff on an all-expenses paid vacation to Hawaii every year. His office is only open four days a week (and he’s not in the office at all every-other-week). Flaunting excess wealth like that does not make people happy to hear that he’s keeping money that doesn’t belong to him!

I’m sure glad that my PCP isn’t like that! Sometimes my doctor’s office even waives my co-pay. In truth, I wonder how he can make money by not charging. Sometimes it happens, though. If I am seen only briefly by a nurse (for instance, the second or third in a series of vaccines), the receptionist returns my check to me when I leave the office. There have even been a couple times that I’ve arrived for an appointment and been told that I don’t owe a co-pay that day because there’s a credit on my account. In these instances, the billing person had stuck a little post-it-note on the chart so that the receptionist would see it and not collect. All of these times have been due to someone deciding, after the fact, that a co-pay should be waived. My doctor could keep that money and nobody would ever know. I do not ever send extra money, and since my policy says that I owe $20 every time I go in, I expect to pay that money.

It’s Worth It
It is well worth taking the time needed to decipher the Explanation of Benefits sent out by your insurer. You’ll know that the right amount was paid — and you might even get money back!