Trying to fix a medical billing error: At what point do I give up?
March 20, 2014 10:57 AM Subscribe
I got a small bill for lab work done as part of a routine annual exam. The entire amount should have been covered in full. At what point do I give up and just pay the bill?
posted by tckma to Health & Fitness (13 answers total) 1 user marked this as a favorite
I have a high deductible health plan with associated HSA funded via pre-tax payroll deductions. My deductible has been met for 2014 and I'm now in the coinsurance period.
I received a small bill ($8.25) for lab work done as part of a routine annual exam at an in-network doctor. It's my understanding that routine exams and physicals are covered by my health plan at 100%, regardless of whether or not the deductible has been met. I understand this is also a new requirement of insurance plans under the Affordable Care Act.
$8.25 is not going to break my bank by any means. However, I pay for my health insurance, and so does my employer, so in principle, I'd like to have any and all covered expenses, well, covered.
I called my insurance company this morning. They looked over the claim. They said yes, all the lab work is 100% covered as part of a routine exam. However, the doctor's office used "an inappropriate billing code" for some of the tests. The customer service rep went on to explain that there were billing code changes resulting from the Affordable Care Act that "your doctor might not be aware of." They only covered the charges billed under the correct ICD-9 code, and gave me a list of ICD-9 codes that should have been used for the other tests. (Googling these codes and what they mean, it makes perfect sense.) I was told to call the doctor's office and have them resubmit the claim with the additional codes.
I called the doctor's office. I was bounced between them, their billing office, the lab's billing office, and finally back to the doctor's office. Per their request, I faxed over a copy of the bill I received and gave them the list of ICD-9 codes that my insurance company gave me.
I just got a voicemail stating that they're not going to change the billing codes because everything is correct "as far as I and my manager are concerned."
At this point, looking at my current salary, I've spent far more than $8.25 worth of my time fighting this bill. Should I give up on this and just pay the bill from my HSA?
My principles on this say I'm not getting what I'm paying for (insurance coverage). However, if I hadn't hit my deductible for this year, this bill would have been around $55. I haven't spent that much of my time on it yet, but I have certainly exceeded $8.25 worth of my time, and part of me says I should just give up and pay it.
No, I'm not going to give out the diagnostic codes, either the ones used or the ones given to me by insurance, because anyone can Google what they mean and (in my opinion) that would violate medical privacy.