I need help managing my medical insurance claims

November 7, 2014 2:14 PM

I am really bad at dealing with medical bills and keeping track of when I've met my deductible, particularly with out-of-network providers. Is there an app or software that can help with the administration?
posted by Dragonness to Work & Money (9 answers total)

Are you able to log in to your health insurance website and see where you stand? Ours (BCBS) shows how much we've spent on the deductible and co-insurance based on processed claims, and that's all I've ever needed to look at (rather than keeping track of it myself). All of our providers will bill insurance first, even before we meet the deductible, and then send me a bill for anything leftover. I have a medically complex kid and we hit our max OOP every year, so I deal with a LOT of medical bills - but I've never had to keep track of this information for myself.
posted by peanut_mcgillicuty at 2:25 PM on November 7, 2014

Do you not receive Explanation of Benefits (EoB) mailings after each time you use your insurance. These usually show your year-to-date numbers.
posted by Thorzdad at 2:27 PM on November 7, 2014

Agree with the above; you should be able to login or call the number on the back of your card to get this information.
posted by ThePinkSuperhero at 2:44 PM on November 7, 2014

Definitely check with your provider to see if they have a website. Blue Shield of CA just redesigned their website for example and they made it really easy to see how much you've paid to the deductible, etc.
posted by radioamy at 3:03 PM on November 7, 2014

Response by poster: The problem is I have weekly visits with an out-of-network provider who doesn't take insurance, so I have to submit those claims myself.
posted by Dragonness at 3:10 PM on November 7, 2014

Your insurance company should provide the same documentation whether you file the claim or your provider does. But I understand the problem -- I recently dropped an OON provider large part because he didn't take insurance and put the burden on me. Is that an option?
posted by SallyHitMeOntheHead at 3:27 PM on November 7, 2014 [1 favorite]

Response by poster: >Is that an option?

Not really, unfortunately.
posted by Dragonness at 6:12 PM on November 7, 2014

Best answer: I don't find knowing the deductible is much of an issue - all of the claims need to be submitted regardless of whether I've met the deductible yet or not. (If I haven't I need to send it in so it counts towards the deductible, if I have, I send it in and get money back). The main issues for me is figuring out if a claim was received, if it was processed or rejected or sent back for more information and then if it was an obvious mistake in processing. So, a basic spreadsheet works - date of service, doctor, amount, date claim submitted. When you get the EOB, if it looks right, fill in the amount paid, amount credited to deductible. I there is a problem with EOB or it is missing, make a note.

I also keep a copy of every claim sent in and write on a post-it the details of any follow up calls including dates and reference numbers. Messed up situations get a envelope of their own to keep everything together (corrected claims, documentation etc)
posted by metahawk at 10:41 PM on November 7, 2014 [1 favorite]

Response by poster: Perfect! Thank you!
posted by Dragonness at 8:06 AM on November 8, 2014