How to get my health insurance to pay more of this bill?

November 25, 2019 2:14 AM

I mistakenly had a doctor's appointment that was an uncovered service. But at least that shingles shot should be covered. How do I get them to pay up?

A friend of mine told me the primary care doctor she had recently seen was the best doctor she'd EVER seen. I can't say that about my primary care doctor so I thought to schedule my next physical with Dr. Best Ever.

My physical wasn't due until March but they said I would need a get-to-know-you visit before hand. In hindsight I can see I should've asked if this was a covered kind of visit and checked with my insurance, but I've been very lucky in my insurance and never had anything not covered, and it just didn't cross my mind.

Which is how I became responsible for more than $2000! About $800 of that was routine lab tests (like cholesterol) that I had skipped at my last physical (in a hurry that day) and about $800 was a shingles shot. At my age, my insurance will cover a shingles shot.

I asked the billing department (large university hospital system) if a discount was possible, after all my insurance company would get one. After a polite denial, keeping the guy on the phone for a while while I fretted aloud somehow resulted in a 50% discount on the actual doctor's fee (about $250) and a 70% discount on everything else. Now that's what I call service!

Now my bill is a little over $600. If I am figuring correctly about $250 is the shingles shot. The bill just has an "adjustment" on it for a lump sum, the individual charges show the original amounts.

should I
A) pay the whole bill and submit the shingles part to my insurance company for reimbursement
or
B) pay all but the shingles portion and ask the billing department to resubmit the shingles part to the insurance company
or
C) something more effective that you guys know about and I don't?

Thanks!

(and yes, he was a really good doctor! I'll be sticking with him, but pestering the insurance company before every visit to make sure it's covered)

posted by Jenny'sCricket to Work & Money (2 answers total)

Is this doctor in-network? Is the lab where you had bloodwork in-network?

I've never paid the full sticker price for lab work at in-network labs, even when I had a very high-deductible plan--the paperwork always showed that I was paying the negotiated fees (what the insurance company would pay if they were paying.) I realize this is not exactly the same situation but I think it should be similar. If all this is in-network, it sounds like something may have gone wrong either in the way your insurance company was billed or in the way they dealt with the bill. I would (for a minute) ignore the way the billing department let you bargain with them and just talk to your insurance company about what happened.
posted by needs more cowbell at 4:26 AM on November 25, 2019

Have they submitted a claim to your insurer and it's been denied, or have they not submitted a claim? If the claim has been denied already, call your insurer and ask them specifically what needs to happen on the shingles portion since you understand it's a covered benefit. It's hard to say you're paying everything except the shot when you submit payment - they're just going to decrement the balance owed. If they haven't submitted a claim for various services, they need to do that (and usually windows on health care payment are long, and also sometimes if you pay things over $500 promptly you can get yet another discount, so perhaps ask about that as well?). Maybe ask customer service at the insurer to walk you through why everything was denied (the office visit is one thing, but labs etc. might be covered if you haggle with them a bit).
posted by OneSmartMonkey at 8:33 AM on November 25, 2019