The semi-good kind of medical billing problem
July 18, 2022 12:46 PM   Subscribe

[USA-health-care-filter] I keep getting partial refunds on medical bills that I paid in full. Who's to blame, the insurance company, medical provider, both? Should I be paying my medical bills differently?

Here's the situation that has happened multiple times in only a few years:

1. I go to the doctor's office, meet with the doctor, get a procedure done, etc. I may or may not pay a co-pay.
2. The doctor's medical group sends me several bills, one for the doctor, one for the technician, one for the lab processing the results of the procedure, etc.
3. I sigh heavily, wistfully remember the days when I had an HMO, curse the United States' lack of a health care system, and pay the bills in full as they arrive. What else would I do?
4. I check my account online and it says I have a zero balance.
5. Several months later, I get a check in the mail that says I overpaid by some random amount.

I am troubled by step five, as it seems that I cannot really trust anything sent in step two, and the whole thing is just weird and smells of incompetence.

I assume this is a problem caused by the interaction between the health care group and the insurer. Is there one that is more likely at blame here? Would it help if I paid my bills through the insurance portal instead of the medical group, even though there seems to be more bills and a bigger delay between the medical interaction and the bill/claim generated? Should I wait a month to see if the bill amounts from the medical group change?
posted by meowzilla to Work & Money (7 answers total)
Best answer: In step 2, when you receive the bills, they are probably still pending payment from insurance. Look at them closely to see if it says anything to that effect, and call the doc's office if necessary to confirm.
posted by Lady Li at 12:57 PM on July 18, 2022 [7 favorites]

Best answer: In other words, you describe a delay between the bills being issued and you paying them, but actually the delay between the medical group issuing the bills and the insurance posting them for you is "the insurance evaluating and paying". So you should wait for them to be done before you pay.
posted by Lady Li at 12:59 PM on July 18, 2022 [4 favorites]

Best answer: The whole system is a mess & you're not wrong to be troubled but it doesn't matter that much. I wait to pay until just before it goes to collections just out of principle & let them send their refund checks, it's no skin off my nose. I let the checks sit a good long while just out of spite.
posted by bleep at 1:07 PM on July 18, 2022

Best answer: I don't pay anything until I get a statement of benefits from the insurer and then I go to MyChart and pay bills that way.
posted by cooker girl at 1:07 PM on July 18, 2022 [4 favorites]

Best answer: Something that happens to me periodically is I get a bill for my estimated amount due based on what the medical provider thinks the insurance is going to pay, or the medical provider asks me to pay a copay at the time of service that isn't actually needed, but then insurance pays more than the Dr office expected and I get a weird $20 refund months later.

The insurance/medical provider system, especially in cases where you apparently have multiple medical providers participating, is a huge juggling act, the odds of them getting it right the first time seems to be pretty low, and that's my experience while being a person in relatively good health who only goes to the doctor a couple times a year.

But, I've found that unless you're outright refusing to pay or ignoring bills, most medical billing offices are very easy to work with. Call them up and ask what's up with this.
posted by AzraelBrown at 1:12 PM on July 18, 2022 [2 favorites]

Best answer: 3. I sigh heavily, wistfully remember the days when I had an HMO, curse the United States' lack of a health care system, and pay the bills in full as they arrive. What else would I do?

I generally wait several weeks or even a month or two to see what the insurance company does. Do you get EOB (Explanation of Benefits) statements from your insurer, either online or in the mail? Those should explain what they're paying vs. what you should be paying. Even if the insurance isn't paying for *anything* because you're under the deductible it could be that the doctor's office is initially billing you for the standard rate but when they submit it to the insurance company your bill gets adjusted to the insurance company's negotiated rate.
posted by mskyle at 1:26 PM on July 18, 2022 [3 favorites]

Best answer: I also wait until they threaten to send it to collections, at which point I assume everyone has figured out what they want me to pay. I’m not spending hours of my life on the phone with a medical billing office for the dubious distinction of being a person who pays her bills on time. Even at the collections stage I still don’t actually know why I’m paying what so fuck them. I will pay them in the way that is most efficient for me.
posted by HotToddy at 2:59 PM on July 18, 2022 [3 favorites]

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