I have health insurance through work, and I always choose the plan with the lowest deductible (which is $1,000).  Most years, I barely even touch my deductible. 2018 has been a different story!

I’ve already racked up over $500 in medical expenses this year, and I’m sure I’ll max out my deductible by the end of 2018.

Over the past several months, I’ve woken up in the middle of the night a few times with excruciating abdominal pain, back pain, and vomiting. Since it always happened after eating a high fat meal, my doctor suggested getting my gall bladder evaluated.

It turns out that I have gall stones. I had some other lab work that came back abnormal, so I need to follow-up with a specialist to make sure everything is good to go before I have surgery.

Dealing with health issues is never fun, and it’s even more stressful when you see the bills.

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I’ve incurred over $500 in medical expenses this month, and the worst part is that ALL of these expenses could have been avoided. Here’s why this happened – and what you can do to make sure this never happens to you!

Clinic is In-Network, but the Doc Isn’t

Who even knew this was a thing?!  I sure didn’t.

When I found out I needed a gall bladder ultrasound, I talked to the billing coordinator at my doctor’s office to get the CPT (current procedural terminology) code for the ultrasound.

The two of us sat together in her office and called the insurance company.  We confirmed with the customer service rep that the procedure was covered and that the clinic was in-network.

The guy told me that the procedure was 100% covered and I wouldn’t have to pay a cent out of pocket.

Flash forward a few weeks later and I received a bill for $250 – the entire cost of the ultrasound. When I furiously called up the insurance company, the rep told me that the clinic is in-network but the radiologist who reviewed the scan is not.

I had never been told the radiologist’s name and I hadn’t even met him.

I had never heard of this before, but apparently it is actually common. If you ever need to have a test done (like an MRI), make sure that the radiologist is in-network!

If you’re having surgery, verify that the hospital, surgeon, anesthesiologist, and any other relevant doctors are in-network as well.

Exclusions No One Mentions

According to the insurance plan documents I received during open enrollment at work, lab work is 100% covered and does NOT go to my deductible.  Imagine my surprise when I got a bill for 100% of the cost of lab work.

After numerous conversations with different customer service reps (who all gave me incorrect information), I finally talked to someone who know what he was doing.

It turns out that there is an exclusion that no one (including most of the customer service reps) seems to know about. Lab work is 100% covered UNLESS the clinic sends the lab work out to a hospital for it to be processed.

In that case, the entire cost goes toward my $1,000 deductible.

Billing Errors

In addition to the many rules, nuances, and exceptions described above, my insurance company also screws up my bills. On more than one occasion, I’ve been erroneously charged a specialist visit copay instead of a primary care visit copay.

One would think that this would be a relatively easy thing to fix, but of course, it isn’t.

Each time, I call the insurance company and the doctor’s office numerous times until I finally reach someone who knows how to do their job. Basically, each party tries to blame the other and neither will do anything to resolve the situation.

By the time I FINALLY talk to someone who will actually fix it, I’ve spent hours of my life trying to save $25 and questioning whether or not it’s even worth it.

I’ve considered changing insurance companies, but I get my insurance through work, and getting it anywhere else would be insanely expensive.

If you’re ever thinking about getting Humana for medical insurance, I strongly encourage you to look elsewhere.

Lessons Learned

While dealing with unexpected expenses (and insurance companies!) is never fun, I’ve learned a lot from these experiences, like:

  • It’s not enough to make sure that the clinic or hospital is in-network. Make sure the doctor is too!
  • Don’t believe everything that insurance customer service reps tell you.
  • Even if something is generally covered, there may be exclusions or exceptions.
  • If something looks incorrect on a bill, it probably is!
  • Don’t give up when trying to fight an incorrect bill. Eventually you might talk to someone who knows what they’re doing and will help. (If not, insurance companies have an appeal/grievance process).

 

Have you ever had any unexpected medical expenses?

 

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