Tuesday, September 1, 2015

Medical Issues: We go to the Emergency Room: Part 1

So, late in July Beth had what we were pretty sure was a gall stone attack. She went to work the next day, but the pain reoccurred and she headed down to the local ER to get checked out. Although she was pretty sure it was gall stones the pain is not too dissimilar from certain types of heart attack and who the heck wants to drop dead at work?

She got herself checked in and the rather lengthy process began including and MRI, ECG, and a long list of blood and other fluid tests. You won't have to imagine what it all cost because I'm going to lay it all out as each billing unit (there are 5) comes in and gets resolved. Our insurance company, Cigna,  processed all the claims within about three weeks and we began to receive bills from the hospital's processing company at about the 4 week point.

Important Lesson #1:

Print out all the documentation from your insurer. You'll need it when the bills start to arrive.

These two screen grabs show how our insurance company processed and paid the first set of charges:

Pretty easy to understand, just two line items and it's fairly clear what we should expect to pay. In fact, the company included an easy to read breakdown as well:

Pretty cool. We only owe $56.32! But wait! The actual bill hasn't arrived yet. Which it did just last week:

How could this be? The insurance company paid nearly all of this! The answer lies in the dates. The bill was printed on August 21. The insurance company processed the claim on August 17. I don't have an exact date, but it's pretty easy to believe it took more than 4 days for the payment to make it into the billing system and be credited.

My first step was to figure out which set of charges this bill referred to. That was made easy by the fact that the insurance company itemized the charges in a way that matched that used by the billing company. Once I had the right insurance company statement in hand I called the billing company to find out if the payment had arrived. In fact it had and not only did I not owe $563.20, I didn't even owe the $56.32. The $38.00 "not covered by [my] plan" was apparently waived and I ended up paying only $18.32. Yea!

Important Lesson #2:

Call the billing company before you pay! It's very likely your insurance company's payments have already hit the system.  

Well, in the end it turns out Beth does have gall stones but nothing was blocked. That probably means we'll have another episode some time in the future. I can only hope we'll have medical insurance as good as what we have from Cigna when that happens.

After this episode, we still have four more "billing units".  I'll save 'em up for the next post.

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