Tuesday, March 2, 2010

Please Check Your Medical Insurance Claim Statements

Now we have to make sure we are paying for what we should and not more! The other day I received a claim statement showing what I owed to a hospital for a minor procedure. I noticed a fee for a "service charge." This is something I have never seen before. The discounted amount for this fee was included in what I owed to the hospital.

I also noticed that there was a notation next to the amount owed stating that this fee was paid directly to New York State by the insurance company. So why should this fee be included in what I owed the hospital? That would mean they get paid, by me, for this fee which was already directly paid to the state by the insurance company.

Needless to say, I called my insurance company. They agreed with me and said they will re-write the claim and make adjustments.

What if I didn't scrutinize this claim statement? What if I just sent the hospital the total amount owed without a second thought? I would be out money and the hospital would have made money from a fee they were not entitled to.

I also received a separate claim statement for drugs used for the procedure. It was initially denied by my insurance company because of a missing or incorrect NDC code. I called the hospital and had to speak to 5 different people/departments to get someone to correct this. But when I called the insurance representative about the service charge issue, I mentioned that I was confused since there were drug charges on the larger claim and also on this missing/incorrect drug claim. The rep said that someone did something wrong and that was why it was probably denied. Can you imagine if I was double billed for drugs? What a mess.

Please take the time to go over your insurance claim statements and question anything you do not understand. All it takes is a phone call and patience.

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