Friday, April 14, 2017

Your Call Is Very Important to Us

Over the weekend, I added up the medical bills I've received so far for my little bout with breast cancer. The total:$70,814.39

And this was for a Stage 1 tumor that required relatively little attention. I can't even imagine what the price tag looks like if you have chemotherapy and reconstruction.

My health insurance company negotiated for a reduced price. That total was substantially less, only $26,676.81.

If you live outside the U.S. and you've been wondering what the big deal is with having healthcare coverage here, that's a huge part of it. If you have health insurance, you're only responsible for the discounted figure (of which your insurance compay pays the lion's share). Sans insurance, you're on the hook for the whole $71K.

My out-of-pocket max, per the terms of my policy, is $5500.

Here's the kicker, though: if you overpay someone, it's like pulling teeth to get it back (and let's not even talk about the price tag for dental work, which falls under a whole separate policy). So it's important to stay on top of the bills you receive, match them up to the explanation of benefits forms you get from the insurance company and make sure everything lines up.

Because it won't.

Thus far, I've had the various players in this game:
  • Refuse to pay the $2400 bill for my biopsy not once, but twice.
    1. The first time was because they wanted me to prove I was really entitled to insurance through my husband's company--that I couldn't get it through my own job. (I can't. At work, I have to stay below 28 hours a week to ensure my employer isn't legally required to offer me health insurance. Which I happily do.)  (Two phone calls, a trip to my HR office and proof submitted--the exact same proof I'd submitted less than three months earlier when my husband put me on his policy.)
    2. The second time was because the insurance company said the procedure required pre-authorization and they hadn't received it. Three more phone calls.
    3. Still waiting on the outcome for that.

  • Lose track of my surgery pre-payment.  The day before my lumpectomy, the hospital called and wanted $681. I gave them a credit card and they recorded the payment against my account. For some reason, though, when I went in the next day, they opened a second account and put all the charges there.Three more phone calls to get those married up
  • Send me a bill for $175 worth of labwork. Still another phone call netted the information that the insurance company negotiated the $175 down to $44.85, which was part of my deductible. Another phone call--the lab said they never got that notification. We agreed I'd pay them $44.85 and send a copy of the EOB with my payment.

We're now up to 10 phones calls, a letter, an hour of your-call-is-very-important-to-us-so-we'll-play-tinny-tuneless-music-in-your-ear-until-you-give-up, and a sheaf of bills and EOBs (explanations of benefits) an inch thick.

And my illness was relatively minor. How do people manage all this if they're really sick?


  1. I am sorry you are having so much trouble with bills and insurance. It is bad enough to have to deal with the health issue.

  2. Patience for the patient. That's what I kept telling myself. Our heart (and wallet) go out to you as we relate to every single bit of this.

  3. Holy crap. I think I love our insurance even more! We haven't had to make any phone calls yet. Whew!

  4. I just shove it in a folder. Far Guys meds are out of this world. Depending on the week 25,000 to 52,000 per week. If we didn't have great insurance he would certainly be dead.'I got a refund for 3 cents a while back from FOUR years ago ...our healthcare System sucks :(


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