Approaching medical bills to make sure I don't overpay

y2jake215

Several months ago I was hospitalized and had to have minor surgery. I received two sets of bills from the procedure - a set from the hospital, and a set specifically from the doctor/surgeon.

The bill from the hospital was roughly $1200, and the bill from the doctor was a $40 co-pay.

Here's what throws me off - I have an HRA, and I received a letter showing how it ($725 of it) was applied to a third bill - which would've been around $1500 total.

I looked into my HRA claims, and from that hospital trip it received 3 claims - a $25 claim (paid from the $750), the ~$1500 claim that it applied the remaining $725 from my HRA to, and a third $47 claim it denied (because I had nothing left in the HRA). I have not received a bill, 4 months later, for any of these 3 claims. The $40 co-pay or the $1200 bill were never apparently sent as claims to my HRA.

I called the hospital billing services, with the $1200 bill, to see if the $725 had been applied to THAT bill, but they confirmed it was the doctor-specific side of the fence (with a different billing service).

My question basically boils down to - did my $750 HRA get applied to nothing? If I'm never going to be billed for that $1500 total service, why would I apply the $750 to it? I don't want to call to try and straighten it out, and end up having them realize they never billed me. Does anyone familiar with the logistics of hospital billing know what exactly happened here? Should I expect a bill, it just might take even longer?

Windburn

Depending on what kind of surgery you had, that third bill may be from the anesthesiologist. Another possibility is a second surgeon or assistant that bills separately from the primary surgeon. Your HRA must provide you with details of the claims it paid. Interesting aside, there is frequently a race to submit claims because payouts from insurance and other funds are first come first serve. Claims for a given service are not collected and then funds dispensed proportionately. However, once that first across the finish line race is over and the funds depleted, the other bills typically trickle in. It's one of the factors that is infuriating for patients (and providers) and makes managing medical debt very difficult.

Also, hoping that they might forget to bill you for services is not a good idea. First, you HAVE already paid some of it (through your HRA). If that bill is incorrect or spurious, you want it investigated so that money can be paid to one of your other bills. Second, there is frequently a very long lag time between when services are rendered and when the bills arrive. The reasons for this are beside the point, but needless to say, seeing a bill pop up a year or two later is not unheard of. Not having an accurate accounting of the charges and services will not protect you from this. Call and sort it out. Anything else is just wishful thinking.

zepherin

Call your insurance company first. They are really well versed in billing rules and law. And at least with BCBS and Aetna, they will tell you what you should pay for and how much you should pay. They have negotiated rates and they know what the rates are.

Also knowing your state allows for balance billing or not. It will change how, whom and what can be billed for. As Windburn said there is a billionth race and if the insurance company won’t pay for it. They bill the patient. Some states allow that if the hospital is in network some don’t.

HappylilElf

zepherin wrote: »

Call your insurance company first. They are really well versed in billing rules and law. And at least with BCBS and Aetna, they will tell you what you should pay for and how much you should pay. They have negotiated rates and they know what the rates are.

Also knowing your state allows for balance billing or not. It will change how, whom and what can be billed for. As Windburn said there is a billionth race and if the insurance company won’t pay for it. They bill the patient. Some states allow that if the hospital is in network some don’t.

Yeah, this. Medical billing is an utter clusterfuck. Like to the point that it's a legitimate contribution to how messed up our healthcare system costs are.

Don't ever hesitate to try and figure things out more if you feel like things aren't right, especially with an HRA/HSA/HMO.

Those plan types are often almost entirely built around the idea that the patient will pay too much because they don't (and frankly shouldn't be expected to) understand how medical billing and insurance coverage actually works.