Don’t presume your provider’s office knows best

This guest post is from a good friend of mine. She’s not in the healthcare industry, but she is one of the most savvy healthcare consumers I know. When she was telling me about some of her recent dealings with providers and insurance, I immediately asked her to write up her experiences to share with my readers! 

I don’t willingly part with my money, especially when I see a healthcare provider.

I question unnecessary tests, and I don’t want the office staff to be cavalier about spending my money. I expect the office to be familiar with my insurance plan, but I need to know my plan well enough to fight back when necessary.

Two recent cases in point:

Ear Doctor

I saw an otolaryngologist (ENT ear nose throat doctor) for a hearing problem. The visit didn’t start out well. The doctor turned her head and directed her comments to my husband until he hollered at her to talk to me, her patient. The doctor recommended an MRI, CT, inner ear test and an auto-immune test. I questioned the multitude of tests, and in the end I only agreed to the last two.

I presumed, incorrectly, that the office would clear the tests with my insurance company before actually performing the test. That’s why I didn’t ask them if they’d be getting an authorization. Big mistake.

When I received the EOB (Explanation of Benefits) it looked as if my ‘provider could bill me $400!’ I called my insurance company and discovered the provider hadn’t sent the explanation/prescription for the procedure. So I called the provider’s office and said I expected them to follow through with what the insurance company needed.

I checked back twice to make sure this was done, and finally it was. In the end I only owed $60. But what if I hadn’t started the ball rolling? I could have owed and paid $400.  Maddening!

Dentist’s Office

My dentist knows that I question x-rays and only agree to them when absolutely necessary. My plan doesn’t cover fluoride treatments and the hygienist knows not to give them to me.

But little did I know I also needed to watch out for the office manager.

At a recent visit I was scheduling the next appointment. The office manager is an experienced employee and she told me that my plan covered two visits during a calendar year, and that it didn’t matter whether those two visits were six months apart. I was suspicious and I should have questioned it. She was wrong.

When I got the bill, I was annoyed to see that there was a charge. Typically I have a zero balance for a routine visit. I called the insurance company and found out that the appointment had been scheduled one day less than six months from the previous appointment, and the appointment needed to be at least six months apart. Just as I suspected.

I called my dentist’s office and this time asked for the dentist. I’ll admit I said I wanted to speak with her if she’d like our family to continue doing business with her. She called right back and was a good listener. I explained the situation and said her office manager had assured me the scheduling would be fine, so I wanted them to write off the charge. She said they would appeal the decision with the insurance company, telling me that generally they were flexible for one day, and that certainly they would write off the charge if the insurance company wouldn’t bend. In the end, the insurance company did bend.

Another happy ending. My second EOB showed a zero balance and all was well. But another patient might have simply paid that bill and never questioned it.

I can’t emphasize enough how important it is to:

  • Know your plan.
  • Ensure your provider’s office requests an authorization for any tests and procedures.
  • Scrutinize your bills and EOBs.
  • Ask questions until you get a satisfactory answer.
  • Do not pay a bill you don’t understand. Make your provider explain the bill until you know what you’re paying for.

I hope my friend’s experiences highlight the reality that no one cares about your health care dollars as much as you do!  

Sláinte,

Frugal Nurse

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