My Right Foot: Arrrghhh!

The bills are coming in.

I spent one hour and fourteen minutes on the phone with Blue Cross Blue Shield the other morning.  It took that long for the BCBS representative to review the bills related to my foot surgery and to explain who’s paying what.

We talked about “in network deductibles”, “in network out of pocket payments”, “out of network deductibles”,  “out of network out of pocket payments”, “co-pays”, “co-insurance”, and how it’s all calculated.

Yes, this is confusing stuff, and not just for me. It appears it’s even more perplexing for millions of Americans who recently signed up for health insurance under the Affordable Care Act. According to the front page of the Sunday New York Times  (“Newly Insured, Many Now Face Learning Curve”), many people do not have a clue about how their complicated insurance policies work and how to be smart healthcare consumers. According to the Times article, hospitals, insurers, clinics and health advocacy groups are now organizing education efforts around the country. They certainly have their work cut out for them.

From my latest interaction with my insurance company, I can see why there’s a great need to educate American consumers about the how the healthcare system and their insurance policies work.

I have one of those high deductible plans, so my monthly premiums are not so expensive. It’s been a good strategy, because I am a pretty healthy person and aside from an annual physical, I rarely need to see a doctor. Most of the physicians or medical facilities I go to for check ups are “in network” and so I pay a nominal fee for a visit and in a few cases, I have to pay a bit more for a test or procedure or doctor’s visit that is not totally covered.

That’s been wonderful, until now. But because of my surgery, there are many more invoices and “Explanation of Benefits” (EOB) statements from my insurer and so I need to learn this new insurance vocabulary and how to navigate through all this.  Based on my recent conversation with the BCBS representative, I have also learned that the answers to my list of questions are not always what I want to hear.

I am puzzled about a bill I got for an MRI and I ask the representative,  “Doesn’t insurance cover that?”

“It goes toward your in network deductible,” she explained.

“So do I have to pay this or will insurance take care of it?”

“Like I said, it goes to your deductible and out of pocket payments.”

In other words, I pay that bill, until I rack up enough payments to satisfy that huge deductible on my policy.

Okay, next.  “I see that insurance covered less than half of the fee charged by my doctor for a recent visit. What’s that about?”

“That was the ‘allowed amount.”

“What do you mean ‘allowed amount’? It was a critical appointment. It was my last round of X-rays and the doctor explained to me what he was going to do in my surgery. This was not optional!”

“The problem is doctors charge whatever they want, but that is not our allowed amount”, she said, and then as if to comfort me,  “But what you pay goes toward your deductible and out of pocket.”

The reality: it’s more money out of my pocket, again.

Then, I ask about a series of X-Ray charges. BCBS paid for some, but not all. As a result, there is a chunky amount billed to me. The representative looks into it. Turns out the provider put in the wrong insurance code. Good catch on my part, but now I have to go back to the hospital billing department and tell them to resubmit the claim so I don’t have to pay extra. It’s up to me, not the insurance company, to correct this problem. That means another phone call and explaining all this to another customer representative.

I am learning that when it comes to medical bills, you have to study and question every charge; you have the power to negotiate some of the charges, you have to spend a lot of time talking with the insurance representatives and you have to be very very patient. And most of all, getting angry or emotional, won’t change a thing.

I still can’t believe I talked with the representative for one hour and fourteen minutes. And we were just going over the “small” bills. What I am in for when the big ones start pouring in?

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