At first I thought it was junk, since I didn’t know why else a medical center in Florida would be sending me mail. After opening the envelope and finding myself staring at a bill for $54, it suddenly came back to me. When my family was on vacation in Florida at the end of April, my wife developed an itchy and painful rash above her left eye. After she suffered with the rash for a few days, we decided it was time to have it looked at.
We thought we’d done everything right, as we’d taken the following actions:
- Called our insurance provider to obtain a list of nearby in-network providers
- Made an appointment and ensured it was a diagnostic visit (not urgent care or ER services)
- Verified with both the medical facility and our insurance provider that the service would be billed as an office visit to a primary care provider
- Called our insurance provider to obtain a list of nearby in-network pharmacies
- Made a follow up call to our insurance provider to ensure we’d done everything properly
How I Fought My Insurance Bill
Though we’d been assured there would be zero out-of-pocket costs as per the terms of our insurance coverage, here I was looking at a bill.
I immediately pulled out my insurance card and dialed the customer care number. I explained my situation to the representative, as well as the precautions we’d taken while in Florida. After reviewing my information, she agreed we shouldn’t have been charged coinsurance for an in-network diagnostic office visit.
She put a note in the file and sent it back for reprocessing. She said we’d receive a new explanation-of-benefits statement in the mail, which should indicate we didn’t owe anything. She also gave me her name, and said if I had any issues that I should call and ask for her directly.
After a few weeks, we received a new statement from our insurance company. I took a deep breath as I opened the letter, and thankfully, it reflected a new balance of zero dollars.
The wheels of health insurance may turn slowly — but with a little nudge, they do turn.
Have you ever questioned the outcome of a health insurance claim? How did it turn out for you?