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If a person clears $50/hour, an $800 medical bill takes 20 hours of work to pay. It's worth more than a few minutes making three or four phone calls. When I call my insurance company, I either use a headset or my blue tooth and I make sure I have time. Generally, I do it while at work when I'm reviewing something. It is reasonable that making phone calls while grading papers would work as well. It is a hassle....
When an insurance company denies a claim, I call and explain my position: it is covered because ..... Then, I ask two questions: "Why did you deny it?" and "What do I have to do to have it approved?" Most of the time, it is because of a code error – the doctor's office used the wrong code or the insurance company missed something in the description. Then, I ask "What is the correct code?" They never tell me. So, I ask "Who, specifically, should the doctor's office ask for when they call?" They never tell me that either but I use that to get to a supervisor. I start the same thing with the supervisor. It ends with "What do I do to have it approved?" I generally get the correct answer at that point, something like "They used the wrong code or the wrong explanation."
Then, I start on the doctor's office. I get to know someone in the billing department. I talk to them. They get mad and put me on hold. I sit. They finally hang up on me. I call back. It can be bad the first time but never more than an hour on hold. I tell them what I learned from the insurance company. If the person at the doctor's office get testy, I conference in the supervisor from the insurance company and moderate between the person at the doctor's office and the supervisor. It generally ends with an agreement.
Now, a warning about Doctor's offices.
SCAM #1. Some offices will send a claim to the insurance company and send you a bill stating they have sent the claim and you owe the full amount. Note, they didn't lie, they sent the claim but they haven't heard anything aback and if the insurance company denies the claim, you do owe the amount. When you see this, call the insurance company and find out the status of the claim from them. Then, call the doctor's office and tell them the status. NEVER, EVER pay that first bill. The doctor's office is trying to collect from both you and the insurance company.....
SCAM #2. Insurance companies negotiate with doctors for reduced rates. You should get a statement from the insurance company listing the price, the allowed amount, what insurance paid and what you owe. All of that should agree with the doctor's office bill. I have seen on several occasions a bill from a doctor's office deducting what insurance paid from the full amount and not from the reduced amount. ALWAYS check...
A warning about Insurance Companies.
Some will simply reject a claim for no apparent reason. They are betting you will just pay. You must fight to get them paid.
Insurance companies don't care about getting sued. They do care about complaints to the state or other government regulators. Most states have a procedure for contesting a bill or a denied claim. Know what that procedure is and go. Then, know a good lawyer who is a LGBT supporter or ally – they give great advice.
In the end, you can fight and win. It takes time. However, it's less time than you spend with a lawyer and it resolves far sooner.
Good luck.
Hugs,
Jen
