Medical Billing Errors: Know What Your Health Insurance Covers

by Michael on Nov 16, 2012

Image of a Patient Medical History Form

A few weeks ago, my wife and I took our kids to get flu shots. We ended up getting them at our local pharmacy because they’re convenient and they take our insurance.

After we got done — all six of us — I went to settle what should have been a $0 bill. Instead, I was greeted with a request for a $90 payment.

You see, despite having a high-deductible health plan (HDHP), we have 100% coverage for preventive care, including vaccines. But for some reason, the billing system said that we had to pay $15/each (vs. the regular price of $30/each).

When I pointed out to the guy behind the counter that our insurance should cover 100% of the bill, he just shrugged and said this was what the computer told him when he ran our insurance through the system.

While I could’ve just accepted his answer, I knew better. I’d previously previously read through our policy, and I knew the details of our coverage.

Ultimately, I let the guy at the counter off the hook as he didn’t have the power to override what the computer was telling him. But when I got home, I promptly filed a claim with our health insurance provider.

The claim-filing process wasn’t terribly hard, though it was annoying to have to fill out the same forms for six different people. Nonetheless, it was worth the effort to get back the $90 that we shouldn’t have been asked to pay in the first place.

The lesson here is to review your health (and other) insurance policies so you’ll know what’s actually covered. It’s not uncommon to run into billing errors, so you need to keep a close eye on things.

Of course, this also extends to reviewing your bill in cases of balance billing, where the provider files the claim with insurance on your behalf and then bills you for the difference after the fact.

Regardless of how things go down, don’t just assume that they got it right. Medical billing errors are actually quite common so you need to be proactive. And don’t be afraid to take it up with your insurance company (and/or the provider) if you think there’s been a mistake. The added hassle is (usually) well worth your time.

Oh, and if your request is initially denied, don’t hesitate to appeal. It’s not uncommon to have an initial claim denied only to have that decision reversed when you challenge them. Annoying but true. 🙂


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