Discussion » Questions » Finance » For a medical procedure costing $781, I was billed $250 in addition to the co-pay as part of “patient’s responsibility”. Grrrrrrr.
Randy D

For a medical procedure costing $781, I was billed $250 in addition to the co-pay as part of “patient’s responsibility”. Grrrrrrr.

 

  Normally, all I have to cover is the $45 co-pay, and the rest is covered by my PPO health insurance. When I was billed $250 of the PPO portion, I immediately contacted the insurance company, they stated that it should have been a covered expense, yet they had nothing to do with it because the billing office at the medical provider’s end charged me, not the insurance company. However, instead of leaving it at that, my insurance company informed me that they would contact the billing office to work it out. They asked me to wait approximately two weeks for everything to be ironed out, also stating that they were almost 100% sure that it would be resolved in my favor, that it was what is known as a “coding error”. They said I could most likely count on all of the $250 eventually being paid by the insurance. 

  Instead of being a complaint, this post gives kudos to not only my insurance company, but also the people of that billing department of the medical provider. Approximately 36 hours after I hung up from speaking with my insurance company, the situation was resolved, and I only had to pay the $45 co-pay. The $250 disappeared completely from my billing responsibility. The entire issue, which started out to be stressful and worrisome for me, not only was resolved well under the two week forecast, but it was also resolved smoothly and to my complete satisfaction. I’ve already contacted both agencies and given them praise.


  What’s a recent financial victory that you have had similar to the one that I list here?

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Posted - June 3, 2023
Tags : None

Responses


  • 34246
    A couple years ago, my son was driving while it was raining and ended up 50 feet off the road in the woods.   He was OK and so was his vehicle.  But it was 50ft off the road and down a hill in the woods with a huge stack of boulders directly behind it.

    We called AAA, they sent a tow truck but he said he could not do it, and claimed it was farther off the road than AAA covered.  1 day wasted.  
    We also have road service through our regular car insurance  (Progressive) So we called them. And explained that it was far off the road and down the hill in the woods.  They sent another tow truck driver out. He looked over the situation,  said given the condition of the vehicle, he did not want to just wrench it up because dragging the Jeep over the boulders would just tear the undercarriage and who knows what else up. So he wanted to clear trees in front of the Jeep and pull it forward saving the vehicle.  He said he would have to get permission from the county and discuss it with the road service insurance.   Thus took a few more days but he managed to get approval for all.  And we scheduled it for 2 days later, then the tow truck guy calls back and says the insurance only agreed to pay up to a certain amount and we needed to pay him $1500 more to complete the tow and he was going to tow it to his storage lot until we paid up. This guy was trying to gain possession and possibly ownership of the car. 
    We told him to go ahead with the tow. We would figure out how to get him paid.  I then proceeded to read up on the road service policy and it did not state and limitations as long as the vehicle was within 100ft of the road, it was a covered expense.  So, I called them and asked why the full amount for the tow was not being covered.  And after about and hour of discussion and the service rep getting approvals from his supervisor.  They agreed that the tow should be covered and the tow truck should not have asked me for more money. They then got all of us (myself, the road service person and the tow truck guy) on a 3-way call to make sure we were all on the same page.   I do not know if the tow truck guy got the extra $1500 from the insurance or not but I know I did not have to pay anything else out of pocket for the tow.

    The Jeep is still being driven by my son today.  The only thing we had to fix was the catalytic converter. Someone had actually climbed down the hill and cut it off while it was waiting to be towed.  



    This post was edited by my2cents at June 4, 2023 7:36 PM MDT
      June 4, 2023 4:41 AM MDT
    2

  • 53503

     

      Thanks! I’m glad that your son was not hurt in all of this, it’s the best part about the whole thing.

      The theft of the catalytic converter at the end, however, absolutely floored me! Grrrrrrrrrrr. Thieves will take advantage of even the slightest opportunity, won’t they? What lowlifes. Did you then file a separate claim due to the theft?

      Your saving grace in the entire story was your reading through the policy to verify exactly what coverage it offered (especially if you found it in the fine print), and holding the insurance company to its accountability for it. Great job standing your ground. 

       (P. S. I’m not intimating that the woman in the photo is supposed to represent what you look like, nor that I think that that’s how you look. It’s her actions that I mean to convey. Lol.)
    ~

      June 4, 2023 7:20 AM MDT
    1

  • 34246
    The insurance company was great. I did not have to fight with them at all. I just needed to know exactly what the policy was before I callled them in case they tried to fight it. It was the tow truck guy trying to be underhanded and get extra or get my son's Jeep.   
    We did not have full coverage so there was not a 2nd claim to file. If I remember correctly the converter cost us about $500 total to replace and have installed. This post was edited by my2cents at June 5, 2023 4:00 AM MDT
      June 4, 2023 8:45 AM MDT
    2

  • 8214
    What a horrible experience for you.  By the way, are you aware Progressive is owned by Scientology.  My daughter worked for Progressive for a while, she could tell you stories....Just sayin...
      June 4, 2023 1:36 PM MDT
    3

  • 34246
    No I was not aware of that. I just know they give me the best rates.
      June 4, 2023 2:08 PM MDT
    2

  • 8214
    I used to have Progressive then switched to Geico years ago which I was very happy with but two weeks ago  i discovered Erie Insurance and now pay half that Geico changed me with the same coverage 
      June 4, 2023 7:46 PM MDT
    2

  • 34246
    I had Gieco years ago, I switched to Nationwide when we bought our house, they gave a better bundle rate.  But canceled our car policy when we purchased a 1 ton truck, they did not cover trucks that size.  So now we have Progressive. But not for the house because they do not cover trampolines and pools. 
      June 5, 2023 4:03 AM MDT
    1

  • 8214
    So glad it all worked out for you.  I'm waiting for the hammer to fall after my surgery.  
      June 4, 2023 1:25 PM MDT
    3

  • 13277
    I was hospitalized for three nights with a touch of pneumonia at the end of April. The only bill I have received was for $26 and change. It appears that our gold level insurance from the New York State Obamacare exchange is covering the rest of the $53k cost.
      June 4, 2023 7:53 PM MDT
    2

  • 44602
    Tri-care for life...military retired. $200k for three surgeries...$0.
      June 4, 2023 8:10 PM MDT
    1