A “Don’t Be A Mule” Moment-Health Insurance

by David Bakke

health insuranceI chose the title that I did for my book (“Don’t Be A Mule…”) because what I realized during my trip to financial hell and back is that there are a lot of things that we can do in our daily lives to improve our personal economies that involve simple concepts.  Concepts such as “waking up”, concepts such as “fight for yourself” and so on.

Some of these concepts are one time changes in our buying attitudes, our shopping habits, etc.  With others, there are specific instances that happen to us in life that require us to act.  And they also require us to practice certain things like standing up to people; things like fighting for ourselves, and things like not giving up.

These things are not easy to do, and I think a lot of us out there decide to take the “easy way out” sometimes.  We just let ourselves get run over by people (or companies) rather than fighting for what is rightfully ours.

 

I have been speaking in concepts and hypotheticals so far, here is the meat of my story.  When you see something happening in your life where you know someone is trying to take your money unfairly, or you come up against some company policy that you know is unfair-you need to fight back!  You need to step up and do what it takes to get your money back!  Or, if it hasn’t been taken yet, to keep it from happening.

I will try to be brief and give you just the main facts.  Last month, we had to take our son to the emergency room.  It turned out to be bronchitis, we just ended up taking him there because by the time we realized he needed to see a doctor, our primary care physician was closed and he needed some medical attention.  He is fine now, but we did have to go to the emergency room.

This happened in November and I just got the bill in the mail.  The total for all the services performed was right around $1200.  Which sounds about right.  However, after insurance paid their part, the hospital (or actually, the insurance company) was claiming that I still owed almost $600 of this.  Since my son has been born, we have been to the emergency room a time or two and normally after all is said and done, I usually owe about 10-15% of the bill.  In this case, I would have thought it would have been about $150.  This was calculated just by going by what I had paid in the past.

I knew there was something funny about this bill; I just didn’t know what it was.  At first, I thought I would just pay it (you see, I almost got lazy myself!) but then again I knew that there was something wrong and I was going to get to the bottom of it and fight like hell before paying out $500 more than I thought I should owe.

After calls to the hospital and the insurance company, this is what I found out (another unfortunate aspect of these things-most situations do involve a little “digging”).  My insurance company says that I have a $500 deductible with them with regards to emergency room visits and they said I hadn’t met it yet.  Technically, they were right.  My employer switched health care providers in March of this year, so technically I hadn’t met my deductible with the new insurance company.  However, like I said, I was certain we had been to the emergency room a few other times with my son in 2009.

After some more digging and some more calls to the emergency room billing department and the insurance company, it turns out that in cases like these, many times, insurance companies will have what is called a “carryover” policy to where in this instance, the fact that I fulfilled my deductible with the old insurance company will still count with the new one.

No one could tell me for sure that this would be the case in my situation, but this is where things stand right now.  I keep detailed records of all my son’s doctors’ visits (for tax reasons and plus, as you can see, you never know when you’re going to need them).  I got together the records of my son’s two previous visits to the emergency room in 2009, complete with where I fulfilled my deductible, and a copy of this most recent bill.

I have emailed the person that deals with benefits at my employer’s home office and I’ll be faxing all this stuff over to her today.

 

I am fairly certain that I will get $500 knocked off of this bill, and will only be paying around $100.  Of course, a lot of things had to take place for this to happen.

I had to be smart enough to realize that this bill sounded wrong (this is called “paying attention” or better yet “Don’t Be a Mule”).

I had to make the effort to find out what was going on (calls to the insurance company calls to the emergency room billing department, and many, many minutes spent on hold).

I had to already have the documentation handy (my son’s medical records, just a step away in my filing cabinet).

Now, I just have to follow up and follow through.  My insurance carrier should have this “carryover” policy.  If they don’t, you can bet that I will still fight for myself.  There is a chance I won’t win, but I will not go down without a fight.  If we were talking about $20, I may not go to this trouble.  Considering that $500 is close a full week’s work for me, I’d be a fool not to invest the time and effort into trying to get this fixed.

Have any stories of your own where you fought and won?  Fought and lost?  Please share!  Both myself and my readers would love to hear about it.

{ 8 comments }

1 Jackie December 15, 2009 at 3:49 pm

Good for you for being committed to getting to the bottom of things. Especially with large bureaucratic organizations, you really do have to fight for things.
.-= Jackie´s last blog ..The Best Money-Saving Idea EVER (According to Me) =-.

2 David/Yourfinances101 December 15, 2009 at 7:08 pm

Jackie,

Unfortunately, you do. You can win if you stay focused.

Thanks for stopping by
.-= David/Yourfinances101´s last blog ..A “Don’t Be A Mule” Moment-Health Insurance =-.

3 Peter December 15, 2009 at 8:01 pm

Sometimes you have to do a little extra leg work in order to get a discount. I hope it pays off for you!
.-= Peter´s last blog ..$25 Gift Card Giveaway: What Frugal Gifts Would You Buy With This Gift Card? =-.

4 David/Yourfinances101 December 15, 2009 at 8:11 pm

I’ll be sure to do a follow up post on this one.

Thanks for the comment
.-= David/Yourfinances101´s last blog ..A “Don’t Be A Mule” Moment-Health Insurance =-.

5 ARAMVIZ77 December 29, 2009 at 9:01 pm

Good for you! I tend to have the bad habit of just paying them and not questioning until this past month when I had a few visits to the ER and I gave birth as well. I kept getting multiple bills for the same visits and I noticed I was getting billed twice for some services. I am still in the process of sorting these out and trying to figure out what I really owe.

6 David/Yourfinances101 December 30, 2009 at 1:01 am

Hey there—I would go thru those bills with a fine tooth comb and starting asking lots of questions!!

Thanks for the comment
.-= David/Yourfinances101´s last blog ..Looking Back, Looking Ahead-With No Goals Whatsoever =-.

7 Lily January 19, 2010 at 3:20 am

Great post. I’m new to “frugality” and blogs like this are very helpful.

The stress of all that work is why we are “mules.” Just the thought of all those phone calls and being put on hold, and entering all your account #’s and having the telephone attendant ask you to repeat all that information to them once you actually do speak to a live person – is enough to give me chest pains. And your story is one that speaks to the dysfunction of our current “for profit” healthcare system – but I shall not digress from your point…

New to paying cash only, 2 weeks ago, I went to the grocery store and calculated in my head that the bill would be about $60. (I only had $70 with me.) The bill ended up at $98.47. I was distracted talking to the man in line behind me and hadn’t paid attention to the checker’s entries. I ended up giving him my credit card but while leaving with my grocery cart, I looked carefully at the receipt and noticed that the checker had charged me for 72 bunches of green onions at .59 each, when I only had purchased one. I immediately went back and he apologized and credited my card back for the $42 mistake and basically let me have the one bunch of onions free of charge.

In the past I may have not even noticed. But these days, I am finding all sorts of ways in which my extra attentiveness has saved me $.

8 David/Yourfinances101 January 19, 2010 at 10:54 am

Lily,

First, welcome to frugality!

Without sounding like a conspiracy theorist, I think it is all part of the health insurance industry’s game to suck more money out of us. By creating layer upon layer of bureaucracy, I guess a lot of people do give up!

That is where you have to retain your resolve.

Now, will I spend three hours on the phone to get back $5 I was overcharged?? Absolutely not–you do have to pick your battles.

About paying for cash–congratulations.

I never paid attention to all of these so-called “little things” in the past either. It was only until I realized that I work hard for my money, that should should at least do a little work to try to keep as much of it in my life as possible.

Thank you so much for commenting! Hope you can stop by again some time.

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