Tag Archives: Insurance

Bills and such

10 Jun

I’ve been out of town for a bit, and I returned home this morning to find some billing-related materials waiting for me.

The only actual bill came from Bay Imaging Consultants Medical Group. as far as I can tell, this has something to do with the x-rays I received in the hospital. This is apparently separate from the radiology item on my statement from the hospital. The bill lists charges for three items: “ORTHOPANTOGRAM”, “SHOULDER COMPLETE”, “FACIAL BONES, COMPL., MINIMUM”. The total charges were $147, but payments from my insurance brought it down to $53.79. The bill doesn’t say, but I’m pretty sure (based on my memory of some paper which I think I have in a big stack somewhere) that those payments come from my UC Berkeley SHIP plan, rather than my parents’ plan (which is supposed to be my primary insurance). I’ll have to give them a call to see if I can get them to bill the other insurer for the remainder.

I also received an explanation of benefits from the university insurance plan for my services from the oral surgeon. The insurance was billed for $3,720, of which $3,200 was for the surgery and $520 was for anesthesia. The insurance company has covered $1,831.82, and they expect me to pay $1,888.18. Of this amount that I’m responsible for, $146.21 is applied to my deductible, $457.95 is my coinsurance responsibility, and $1,284.02 “exceeds the allowed expense and is the member’s responsibility to pay.” For the record, I don’t really understand what all of these words mean, but maybe some day I’ll find out.

I’m hoping that the oral surgeon’s office will bill the remaining balance to my other insurance. I shouldn’t need to remind them about my second insurance, seeing as they called me for information about it while I was still sleeping off the anesthesia from the surgery.

The last related document I received was an explanation of dental benefits from MetLife, which provides my dental benefits for the SHIP plan. This was for the repairs of the chipped teeth. The statement tells me that the fee for my services is ordinarily $372, but the dentist agreed to accept only $286 as part of his participation in Metlife’s Preferred Dentist Program. Metlife reports having paid $208.80, leaving me to pay $77.20. As I understand it, they are applying $25 to my deductible and then paying 80% of what’s left. I’ll have to ask the dentist if they are also billing my parents’ dental insurance. Either that or I will just wait until I have a bill before I do anything.

A day late

28 May

Somebody from Alta Bates returned my call a few minutes ago. It didn’t seem like she had any record of billing Blue Shield of California, but she did take my correct insurance information. She seemed surprised that I didn’t have a group number for my primary insurance, but she took my father’s name, date of birth, and employer information instead. She also told that they had the wrong member number for my secondary insurance.

Now I’m back to waiting for more bills (and non-bills) to roll in.

Non-bill update

27 May

On Saturday, I mentioned that I’d have to call Alta Bates on Monday to give them my correct insurance information. Of course, I was forgetting that Monday was a holiday, so I ended up calling Tuesday morning instead. I left a message on a voicemail system, and I was supposed to hear back within one business day. I called a few minutes after 9AM, so they still will have a few minutes to meet that deadline after the phones open, but I’m not very optimistic.

If I don’t hear back, I think I’ll wait until I receive an actual bill before I take things further.

More non-bills

23 May

I opened the mailbox today to find an envelope from Blue Shield of California. I figured that this had to do with my medical bills, but I was surprised to receive mail from Blue Shield of California because neither of my insurance policies were through that entity.

Opening the envelope, I found three sheets of paper with two explanations of benefits. Each was for a claim for services rendered on 04/05/09, the date of my accident. Both claims were received by the insurer on 04/24/09 and processed in 3 days, and the documents claimed to have been issued on 4/28/09. Each carried a “Subscriber ID” number that somewhat resembled the one on my card for the UC Berkeley Student Health Insurance Plan.

One statement was for services from Alta Bates Summit Medical Center, the hospital where I received emergency care. It listed 10 items, all classified as “MISC SERVICES”, for a total cost of $1,944.10. The second statement was for services from the Berkeley Emergency Medical Group, and carried 3 “MISC SERVICES” items totalling $1,179.00. This was the first I had heard of this entity or any of its charges. Both statements explained that Blue Shield hadn’t paid any of the costs, justifying this with a note:

Our eligibility records indicate that htis person is not currently enrolled in a Blue Shield plan. Please contact the Blue Shield Customer Service Department if you have additional information regarding eligibility.

In other words, Blue Shield sent isn’t paying for my medical services because I don’t have insurance with them. It would have been nice if they had, obviously, but I can’t say I expected any better.

Of course, this raises the question of why a claim was submitted to Blue Shield of California in the first place. It’s possible that the hospital confused Blue Shield with Anthem Blue Cross, which administers Berkeley’s SHIP plan. However, I already received on Wednesday (but was too lazy to blog about) an Explanation of Benefits from the SHIP plan for some small charges for Radiology services from Bay Imaging Consultants administered on 04/05/09, so it seems that somebody in the hospital must have gotten their hands on my correct SHIP insurance information that day. The other possibility is that they billed Blue Shield of California instead of Blue Cross and Blue Shield of Massachusetts but used the my SHIP member number.

I’ll have to call the hospital’s billing line on Monday to get things straightened out. I may have to call the Berkeley Emergency Medical Group, also. I’ll try to get itemized bills, as well. I really don’t understand, though, why everything is getting billed incorrectly. All of my providers have seen my insurance cards, so it just shouldn’t be that hard.

A corollary and a question

14 May

This morning, when the person from Blue Cross and Blue Shield of Massachusetts told me that no claims had ever been submitted for me, it occurred to me that this meant that the oral surgeon’s office hadn’t yet submitted a claim. This isn’t a big deal, but if they were going to wait five weeks before submitting the claim, did they really need to call me for insurance information just two hours after the procedure, while I was still sleeping off the anesthesia?

Resolving the ambulance bill

14 May

I called American Medical Response this morning about the bill I received. I first said that I thought that they weren’t giving me enough time to resolve the insurance situation, and that the five day turnaround that they expected was inconsistent with the policy on their website, which says “Payment of the account is required within thirty (30) days of receipt of the invoice.” The customer service representative offered to extend the deadline by thirty days, and, naturally, I agreed to this.

I then asked whether they had any insurance information for me at all. The rep said they had that I was insured by BlueCross, and that I should contact my insurance company about an authorization. This wasn’t very helpful because both of my insurance plans are affiliated with BlueCross, but I didn’t press the issue further.

I next called Blue Cross and Blue Shield of Massachusetts (my parents’ insurer) to see how I could go about getting an authorization for the transportation. The representative informed me that no claim had been filed by the ambulance company at all, and that, in fact, no claims had ever been filed for me on the plan. I told her that I’d call the ambulance company with my information, and asked whether I’d need an authorization. She looked it up and determined that I would not. She asked if I knew whether it was in-network, but I didn’t know. She told me that for emergency service, they’d cover the charges in full, but for non-emergency service, I’d have to pay 20% if it were out-of-network. She also mentioned a deductible of $250 per person or $500 per family.

I called the ambulance company again, and they confirmed that they only had my student insurance plan information. I don’t know how it happened that way because the EMT on the ambulance did find both insurance cards in my wallet. In any case, I gave the representative my information for my parents’ insurance, and he said they’d submit the bill that plan. I asked him if he could tell me what the due date on my bill was, and he told me that I could disregard that, and they’d send me a new bill if I ended up owing something after insurance.

I’m still not entirely convinced that the insurance companies are going to pay for this. I’ll believe that when I see it. If nothing else, though, at least I have some time for things to work out.

The first bill

13 May

My accident was five and a half weeks ago, and I just received the first bill from the incident today. This bill, from American Medical Response, is just for the ten-mile ambulance ride, and it came out to $1,592.90. Most of this should be covered by my insurance, but the bill tells me,

No authorization has been provided for this claim. If you do not obtain an authorization you will be responsible for payment in full for this claim.

I’m surprised that they don’t have an authorization from my insurance because the EMT on the ambulance went through my wallet (with my permission), found my insurance cards, and told me that my insurance information was “going through.” Obviously, this isn’t the same as claiming to have an authorization, but I don’t know what else he could have meant.

This message was followed by a customer service number, which was closed for the evening when I dialed it. I followed up by attempting to call both of my insurance providers, but they were also closed for the day.

The due date on this bill is May 18, which is Monday of next week. The invoice is dated May 8, which was Friday of last week, but the bill didn’t arrive until today.  Fortunately, any payment that I owe will only have to travel as far as San Francisco, but that still means I’ll have to put a check in the mail on Saturday, so I need to resolve the insurance situation by Friday.

Even giving American Medical Response the benefit of the doubt and supposing that they actually mailed the bill on Friday, it took them twenty-five business days to get any billing information on its way to me, and I’ll have two business days to sort things out. I’m very lucky that I can afford to pay for it if I have to, but I can’t help but see this as symptomatic of a badly broken healthcare system.

My dual insurance coverage explained

14 Apr

I’ve come across some information on the University Health Services (UHS) website on how my dual insurance coverage with the Student Health Insurance Plan (SHIP) and my father’s plan works:

Services provided at UHS will be billed exclusively to SHIP regardless of whether you have dual coverage through another plan in addition to SHIP. For services provided outside of UHS, SHIP is secondary to all other insurance plans, (except Medi-Cal) meaning the other plan must pay for services first. In this case, SHIP will cover any charges, within the plan’s benefit limits, not covered by your other plan.

It looks like SHIP would ordinarily cover 70% of costs for the oral surgeon with it being out of network, so if my father’s plan covers anything near that proportion, I won’t be liable for much.

My insurance situation

7 Apr

When it comes to insurance, I happen to be very lucky. I have dual coverage for both medical and dental insurance. I get one set of coverage through the university. The fee is waived because of my job as a Graduate Student Instructor, but the plan is the student plan, which is most likely not as good as the plan that faculty and other employees have. I also have coverage through my father’s health and dental insurance plans, thanks to the Massachusetts healthcare reform law. While the main effect of this law was to expand coverage to almost all Massachusetts residents, it also contained a provision that required healthcare plans in the state to cover children for two years after loss of dependency (or until a certain age, which I think is 25). Since my parents are insured in Massachusetts through my father’s work, I’m covered under their plan. If I get through this situation in decent financial shape, I may just have to send Mitt Romney (who signed the healthcare reform law as governor) a letter of appreciation.

An insurance form

6 Apr

This afternoon, I completed an insurance form for the cycling club. I don’t really understand what it’s for. I don’t see why there would be an insurance policy that would pay anybody other than me (the club didn’t incur any costs from the accident), but I’ve already signed a waiver freeing the club from any liability.

The form wasn’t particularly remarkable except for two things. First, it had checkboxes for 21 body parts, and I was to indicate which had been injured. I ended up checking just under half of them (10). However, most of the injuries were very minor, such as light scratches on the front of my neck and my right ear. The second thing was that I was asked to indicate whether my injuries were minor or serious, and I wasn’t sure what the answer was. While a broken jaw certainly isn’t fun, plenty of people recover from it, and relatively quickly. I assumed that there was some serious legal definition of “serious injury,” and I looked around and found that I was right, at least in the State of New York.  A Google search turned up a page on the New York serious injury threshold:

“Serious injury” means a personal injury which results in death; dismemberment; significant disfigurement; a fracture; loss of a fetus; permanent loss of use of a body organ, member, function or system; permanent consequential limitation of use of a body organ or member; significant limitation of use of a body function or system, or a medically determined injury or impairment of a non permanent nature which prevents the injured person from performing substantially all of the material acts which constitute such person’s usual and customary daily activities for not less that ninety days during the one hundred eighty days immediately following the occurrence of the injury or impairment.

I’m nowhere near New York, and neither is the insurer, but this was good enough for me. While most of that wouldn’t describe any of my injuries, I definitely have a fracture.

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