I have a PPO plan. I have a $50 deductible and owe 10% co-insurance when I see in-network providers. It's a student health insurance plan.
However, despite this contract, nearly every provider I go to bills me more than what my insurance says I owe according to the explanation of benefits I get for each claim.
About 5% of the time, the provider acknowledges the mistake and sends me a new bill with the corrected balance. But for all the others, they refuse to budge and threaten collections if I don't pay the full amount.
Sometimes the provider will say, "this is a [insert random name] fee/surcharge etc. that insurance doesn't cover." Other times, the person that answers the call either doesn't understand medical billing at all or is pretending to not understand it to get me off the phone.
I'm on the phone with my health insurance nearly every day. They've said they've done investigations, except all but one "investigation" has dragged out for several months with nothing to show for it. And each time I call up, they act like they've never heard of any of these investigations until I start reading off codes, dates, and people. Then they magically find it and act like it's the first time anyone has been made aware of it and say they'll call me up when they get an answer. And then they never do.
Is there something I'm missing here? I've read similar complaints from people, but people seem to experience these things rarely - whereas in my situation, not having a medical billing headache is the rare exception.
This also seems to be a problem with the providers near my university (small city in upstate New York) more so than where I grew up (suburb of NYC).
Submitted February 03, 2019 at 09:15PM by AmbitiousMonk http://bit.ly/2TpEzJf
