Wow. What a crazy little roller coaster ride that was.
Backround: received services from dermatologist and was appropriately billed (albeit a large amount) my portion after insurance did their part
Concern: this was my first experience while under a high deductible plan, and I started to question if I should have waited to get the services done until after my lower deductible benefits kicked in (Oct 1)
Assessment: at first I thought my provider must have surely been out of network and that's why my OOP (out of pocket) cost was so high. This was not the case.
Next I researched Reddit to see if I should even attempt to negotiate what I still owed the provider... Main consensus, "doesn't hurt to ask."
So I asked and they said, "no." I then asked to speak to a supervisor and was sent to voicemail, at which point I left a message.
That very night I decided to research Reddit some more and this time I read every thread/post that came up under the search "Negotiating Medical Debt". Main themes varied widely from ... Pay what you owe to ... Let it hit collections to increase your leverage (surely they'd rather take 50% of monies owed versus pennies on the dollar).
Then there was this one thread that threw out an interesting idea... Go back to the insurance company to see what they could do (not just to complain to them but to see if you could find a valid reason or proposal to appeal for them to reconsider how much was paid and if they'd be open to paying more, hence reducing the patient's ... my... OOP).
Ding ding ding
So I called my insurance and had a very enlightening conversation with the agent... Who helped explain that even if I had waited to receive services I'd more than likely have been in the same boat regarding my expected OOP costs. That brought some relief but not to my wallet.
The one benefit of waiting would have been that I could have met my deductible for all of 2020 but because my services happened before my "new" plan kicked in (Oct 1), I'd only get credit for that large dermatology bill against my deductible through 2019.
This was the key turning point... I asked if I could "appeal" the claim decision based on the confusion surrounding how and when my deductible would have been applied and ultimately met, either through 2019 or all the way through 2020.
Once I mentioned "appeal" and, honestly, because I believe we had a very informative conversation she offered two options....
1) Do exactly as I had asked... To see if I could get credit for my deductible being met through 2020 even though I should only get credit through 2019. Essentially switching the dates of services to after Oct 1st versus their original dates of Sept. I'd still be on the hook for the OOP bill I received but for the next 13+ months I'd get better coverage from all procedures moving forward because my insurance would be more on the hook for coverage
Then she explained option 2:
2) She could submit for an exception based on the confusion about my coverage and ask the insurer to "overpay" on the claims and instead of me being responsible for the left over amounts, my insurance would pick up the tab. They'd instead charge me my co-pay visit fee of $30 for each of the two visits in question. There were limits but she thought she'd be able to tackle the total large bill I was facing and reduce it to $60 total!
That second option felt like a no brainier. The only down side is that I'd still be on the hook for my full deductible moving forward but the great part is, since it is now after Oct 1, my new plan's deductible is a 1/3 of what it was compared to the high deductible plan I was under through Sept.
Essentially, it boils down to never hurts to ask, but tack on, it only helps to be educated about what you're asking for...
Hope this helps others and if any details need explaining or if I can help answer specific questions. Let me know.
For the record the bill was for about $1,100. Which I will now only owe $60.
And my insurer was BlueShield of California PPO (non-ACA).
Deductible before Oct 1st was originally $3,000. I switched to the $1,000 deductible plan as of Oct 1.
Everyone did their part right, the doctor, the insurance company, etc. This was more of a compassion play on the insurer's part and may not be available across all payers.
Good luck.
Submitted November 08, 2019 at 06:54PM by RyanBorck https://ift.tt/2qx1CIH