There are so many types of insurance that can be purchased including life insurance, health insurance, homeowners insurance, renters insurance, accidental death and dismemberment, car insurance, and dental insurance. There are also so many different companies. And there are so many different terms to be aware of like deductibles, out of pocket expense, multi-policy discount, good driver discount, property damage coverage, uninsured motorists coverage, medical payments to others and so much more.
It is important to trust the insurance agent and the company that is responsible for the coverage and any payouts. You should also understand the terms in your policy. However, after you feel confident that you have the coverage you need and you have a plan in place to pay the bill, you can’t sit back and relax. The company may seem qualified but that doesn’t mean they are always right.
When I started questioning my insurance expenses.
When we learned I was pregnant with our first child, we were ecstatic. It was a few weeks later that I lost my job and with it my health insurance. Back then, having a baby was about $2,000. Having lost my insurance meant my husband and I were responsible for the entire bill. For the first time in my life, it was important to check every expense and reduce any I could.
I did research and found out I would be charged for the pitcher, tray, and cup for water. So, I brought my own, which was not marked up heavily like the hospitals. I didn’t use the set they provided, so they couldn’t charge me. They charged me for it anyway because it was a standard cost. Another standard cost was an enema. I didn’t have one, but once again I was charged for one. I wrote a letter explaining that I shouldn’t be charged for these items and they took them off. Yes, these were minor costs, but when you are responsible for the entire bill, it is important to check every cost.
There have been two, vehicle accidents that my husband was involved in where the insurance wasn’t siding in our favor. Between pictures and a letter explaining what had really happened, the insurance covered everything for us, because we were not at fault. We would have assumed that they would be on our side immediately since we are their client, but it seemed like they were ready to settle, instead of fight for us. Be sure you are ready to fight if you feel you are the innocent party. It is definitely worth your time.
My most receint insurance discrepancy.
In 2019, I had MRI’s and testing that eventually led to major surgery, with four days in the hospital. I was pretty confident I would hit my maximum out-of-pocket expense, almost before the surgery in November. At the end of the month of my surgery, I received my bill for my surgery. The bill was so different from the bill I received after my daughter was born. Not much detail this time. I was charged $13,522 for intensive care, $10,179.50 for medical/surgical supplies and devices, other implants, and my total for the 13 items listed was over $150,000. This didn’t concern me because I had a deductible of $2,500 and an out-of-pocket maximum of $7,550. So I believed I would owe the out-of-pocket maximum of $7,550. Since I had paid to date over $5,000 I was shocked to see that according to my insurance provider, I still owed $6,069.52. Without using a calculator I knew something was not right.
Early December, even though I was still recovering from having a brain tumor removed, I started calling about the bill. They were pretty confident they were correct. I asked that they send me a list of every payment that I had made for the year. I didn’t hear back after being told it would take a few weeks for them to mail the requested information to me. In January I called again. By then I had added up every payment I had made and discovered that many of my payments on my charges had been applied to my husband’s account. Also, a payment of $1,810 that was paid the date of surgery had not yet been applied.
I questioned whether they were expecting me to pay the deductible and the maximum out-of-pocket for a total of $10,050. The woman said no, we would only expect payment for the maximum out-of-pocket. A few weeks later, I received a response of 13 envelopes from my insurance company. Each one was a sheet of paper that showed “not a bill” on the top with the charges for that month, not necessarily the payments. I had all of those already. Why were they sending them to me again with no explanation, especially sending them in 13 separate envelopes?
Progress at a snail’s pace.
I called a few times in February, each time requesting a list of payments being applied to my maximum out-of-pocket. And each time verifying that I wasn’t being charged $10,050 instead of the $7,550 I believed was the maximum I owed. No, they would only charge me $7,550. I asked that it be noted in my account that I am waiting for an explanation on the money I actually owe. By the end of January, they had finally applied my payment of $1,810 that I had made on November 11. It was progress, but they still weren’t close.
In February, I closed out my H.S.A. balance of $1,153.44 and paid it on my bill, since I was being charged a monthly fee to have the money there and I felt I was not even close to a resolution. I had wanted to pay everything I owed at once after they figured it out, but I realized that my bills were being marked past due. Additionally, the bill said if I couldn’t pay the full amount I needed to call to make payment arrangements or I would be put in collections. From what I knew about collections, I didn’t want my credit history damaged by it and once it went to collections it would be close to impossible to fight, I would no longer be dealing with my insurance company. So I paid $606.08 while on the phone with my insurance company. I didn’t believe I owed the full $606.08, but by doing so I ended up with a balance of $2,500 which I was confident I did not owe.
Avoiding Collections.
I didn’t receive anything in the mail to show that my bill had been adjusted so in March I called again. My bill was down to $3,106.08, with the $606.08 still not applied. I spoke to someone on March 6 and I felt that maybe they finally understood and my bill might be resolved soon.
Even though I was gaining confidence with each call, it was March when I finally caved in and started making monthly payments to stop my bill from going into collections. I was transferred to someone that I felt treated me like a deadbeat who wouldn’t pay her bills. I was given the option to pay my bill over a period of time. How much did I want to pay? Nothing actually, but once again I was nervous about the fact that it was taking so long for them to resolve this, and I didn’t want to pay any more money to them, especially not $2,500, which I remained confident I didn’t owe. But I started paying $137 a month. My first payment was made then, with the next one due at the beginning of April.
March arrived.
Out of concern I called in mid-March. I didn’t want to pay the April 1 bill. Why was I paying money so they could take their time figuring out my bill? It had been almost four months. I felt I had been patient. The next person I talked to assured me that my bill would be straightened out. Yes, I only owed $7,550 in total. She had me convinced I would hear back in two weeks. She called me back about a week later and apologized, but it would take a little longer.
I received another call from her soon after that one saying they had the bill figured out, except my prescription part. They had stopped my payment plan. They would be sending me a check. She read me the letter I would receive in which they apologized for any confusion or frustration I might have been feeling about my bill. They appreciated the opportunity to serve me. And they thanked me for the information I had provided. Even though I was in shock that this was finally going to be over, I would not believe it was, until I received the check.
Success at Last.
On April 2, four and 1/2 months after my surgery three envelopes arrived from my insurance. One was my confirmation that my payment plan was approved. Another was my “this is not a bill” summary of my surgery plus a list of payments I had made for the year, with no total included. And the final one was my letter of refund/review of my account, which included a refund of $466.58. That was the $137 payment made on my payment plan plus an overpayment of $319.58 from my payment of $606.08. Suddenly my $2,500 deductible was no longer due.
It took a long time to resolve. To do it over again I would have called more frequently and started out with a letter. I could have accepted their view on what I owed and I doubt they would have done a comprehensive review of my account, which would have caused me to overpay by almost $3,000. And I would have never known it.
If you find yourself doubting your insurance be sure to:
- Don’t assume your insurance is correct. If you are sure you are right, pursue it. Even if you are not sure you understand what they are saying, question it. It doesn’t hurt to double-check. Do not harass them if they are correct.
- Call them to establish the first date of contact in their records. Be sure they note this in your file. Be friendly. Everyone makes mistakes at times and they could be more helpful if you treat them nicely.
- Send a letter to make sure they heard your request correctly.
- If you have pictures to prove your point be sure they are given copies.
- If you have not heard from them in three weeks from your first call, call them again to check on the status.
- Is the process of collections on the horizon? Do not let your account go to collections, even if you are positive they are wrong. Once it goes to collections you will be dealing with the collection agency. Start a payment plan with the smallest payment possible.
- If you had a vehicle stolen or a house burn down, you must continue to pay your loan payments until your insurance resolves the claim and pays off the loans.
- Don’t give up until you have a satisfactory answer. I was told several times that everything was correct and I owed them money. I insisted that they prove it to me.
If you find yourself in this position be patient. Don’t let them talk you into paying the bill in full and getting a refund back when they figure it out. I hope you are never in this position, but if you are, good luck.
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