Coinsurance. Co-pays. Deductibles. Explanation of Benefits. Out of pocket expenses.
These words can be quite confusing, especially when the bills start coming in.
Wouldn't it be much easier if you got one bill for a surgery? Instead, you get the hospital bill, the anesthesiologist bill, the doctor bill...am I missing anything?!
Unless you have big medical expenses every year, you probably typically only deal with the copay's and maybe a few one-off doctor appointments. Throw in a surgery and you have to study your insurance coverage the equivalent time you would to get a Master's degree.
Now here I am Kara Robinson, M.S.I. - Masters of Science in Insurance.
I kid, I kid.
But not really
To give you the easy version, our BCBS deductible is $5,000. We have a secondary insurance that covers $4,250 of that; meaning my deductible is $750. Then anything over $5,000, we owe 30% up to an additional $1,350. So the most money we should be out for Mark's surgery is $2,100.
So before Mark's surgery we had to pay our deductible amount ($750), our secondary insurance would cover $4,250, and then we would pay the 30% up to an additional $1,350.
I transferred the money from savings to pay the doctor.
Then two weeks after Mark's surgery we get the hospital bill, and while it was around the amount I was expecting, something didn't seem right. So I called them. They said that we had not reached our deductible ($750).
That was very confusing to me since we had in fact paid $750 to Mark's surgeon. But at this point there was nothing I could do since the explanation of benefits form was not available in BCBS yet.
Once that became available (yesterday), I saved the two from the surgeon and sent an email to his office. It went something like this.
...I have a question for you, and I'm not sure if any of it's going to make sense. And, I'm not sure if you can even help me....
Next thing you know, I get a call from my husband saying that he got a call from the surgeon's office saying that we were getting a refund of $628!!!
How. About. THAT!!!!!!!!!!!!!!!!
Turns out insurance covered more of his surgeon bill than they quoted when we paid $750. So when the hospital said I had not met my deductible for Mark, that was in fact true.
I do feel like I have a pretty good grasp on our insurance and secondary insurance, probably because I am coming off of having a baby which brought all sorts of bills throughout the year.
If you are unfamiliar with how your insurance works because you've never had to use it (**ahem**Dustin**ahem** - he's so healthy and has perfect teeth. UGH!), then good for you! However, if the time comes when you are going to be hit with some medical bills in turn making you reach your deductible and your out-of-pocket max; please, please, PLEASE pay attention to the bills that come through. And always remember to view your explanation of benefits. That's how I came up with my question to the surgeon's office when it showed that three of the four expenses that were charged had a zero dollar balance and that fourth one showed we owed $99. When really we had already paid $750!
So now here I am able to through that unexpected money into our savings for a new vehicle! Yay yay YAAAAAAAAAAAAAYYYYYYYYYYYY!!!!!!!!!!
Hi there! I'm Kara, of taking KARA myself! I've dabbled in blogging off and on for a while now. Mostly off. But I'm trying to change that and make a dent in this side of the world wide web. Enjoy!