Last year our, then, one-year old son had to have three surgeries. That meant we got very familiar with our insurance. Thankfully when we found out he needed his first surgery, we had about 5 months to plan for it. During that time I really studied everything I could about our insurance. I didn't want to have any curve balls thrown my way.
Personally I'm not new to surgeries. I've had two knee surgeries, so I know you don't just get one bill. You get the hospital, the doctor and the anesthesiologist. Now, let me break it down for you, and I'll give you the easy version. Our BCBS deductible (at the time) was $5,000. We had a secondary insurance that covered $4,250 of that; meaning my deductible is $750. Then anything over $5,000, we owed 30% up to an additional $1,350. So the most money we would be out for Mark's surgery was $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, I pulled it up. 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.
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!
I remember this like it was yesterday, and not last year. It was such a blessing to have got over $600 refunded to us. Trust me, I know how overwhelming it can be to get medical bill after medical bill in the mail. That is why I urge you to pay attention to every detail, even if you feel you have a great handle on how everything works!
Has there been a time when paying attention to details has paid for you?