It's February, the time of the year when you end up getting those unexpected bills for medical services you've received since the beginning of the New Year. What...!!, you say, bills for health care? I thought my insurance covered that!
Most insurance companies, including Medicare, have an annual deductible that must be met before your insurance actually insures you.
What does this mean? What it means that before your insurance will start paying for your nebulizer, or doctor's visit, or hospital stay, you have to pay. There are thousands of insurance plans, some have no deductibles ($.0.00), some have low deductibles ($250.00 or less), and some have very high deductibles (>$1,000.00 or more).
On top of that, many plans have co-pays. They pay for part of the bill, and you pay for the rest. Your co-pay usually ranges from 0% to 10% to 20%, depending on your plan. Medicare, for example pays 80% of the claim charges, meaning that you, or your secondary insurance, is responsible for the other 20%.
This can be frustrating, maddening and discouraging--both for you and for us. The only party that seems to be unscathed is the insurance companies. (To add insult to injury, take a look at a sample Explanation Of Benefits--EOB. This is supposed to help you understand your bill better. If you get it, you receive an A)
What do I mean, it can be frustrating for both you and us? Well for you, it means that if you were dispensed a $600.00 wheelchair, or a $200.00 nebulizer, you are going to be responsible for the deductible and the co-pay before the insurance company will pay one dime.
Let's say, for example, your insurance plan has an annual deductible of $100.00 and a co-pay of 20%. If you receive a nebulizer from us, or any other provider, then we're going to bill the insurance company for that. Let's say it is a $200.00 charge that we bill to the insurance company.
Then the insurance company is going to turn around--usually after a longer than necessary wait--and send us a check for $60.00. If we're lucky. Why only $60.00?
1. Because you had a deductible of $100.00
2. And you had a co-pay of $40.00 (20% of $200.00)
o $200 - $100 - $40 = $60.00
So, your insurance plan may be a good one. But it is no good at all until you've paid your part. That's why you get a bill from us for $140.00. The insurance company didn't pay for it. They paid us only $60.00 of the $200.00 cost. And so you get a bill from us.
You're not happy--understandably. You pay hundreds, if not thousands of dollars a month for healthcare coverage.
We're not happy--we have to send you an invoice and then collect a payment from you. It makes "Customer Service" a challenge sometimes. But that's life in the American health care system.
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