I am a firm believer that everything happens for a reason.
When I graduated from college, I spent several months job searching for an entry level position in the arts. A kind family member allowed me to work in his office part time while I searched. He was an insurance broker and I handled claims and additional administrative customer service tasks for his clients. In short, I spent hours on the phone with healthcare providers. Not looking at paintings.
While I was frustrated to not be gainfully employed in the arts, I should have been bubbling over with gratitude. In those few months, I learned the necessary skills for organizing, communicating, understanding, and generally dealing with medical claims. I had no idea how much this would come in handy in the subsequent years of my life.
The complexity of both mine and W’s allergies means that we have stepped foot in too many doctors’ offices to count and our subsequent bills are, simply put, not the simplest. Some specialists are in-network, others are not. Some labs and procedures count towards our deductible, others do not. Some hypoallergenic formulas are covered, others are only processed if they are a certain weight or poundage (that is actually true). Some food introductions need an additional authorization, some need the official seal of the Governor (that is not actually true, though it doesn’t feel too far off).
To navigate as simply as possible (drawing on my healthcare customer service days), I stick to a strict system for paying bills.
As a first step, I collect:
-Oodles of patience
-A writing utensil
-Folders marked Explanations of Benefits, Bills, and Paid Medical Bills
The second step is to marry Explanation of Benefits documents (EOB) and bills. After I receive both an EOB (sent by the health insurance company) and a corresponding bill (sent by the healthcare provider), I make sure they align. For example, if the EOB says the immunologist appointment is covered by insurance except for $34, I ensure the bill from the immunologist is $34.
The third step becomes sort of like “choose your own adventure.” If the EOB and bill amounts are the same, I pick up the phone and pay the bill. I pay via phone and speak to someone in the billing office instead of sending a check so that I have a confirmation number or authorization code immediately. This limits the room for error such as checks lost in the mail, an administrator claiming it wasn’t paid, etc. I then write the confirmation number down on the bill, staple the bill to the EOB, and file it in a folder labeled “paid medical bills” and the year.
If the amounts on the EOB and bill are not the same, I call insurance customer service. A friendly yet generally annoyed agent then tells me – while I stay cool, calm, and collected as that is always best – that they will reprocess / put it in a queue / whatever they need to do to determine the reasoning for the discrepancy. I always ask for an anticipated time frame for an answer and write that date, as well as the date of our phone call and the name of the representative with whom I spoke, directly onto the EOB. (Some unfortunate lost Post It notes led to writing all related notes directly on the paper.)
Afterwards, I immediately call the billing office of the healthcare provider to speak to a different friendly yet generally annoyed individual and request that their office put a hold on the bill until the date insurance provided. This way, they will not send a second bill. I then patiently wait for insurance to provide their answer, or follow up if I have yet to hear back by the given date. (Here is where it helps to have the name of the representative.) Once the insurance folks and I connect, I take notes on the claim status per the representative and then get to work chasing down the Gov’s signature or whatever I must do to make sure all discrepancies are corrected. And once they are, I pick up the phone and finally pay the bill and add it to the “paid” file.
Then I take one of W’s olives and make a well-deserved martini!