Tuesday, June 24, 2008

The 5-letter word that saved me $1150

When Brad's brother had a heart attack in March, we hopped in the car to go visit. Along the 11 hour drive we realized Camille had fever and was very restless, so we went to an emergency clinic as soon as we arrived in Houston. We first confirmed that they "took" our insurance, showed up, got her tested for strep (positive), gave her a shot, and left about 45 minutes later.

Imagine my surprise when we get our bill for almost $1200 in May. It all shows up as "out of network" deductible applied, so it was really a bill meant to be paid by us. I procrastinated calling about it, or paying it for a couple of weeks. When I finally did, I was calling about a double charge (of $175) for shot injection. Camille only got one shot. They agreed to remove that. Then, out of the blue, I just asked a general question about how we should word the "do you 'take' our insurance" question next time to avoid this out-of-network mess.

Kim (who is pretty much a saint in my book), explained to me that in Texas all clinics like this have to handle emergency visits as "in network", and non-emergency can be out of network. It turns out that someone didn't code FEVER as the reason for the visit. FEVER is an emergency, STREPTOCOCCUS that causes fever is not an emergency. So Kim is going to resubmit as a FEVER visit and we should be about $1150 better off. Crazy.

I could have paid this entire amount, and no one would have ever noticed or cared. I've never been so happy remembering that one of our kids had F-E-V-E-R before....


Sgt and Mrs Hub said...

Whoa! That's a lot of money saved!

We had that happen with our insurance after I had Eliza. They were charging US for her birth because they hadn't put my referral paperwork through. They also cited 'out of network.' Crazy stuff!

I am do glad you talked to Kim - who I agree is a saint - on the phone and it is getting all ironed out!


Mrs. Staff Sergeant said...

Whew, Thank goodness it all worked out. That is alot of money!

Isn't insurance a pain in the butt sometimes! I swear the amount of time I've spent on the phone with our insurance company correcting stupid mistakes like that has cost me years of my life.