This quite possibly might be the least interesting thing to write about on a photography blog, but if it helps one person then I’ll be super happy I wrote it! After a recent experience with a doctor’s office over disputing a bill, I’m inspired to write just a few basics about insurance and how it relates to your medical bills. There’s no way for me to know exactly what your insurance policy says, but most of this is general knowledge of the people filing your medical claims (doctor’s office) and processing your medical claims (insurance). I’m not promoting insurance in this post at all, in fact I’m promoting consumer awareness of the policy that insures them. This is how heathcare works in this country so we deal with it as best we can!
A little background on why I possess this amazingly interesting information….while in college, I worked as a customer service representative for a major southeastern insurance company for almost 4 years. Regardless of what you might think of insurance companies, this one was a great organization to work for. Sure there are certain obstacles in a corporate environment, but the knowledge and experience I received from that job will serve me well for the rest of my life. I know there may be some CSR’s out there reading this and saying how could you like doing that job?! Well some days were better than others, but I had a great department of girls (and a few guys) that made the days go by quickly. Because I spent so much time with those fabulous people in a close-quarters calling center, I’m still in close contact with many of them. I’ve got some awesome success stories, some sad stories and others that would make me mad to tell them. Marchelle and Jamie you feel me?!?
Ok, on to the pertinent information.
#1 Insurance companies are typically going to pay your medical claims. They do not just deny them for fun (hopefully). Although they make their money by their customer’s premiums and hopefully those customers not getting sick, on a daily basis they are paying out money on your claims. If they are not paying money on a specific claim, just call them and check….the money/claim filed by the provider might have applied to your deductible or something of the like.
To break up the monotony of this post, take a look at this cute lil pup (:

#2 There’s no such thing, in my opinion, as “good insurance” or “bad insurance”. There may be good or bad insurance companies, but that’s a different story all together. Now this might get certain people all hot and bothered, but if your insurance stinks it’s not the insurance company’s fault. It’s probably because you aren’t paying enough to get the coverage to meet your expectations, your employer isn’t or can’t pay enough to get better coverage, OR the claims are being denied for various reasons (which I will touch on later). If you have a policy that pays 100% after a tiny little copay for any service, that’s pretty awesome to me! But I bet you or your employer are paying a boatload of money for a policy like that. If you have an employer that pays for a plan like that, you better count your lucky starts because insurance is super expensive. Just to give you an idea, to insure a family of 4, an employer may pay in upwards of $800-$1200 PER FAMILY for a policy like this. Maybe more actually. Even though you pay your little bi-weekly insurance payment, that’s only a tiny bit of the cost.
Helpful tip:If you are seeking out better coverage on your own, go ahead and shop around. Get several quotes from at least 3 different companies to see what it will cost you. Would you like to pay more in premiums on the front end so that you could have less money due on your medical bills? Then you need a copay play or a lower deductible plan….which of course is going to cost you. I did a quote on Blue Cross website recently and for a copay plan, $25 office visit/well visit, $10/25/45 prescription plan, $500 deductible for hospital/surgery, NO maternity was over $600 for a family of 3. OR would you be ok with a higher deductible heath plan where you are more in control (and responsible) for money on the front end. The plan might look like this: $2500 family deductible then 100% (office visits, prescriptions, well visits, NO maternity). Basically when any claims come in at the first of the year, the total allowable amount will apply to your deductible. This also includes your prescriptions. So if you have a lot of prescriptions you will likely meet that $2500 fairly quickly. After your deductible is met then everything will be paid at 100% (if that’s what your plan reads,,,,sometimes it’s 80% and then you would still owe the 20% remainder. Again, it’s all depends on how much you want to pay in your premium. If you have a high deductible health plan you may be eligible for a Heath Savings Account. This is a tax-free account that you put money in at the beginning of the year and spend that money for your copays and deductible payments (dr’s visits, prescriptions, etc).
#3 Just because a doctor sends you a bill doesn’t mean that you should mail a check right then.Wait until you receive your EOB (Explanation of Benefits) from your insurance company. This is a statement (NOT A BILL) showing how they paid your claim. Your doctor’s office also gets their version of a provider EOB with a big old fat check. The provider’s EOB also tells them your patient liability (the amount you owe). If you already paid your copay at the time of your visit then likely you don’t owe any more money.
Helpful example: I had a situation recently that went like this…..I paid my copay of $25 at my doctor’s office before the visit as usual. My doctor didn’t bill an office visit, he just billed for an antibiotic injection and sent me on my merry way. Once the claim was processed by my insurance company, it only showed that I owed $8.06. So what happened? My doctor billed me for an additional $8.06. Me being the smart consumer that I am, I checked my EOB statement from that visit and sure enough I only owed the $8.06. This means that the doctor’s office owes me $25-8.06=$16.94. They did the right thing by taking my copy at the start of my visit, but somehow it didn’t translate to the billing office later on that I really overpaid for that visit. The moral? Make sure you check your EOB.
I think I’ll stop so this doesn’t get any longer! If anyone is reading this and you have a problem with some medical bills and you just don’t understand, feel free to email or call I’ll help if I can! (I may regret that statement later lol). No really, I’m here if anyone needs me. I really like sharing this information. I hope it was helpful.
Let’s end this on the perfect note….with another image of Ruby, the sweetest pug puppy ever. I’m doggy-sitting today for her mommy Olivia and you can’t come to Aunt Meg’s house without getting a quick puppy photo-sesh (:
