Top Ten: Insurance Doesn’t Fool Me

I consider myself a pretty smart cookie.  I know when my kids are lying through their teeth.  I can tell when my girlfriends are saying something just to make me feel better (and I’m totally okay with that, by the way).  And, I know when Scott wants to say something but instead says the opposite – benny of learning a thing or two in 14 years of marriage.

What I haven’t figured out just yet is why insurance companies make it so dad-blasted hard to get a claim paid.  In the last several months, I’ve done a lot of question asking, resubmitting and spending time on hold listening to Barry Manilow.  Me learned a few things and I thought I’d share.  Oh, and if you have anything else to add, bring it on!


1.  Keep a notebook.  A big one.  This advice isn’t just for those that have had multiple doctor visits or hospital stays.  It’s for all of ya.  I’ve divided mine into five sections:  Bills (Paid), Bills (Unpaid), Insurance Information (EOBs and such), Medical Information (discharge summaries, doctor instructions, etc.) and Government / ECI.  That helps the visual learner in me keep it all straight.  When I’m on the phone, I can easily find the information I need – all in one place.  Being OCD does pay off.

2.  Everytime you talk to a doctor’s office, government office or insurance company, keep a log.  Write down the name of the person you spoke to, the date and time and what the outcome was.  This comes in incredibly handy the NEXT time you call and they give you grief about not “recollecting” the call.  Don’t let them kid you, they have a computer log and know all that information about you.  When they realize you’re doing the same, it’s amazing how cooperative they become.

3.  If you have a big problem with your insurance company, never talk to the first person that answers the phone.  Huge waste of time.  Ask for a supervisor right off the bat.

4.  Ask for an e-statement (at least that’s what Blue Cross calls theirs), which outlines every claim, what was paid, what applied to your deductible and to your in-network out-of-pocket expenses for every provider.  Best to ask for that at the end of the year for a complete summary, but I think I’ll be asking for one in July for the first half of the year, too.

5.  If they turn down a claim, stating that it’s “not under your coverage plan”, call them back and make them reprocess it.  On three different occasions just in the last three weeks, BCBS has processed three claims as out-of-network (OON), when they should’ve been in-network (IN).  Here’s the skinny.  Even if it was an OON provider, but they performed the service IN, you’re covered under your in-network benefits.  Anesthesiologists and pathologists are your usual culprits.

6.  If you have a hospital stay, make the hospital send you an itemized bill.  You will be amazed (and horribly shocked) at what you’re on the hot seat for come bill paying time.  If you notice something that didn’t happen, or that you were charged multiple times, call and contest the bill.

7.  Follow up.  If a provider says they will reprocess the claim and resubmit it to your insurance company, ask for the timeframe and then tell them you plan on calling and confirming they did it.  Things happen faster when they know you’re watching.  Do the same for your insurance company.

8.  Negotiate.  Providers are notorious for saying things like, “We only have a 3, 6 or 9-month payment plan” and then making you choose.  Here’s the deal.  You don’t have to pay on their schedule, you pay on yours.  They just want the money, no matter how long it takes to get it.  And, don’t let them convince you there’s a service charge associated with paying on your schedule.  After you set the payment plan, you can always call them back a few days later and see what discounts they’ll offer if you settle the bill in full right then.  I’ve gotten a 40% discount on one!

9.  I’ve found it’s useful to ask for the same customer service rep everytime I call.  She gave me her ID# and I use it if they won’t transfer me.  “Rachel” is very familiar with our family and it helps to talk to the same person just about every time.

10.  If something just doesn’t look right, call and ask.  I did that on an OB claim that came through.  When I talked to the insurance company, they said it wouldn’t be covered, but lo and behold, last week the claim got paid.  Never hurts to ask.

BONUS!  11.  If you receive a bill and they say you’ll soon be sent to a collection agency, don’t believe them.  I mean, yes, if you don’t pay your bills for years, I suppose that would happen.  BUT, a few months of waiting while insurance kicks in, they reprocess some claims, etc. and you’ll see many of the problems work themselves out.


  1. Ali on February 3, 2010 at 7:25 pm

    thank you so much for this great information, kathryn. i'm so sorry you've had to learn it, though.

  2. Jenni on February 4, 2010 at 2:51 am

    Fantstic. I do a lot of these but this is great.
    1. Also if someone (insurance or dr is reprocessing) especially insurance have the person you are speaking to call the dr. office while you are on the line and tell the Dr. office/hospital that they are reprocessing. The hospital or dr's office will usually hold your bill for the number of days the insurance says it will take them without starting their internal collection process or anything.
    2. If you have financial difficulties (who doesn't these days) make sure you check hospital/dr payment policies you may be eliglble for their assistance programs.
    3. When recieving multiple bills for the same hospital stay (dr, anestesia, hospital…) or back to back visits, keep your dates straight. It is easy to double pay one and not pay another. I always back mark the calendar for hospital visits. I also make a list of what kinds of procedures and drs were seen while we are there.

  3. Indiana Elephant on February 5, 2010 at 4:03 am

    Kathryn –

    If you haven't run across this one yet, give it time. You will.

    If you get a bill that doesn't have much info on it – St Vincent does that all the time – call back and ask for the UB-04 form. This is the form that hospitals use to submit claim information directly to the insurer.

    A "detailed bill" has been prettied up by the hospital to show what they want you to see, but the UB-04 form has the raw information.

    I got this little jewel of info after sending a nasty-gram to the CEO, CFO, COO and copying the head of Customer Service, head of Marketing and EVERY other department head in the hospital … ;o)


  4. Anonymous on February 5, 2010 at 11:40 pm

    Thanks for the info. Jeff has several medical problems and I have just decided I need to track these bills. I think there are a few I may have paid 2 times but can't figure out for sure. So I'm tracking it this year and keeping better records.
    Hang in there. You will never know how much you and your family are loved.

  5. Top Ten: How to Survive the NICU on February 8, 2012 at 2:31 pm

    […] 6. Get a notebook for all those EOBs (explanation of benefits from your insurance), medical bills, ECI and medical information. You can sort through it all later, but put it one place so you can refer to it when you’re ready. You’ll need that gold mine of information once you arrive home.  Here are a few of my insurance tips. […]

  6. Top Ten: How to Survive the NICU on April 3, 2012 at 2:00 pm

    […] Get a notebook for all those EOBs (explanation of benefits from your insurance), medical bills, ECI and medical information. You can sort through it all later, but put it one place so you can refer to it when you’re ready. You’ll need that gold mine of information once you arrive home. Enjoy a few of my insurance tips. […]

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