I only have a $5 copay………
Posted by djz1963 at 6:05 PM on 09.11.08
I work for a Third Party Administrator. Meaning, the company I work for “administer’s” a “self-insured ” employer’s group health plan. We don’t sell insurance, we only administer your employer’s health plan according to “their” specifications. “They” pick and choose what “they” want “their” plan to cover, because “self insured” plans can do that. 
So, I get a call from a confused gentleman, it goes like this:
Insured: I went to my doctor and all he did was draw out two tubes of blood from my arm and now I am getting a bill for $1500. My insurance card says that I only have to pay $5 for doctor office visits. So why wasn’t this rest of this bill paid in full?
Me: Okay sir, I understand your concern. Can I please have your name and your member id number?
Insured: yada yada yada
Me: Let’s take a look at your insurance benefits. By chance, do you have a copy of your plan booklet readily available to view this information with me?
Insured: Nooooo. I don’t even know where that thing is. Who reads them anyway? It says right on my card I only have to pay $5 for doctor office visits. What else is there to know?
Me: Alright sir. Well, as a friendly fyi, it is recommended that in your best interest as a patient with insurance coverage, to take a little time to get to know how your benefit plan works. Now, with that said, according to your insurance plan booklet, page 53, it explains that your plan will cover doctor office visits at 100% after the $5 copay. However, it also says that “all other medically necessary services” are subject to the plan’s $2000 calendar year deductible.
Insured: Uh huh, so……what does that mean?
Me: Well, unfortunately, that means the doctor will be sending you a bill for $1500 because that is the amount that was applied towards your $2000 calendar year deductible.
Insured: (about a 4 second silence that seems like forever)……………Okay…..then, what I’m going to do is send that bill to ya’ll, that way you can apply it to the rest of my deductible and send the difference to the doctor. Dial Tone……
What the hay??????? Like that’s gonna happen…….heehee,,,,People take some responsibility. Get to know your group insurance plan….PLEASE….get informed. Your poor planning doesn’t constitute an emergency on my part……however, it could mean bad credit on yours…..da-he, da he…….. Oh, BTW have a nice day….Muah!
I copy that sister…..
the story still rings funny on the 2nd day to.
still counting….
good story
still going strong…
still counting…
almost done.
I know what your feeling!. i work in the same field. its funny!!! HAHAHAHA!.
you have got to be kidding me???!!!!????….that is so hilarious, it should be front page news…you go girl!!!
and by the way…if the other half of that dude sketched at the top of this page was there…its a dead ringer for my ex-husband…lol…sry…doesnt have a thing to do with your story…love ya donna!!!
keep it going
you’ve got it.
allmost forgot again.
its almost over D.
I’ve done it….
Great point….I feel bad for the guy.. Yet, that is why they get all the paperwork…
Is it almost over?……:)
What is the detable??? LOL………
funny, but sadly true……….I have that same $2000 deductible on my insurance!
almost finished…
I keep having to call my insurance company. They deny coverage because the doctor was not our PCP. I ask them to check their records and lo and behold the doctor really is our PCP. They ask us to resubmit the bill. Then they deny the bill because it’s a “duplicate that they’ve already denied”. Well, no duh Einstein it was wrongly denied the first time and now you’ve made it two. Then we get to talk to a “supervisor” who resubmits it within the system with comments.
Months later the Doctor gets paid.
thank God learned to read and not ignore the fine print! You go girl.