Author: Michael Todd Oldfield

Inevitably each year there are a number of problems that come up with clients where they receive bills they were not expecting. Nearly 100% the time the problem can be traced back to the same problem; the client screwed up. That’s the only way I know to say it. Nearly every time they went somewhere, received some service or treatment, and never gave any thought to if the procedure or treatment was covered, or if the person performing the procedure or treatment was “in-network” or not. Folks, whether you are in an HMO or a PPO or an RPPO, it’s ALWAYS important to talk to your insurance company about ANY procedure or treatment you need done. It’s also important that you whip out those insurance cards every time you see your doctor or service provider. AND, be sure that you ask new doctors or providers the right questions. Do NOT ask them, if they “take ________ insurance”. They will always be happy to take your insurance card, and file the claim it seems. They do not necessarily care though if the company pays the claim or not. If they do not collect the money from the insurance company, they know they can later bill you for it. You were the one that received the treatment or service. Right? What you want to ask them always is if they are “”in network” for ______ insurance.” That’s the question to ask. And, make sure that your doctors are using “in network” options on all your tests, labs, etc.

I have had a difficult case this year where the client did most everything right, but STILL ended up receiving bills he was responsible for. He visits the doctor about every 90 days for blood work. He did the right thing by asking the doctor to use Labcorp for his blood draws, and the doctor even wrote that on his referral. It says it really clear… “Labcorp” and then has their provider number right there on the referral. A couple of months after he had the blood draw he received a bill for like $95. After 20 hours of research on my part I think I figured out what happened. The doctor intended for Labcorp to do the blood draw… and they did, BUT, the analysis work that was done on the blood ended up being done as a hospital service by the hospital that is over this doctor’s practice. And because the blood was analyzed by the hospitals people, it was due a $95 copay. The client did everything right I feel. He told the doctor he needed Labcorp to do the blood work. And they did. But, I think either the doctor or the hospital messed up when they did the work. Either the doctor only indicated that the blood was to be drawn by Labcorp and no instructions on where to process it, or the hospital just billed incorrectly. Either way, it was a mess. And, still to this moment, my client is stuck with this bill. I am telling you now guys; always, always, always be specific about the services and treatments and providers you are using. If you are not, you will get bills from time to time, and if you are like me, you just HATE these sorts of surprises. Call the numbers on the back of your cards and verify where and how to get all your procedures and services and treatments performed BEFORE you receive them. That is the best advice I can ever offer.