Home > rant > In which mathbabe becomes insurance claims adjuster

In which mathbabe becomes insurance claims adjuster

April 10, 2012

Who knows what I’m talking about with this story.

My husband dislocated his finger sledding with my son last January, so more than a year ago, and the hospital kept sending us bills for the event.

But here’s the thing, we were covered under my medical insurance, which had perhaps recently changed policy numbers when MSCI took over Riskmetrics. So probably what had happened was my husband had given them the old insurance card, but in any case, in the the end I knew I wouldn’t have to pay since we’d definitely been covered.

The hospital called once a month or so, and every time they got hold of me I argued with them and told them to check their records. They kept telling me that the insurance company was refusing payment under any of the policy numbers I gave them.

In the end, last month, I called up the insurance company myself and got them to admit payment, which wasn’t hard since they said they’d already paid for the X-ray from the dislocation on that date. I called up the hospital and straightened it out.

So yeah, I ended up doing their job for them, and that’s both annoying and exciting because now nobody thinks I owe them $2400. In fact I did a victory dance (at work, because you always have to do this during work hours for people to answer the phone).

But why I’m writing about it today is that it’s actually really infuriating how often something like this happens, and I can’t help noticing that I always get out of it but many people wouldn’t. I’m at a huge advantage in this common situation because:

  • I worked as a customer service person so I know how to talk to customer service people. Turns out you should always be polite, but never hang up the phone until your problem is solved. Just keep asking, extremely nicely, things like, “Hmmm… that’s confusing, what do you think could have gone wrong?” or “What would you do if you were me?” or if those don’t work, “Do you think you could tell me who to talk to sort this out? I’d really appreciate it.”
  • I am always covered by insurance, so I never worry that they are right. This is an enormous advantage over people who sometimes lose coverage between jobs or something.
  • I keep all my old paperwork. Impossible for people who don’t have an incredibly boring stable lifestyle like mine.
  • I have a job that allows me to make calls like this during work hours. Obviously huge.
  • I am completely unafraid of forms and red tape. This comes from experience, but I know most people are afraid of such stuff, and that alone would probably keep most people from arguing.

I really do feel like I am relying on my professional skills in order to get my insurance to pay for setting my husband’s dislocated finger, when that should be a no-brainer. If you are inexperienced and poor, you’d probably be completely at a loss for how to deal with this situation.

I wonder how many people have their credit scores lowered by medical claims which should have been paid but weren’t due to crap like this. It’s a broken system, but it only leaks on the most vulnerable people, and I hate that.

Categories: rant
  1. Mark the former mathematician
    April 10, 2012 at 10:01 am

    Good post, and leads into numerous thorny topics (I was recently down this road, trying to figure out how much I did owe after my son was in an accident). You make great points about how difficult it can be for many “everyday folk” who get raked over the coals by the system.
    1. Hospital billing via our current insurance system is completely opaque, and the patient (aka consumer) has no idea what the costs are. What other industry operates like this. There may be huge information disadvantages when one buys a car or a diamond (things one does rarely while the seller is extremely knowledgeable), but health care is really really important and the pricing is a mystery (and changes depending on whether and what kind of insurance one has).
    2. Would the system be better with universal health care, and what should that look like?


    • EdwardM
      April 17, 2012 at 2:10 pm

      The answer to question 2. is “yes”. I’m Canadian and when I was 20 and attending school out-of-province, I broke my thumb. Fixing it required dealing with 2 hospitals (the school was in a small town), plastic surgery, an over-night stay in the hospital and a follow-up visit to have the pins removed. For all this I was required only to show my gov’t health card. I have never spoken with a claims adjuster regarding health insurance and it quite likely I never will. I am simply covered.


  2. Sara Billey
    April 10, 2012 at 3:30 pm

    Why are you the one calling when it is your husbands bill?

    Ok, truthfully I know the answer because I get stuck with a lot of similar jobs. So really I am asking, why does being a woman make you the responsible one for all thorny problems your family faces? And, how can we stop being so responsible so we can do more of the stuff that brings us fame and fortune and glory, or at least do what we said we wanted to do?


    • April 10, 2012 at 4:08 pm

      Hey, I got a blog post out of this! 🙂

      But yes, it’s a good question. Maybe yet another blog post in fact…


    • Mike Maltz
      April 10, 2012 at 5:49 pm

      C’mon now. Every couple splits up tasks like this in different ways. My wife hasn’t a clue how to deal with Quicken, with bureaucratic issues like Cathy’s, etc. [That said, I know she does more than her share anyway.]


  3. Tara Holm
    April 11, 2012 at 10:44 am

    This gets into how crazy medical billing is in this country. If you don’t have insurance, I guess the hospital expects you to pay the crazy number they write down on a piece of paper. Except that it can be negotiable. But most people without insurance would not realize it’s negotiable, and wouldn’t think to try to pay less.

    Even having insurance doesn’t guarantee that you won’t get crazy bills, as this story points out. When I was first pregnant, I was in Berkeley. I had to work hard to find a doctor who took my NY insurance. Once I did, the doctor’s office didn’t really seem to want to bill my insurance, and just sent me bills. Finally, the doctor’s office did actually send a bill to my insurance, which paid the agreed amount. Then rather than writing off the difference (which is what they’re *supposed* to do), the doctor’s office sent me another bill for the balance. It took many phone calls to straighten this out. And as you say, most people may not know to try to straighten it out, let alone have the time/patience/etc to do so.


  4. April 11, 2012 at 12:19 pm

    This strikes a chord with me. I think it’s just another example of how big business relies on their customers’ lack of information to inflate their profit margin. The health care crisis in this country will never be solved until we eliminate the big insurance companies.


  1. October 22, 2012 at 9:12 am
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