REFUNDS, REFUNDS, REFUNDS

My youngest daughter recently went through some rather expensive claims, where we saw #1) Nurse Practitioner , then a few days later #2) Went to the emergency room, had ER charges (facility) and separate ER Physician charges (professional)  and lastly was referred to #3) ENT/Plastic Surgeon.  Our deductible is $500.00, than they pay 80% up to $1500.00, then100% thereafter.  Needless to say, she’s met her deductible and were well on our way to meeting her out-of-pocket.  Here’s where the refund comes in.  When we finally made it to round #3, the physician charged us a consultation and then did an office surgery on my daughter.  Our insurance has a $20.00 co-pays for office visits/consultations.  We paid that, as we realized it was due.  The next part of the bill was for her office surgery.  This was charged separately from the consultation and billed accordingly.  The charge for this part of the service was $345.00; insurance allowed $189.96, and the write off was $155.04 (patient savings for going to a preferred provider).  The $189.96 went towards our deductible, which we paid up front.  Nine days later we had to go back to the physician for a follow-up on her surgery.  Again we were charged a $20.00 co-pay which we paid up front.  Around two weeks later I received an explanation-of-benefits (EOB) from our insurance company stating that the follow up visit was included in the surgical fee.  Benefits are not payable for this as a separate expense.  Okay, so I figure I’ll be getting a check back for the $20.00 we paid up front.  First week goes by, nothing.  Second week goes by, nothing.  At this point I call the physician’s office and ask for the phone number to his billing office.  I’m tell them who I am and am told back that they do their own billing, the biller is on another line and will call me back.  This is usually code for, “take a message so I can see what’s going on with the claim.”  About thirty minutes later “Karen” called me back.  She said that “yes, we are due a refund, she will send the information to the bookkeeper and we will either get it this week or the following week.” Having worked in a billing office, I frequently used the line, “Your refund request has been sent to our bookkeeper and it will take about ten business days to get back to you.”  Truth-be-told, our “bookkeeper” was ten feet away from me in another room.  When you use the term “bookkeeper” it sounds like an accountant’s office in a whole other building. Do you think I would have automatically received our refund if I had not called the doctor’s office?  My guess is probably not.

Today’s lesson:  It’s important to scrutinize your EOB’s and make sure you follow-up on refunds that you feel are due to you.  If you don’t do this, who will?