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Friday, and again today I answer the phone to get a “dun” call from of all places my dh’s gp doctor

Posted on by DS

The canned message says we are in arrears on our bill to them. Say what? We met our out of pocket over 6 months ago. Why in the heck would we owe any doctor anything at this point.
I started thinking about it and remembered dh said he got charged for his rx the last 2 times he picked them up as well. Hmmm something stinks!
So first of all I contacted the people placing the phone call. Yep, according to them we were $70 in arrears to them. I explained we met out of pocket back in March and they said contact the dr and the insurance company.
Called dr first, they said the insurance company said we hadn’t met our deductible!!! Seriously? Hadn’t met our deductible? Remember we met that with the first $16,500 hospital bill back on the 15 of January!!! I thought I had that all straightened out.
So I called BC BS and she claimed we had only paid $3,150 for 2015 and we had a $5,000 deductible and a $12,500 out of pocket before everything should max out. I asked her how we could possibly not have hit those numbers when my dh’s medical total so far for this year came to $66,000? She said I just didn’t know how to calculate a deductible…Now any person who know me with a brain would have ducked for cover at that point. But noooo, this “lady” kept on telling me that they had over paid and therefore we owed at least $2,000 more to meet our deductible. EXCUSE me?
If nothing else the amount medicare paid would have covered that, I knew for a fact that Medicare had approved all the hospital expenses and therefore as secondary would have more than covered the deductible. She informed me that they had nothing to do with medicare, that we still owed them money.
I told her no way did I still owe money when everything they didn’t pay on the original hospital visit should have been paid by medicare and that alone should have been met my deductible and nearly my out of pocket!
Only then did she mention they had a bit of a “problem” with their system during the first six months of the year and that they MIGHT have over paid on some charges and underpaid on others…So she actually pulls up the file and immediately says, “see we paid $13,000 on that first $16,000 bill and we shouldn’t have paid that bill at all because you hadn’t met your deductible. I quickly pointed out that Medicare would have paid on the bill a minimum of $5,000 if not more and that would have still left $11,000 for them to pay. That I was in fact charged deductibles on bills through about April when I raised cane because they were charging me over $9,000 for my deductible at that point.
She goes in and starts looking at the file and starts muttering it was all messed up and then tells me. “You have a choice, I can go in and have everything all recalculated and you might end up owing the additional $2,000 or…you can just pay the medical from here on out until you reach that $2,000.”
Seriously? Does she think me a total idiot? There is ZERO way I am taking either option and I told her so. That if they messed up their calculations, that was entirely their fault and they couldn’t come back six months later and claim we hadn’t met our deductible on $66,000. Give me a break, I may be a senior citizen, but I still have a good mind.
That we had already paid all the doctors and hospitals office and we had with our payments combined with medicare payments if anything they owed me money!
She stammered around for a bit and then said she would like to re-do our calculations, without changing the payout record and get back to me with exactly who owed who what. They are suppose to call back on Friday. In the meantime I am doing calculations of my own.
Because the way I seen it right off the bat, yes they overpaid on that initial bill, because they didn’t charge me anything on it. They paid the full $16,000, but then they charged me $5,000 in deductible on later payments.
I checked medicare and discovered they had approved the ENTIRE $16,000 for payment, but didn’t pay because BC did…
So now we have a problem because it is 8 months later and medicare is not likely to pay a penny due to the delay BCBS created. I am NOT paying due to BCBS error. They can try and talk to medicare if they want to get their money back, but the way I see it that error right there covered our entire deductible and $11,000 of our out of pocket. That means BC BS owes me nearly $2,000 … plus the rest of dh’ medical needs to be paid in full by them for the rest of the year.
Considering he has an appointment with the 3 stooges that will involve lab, xrays, a $300 doctor’s visit and much more on the 18th, they better get this fixed immediately. I am NOT paying that bill, and I am not dealing with the 3 stooges again!
So hang on to your hats here we go again!




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