So last September, I go in for my first ever colonoscopy. I did all the prep work and I was all set. I was treated very well when I got to the “factory” as I call it. It is indeed an amusing sight to see 50 year old men walking around in a hospital gown and black socks! For a moment it seemed like a scene out of “Cuckoo’s Nest.” Thankfully all went well, the doctor said come back in 7 years and all that remained for me was the receipt of the balance bill.

I have a high deductible health plan so I knew that there would be some liability on my part. I was ready to accept my financial responsibility as a proud member of the cost sharing, MOOP loving, consumer directed health plan club of New Jersey! And then the bills came! That’s right, not bill…….bills!

I received 3 bills, one from the “endoscopic center”, one from the doctor and one from the anesthesiologist. Upon opening all three and totaling them up, I looked over my right shoulder because at that moment I felt like someone was behind me giving me another colonoscopy!!!

The total amount of billed charges came to $6,900. Now we all know that I am an insurance professional and I knew that these billed amounts were the work of a demented billing department official who thought they were going to put one over on me.

I called them the following day and the call went something like this,

Billing Nitwit: “Hello”

Me: “Hello, I am an insurance professional and I was medically accosted in your factory 2 weeks ago. I got 3 bills and I think they’re wrong. Can you help me? Oh, and before you pass me off to some other billing genius, please note that I am a member of NAHU so I know what I’m talking about! Yes, I’ll hold.”  (2 minutes go by)

Billing Einstein #2: “Hello” (seems all billing people have a prepared text they read from!)

Me: “Yes, hi. I think you billed me the full amount for these procedures without submitting it to my insurance carrier first. Could you check that for me?”

B.E. #2: “Certainly, can you hold?”

Me: “Yes, it’s a talent of mine.” (4-5 minutes go by)

B.E. #2: Mr. Mordo, we did bill you the full amount. We called your carrier and they said you had not yet satisfied your deductible for the year.

Me: (ready to verbally pounce) “You should be billing me the allowed amount, not the full amount being that you are an in-network provider. And you don’t know the allowed amount because you didn’t send it into the carrier first like you should have! I’m not paying $6,900 in billed charges!”

B.E. #2: (sensing defeat in her voice) “OK, I guess we can do that. So you’re not going to pay anything now, right?”

Me: “Boy, nothing gets by you! Right, I’m gonna wait till I get the EOB back and I will wait for your adjusted bill! After that, I’d be happy to pay my fair share.”

And with that, I hung up the phone, high-5”d myself and went on with my day.

I think it is important that we constantly remind our clients that there is a big difference between billed amounts and allowed amounts. Whether by accident or not, providers on occasion tend to bypass the carrier just because a person has a high deductible and co-insurance and bill folks directly and incorrectly. As brokers and general agents we have to keep a watchful eye on the providers who make a habit of this. We provide a tremendous service to a client when we can alleviate some concern they have when they see these bills come with big numbers in the “amount due” portion of the bill.

This is one of many ways in which brokers earn their keep. I can only imagine how many people might be taken advantage of if it were not for the vigilance of a knowledgeable professional.

Post script: Of the $6,900 I was billed, my carrier’s allowable amount and the amount I was responsible for was $1,635.00.

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