Help! My Health Insurer won’t Pay the Bill!

My Health Insurer is Not Paying the Bill

I am willing to bet that many of you have encountered a situation where you noticed an error in your medical bill, but your health insurer delays in fixing it and paying the remainder of the bill.

I am encountering my first such scenario. I’ve learned some important lessons, but the situation is still not resolved. So I thought I’d share what I’ve learned and then turn over the advice giving to those of you who have been down this road.

I’ll follow up with the end results in a later post.

Long story short:

health insurer wont pay bills1. This year, I switched from a traditional PPO, to a high deductible health plan (HDHP) through Cigna, in order to save money on our health insurance.

2. My wife and I both wanted to take advantage of a $200 HDHP bonus incentive for showing up for an annual physical, which is a preventative service and 100% covered by the HDHP. We did so, the appointment was paid for, no problem, and we later received $400 in bonuses in our health savings account (HSA).

3. At the appointment, the doctor scheduled routine preventative blood work for both of us. There was no suspicion of illness.

4. We get our blood work done, and later get bills for the full amount. Mine was $153 and my wife’s was $459, much to our shock!

5. After a few months, numerous interactions in which the Cigna told us we need to call our doctor because they did not use “preventative” CPT codes (doctor says they did, and really have no incentive to make that up). However, I am able to get them to pay all but $16 of mine and $120 of my wife’s.

6. $136 is better than $612, but I’m pretty damn determined. If everything is truly “preventative”, I shouldn’t have to pay anything at all. I don’t care that the payment would come from funds contributed by my employer to my HSA! It’s about principle. By this time, one of the bill’s has a threat of upcoming collections on it – which gets me even more fired up. I call Cigna back, and this time, did what I should have done in the first place – received a confirmation # on the case and the rep’s name. He tells me they will re-submit the claim.

7. I awaited their verdict on the re-submission.

8. Once again, Cigna comes back with the “non-preventative CPT codes” argument.

Lessons learned thus far:

  • document everything
  • get a case confirmation # right away
  • get the name/number/extension/email of the rep.  you call, to help instill a bit of accountability on their end to resolve things
  • triple check every medical bill you receive to make sure it is correct

Medical Bill Apathy

This whole situation has been very frustrating and makes me wonder how many people simply give up on medical bills or don’t realize there is an error in the first place. My determination has already prevented a loss of $476, however, I won’t stop until they pay the full $612.

If they stall again, however, I’m out of ideas on how to make that happen.

Your Advice on Getting the Health Insurer to Pay the Medical Bill

  • Have you been in a similar situation where the insurer seems to be lagging on paying the bills? How did you get things resolved?
  • Have you tried bringing in a third party to help you resolve the billing dispute? Did it work?

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