Tuesday, September 14, 2010

Working the system

We have been in California 4 years now and I am only just starting to understand how things work here. (talk about slow learner!) Especially when it comes to our medical insurance. Prime example, Annabelle's been going to see a doctor (actually a DO doctor osteopath) since the beginning of the year, this doctor is out of network so the insurance doesn't pay the doctor directly, you have to pay the doctor and then claim back from the insurance (you usually cross your fingers and pray when you send in the claim and hope for the best) because I don't really understand how insurance works I never knew what I would be getting back from the insurance sometimes they would cover a good percentage of the bill then other times nothing. So in this particular doctors case the first few times we saw her I sent in the claim and the insurance paid back a good percentage, then after the 6th visit they only paid $25 on a $160 claim. I couldn't understand why all of a sudden they weren't paying as well as before. So we saw the DO a few more times and I then took all the paper work to the ladies that worked in the doctors office and asked them why there was a difference in what the insurance was now paying. They were extremely helpful looked over the paperwork, they said that most probably one of our benefits had run out and if they changed our invoices to reflect just "office visit" instead of breaking it down into office visit and cranial manipulation that may be they would pay more, and printed me off a new invoice with the new format.

A week ago I sent off the new claim, and I was only expecting to get $100 back (4visits x$25)
To my surprise I had managed to work the system, the check I got was..........

Yes you saw correctly $407.40 I think the ladies at the doctors office deserve a big box of chocolates what do you think?

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