It’s Sunday morning and I’ve moved back into the house from the Hyatt hotel in San Ramon. I’m on the mend and feeling better, but I’ll still not go near Kristen and Jake until Wednesday and won’t see Sammy until Thursday either. They say flu can be contagious for 5-7 days after you’ve started showing symptoms, so I’ll go one day longer. Yep I’m now a conservative on some things.
So, what’s a guy to do when he has to isolate himself? He reconciles his medical costs!
First, we’ve received very few actual bills. It’s amazing how slow the hospitals and doctors are, and then they all have to use their own medical billing company, and then they deal with insurance companies and then you’ll get the bill.
To make matters more difficult, my company caused a huge problem when they shifted their medical processing company on January 1st. Despite my having done everything correctly, they caused a huge amount of stress by not moving the boys over as “covered” to the new provider. I don’t know what went wrong, but let’s just say I’m not surprised that something like this happened.
Anyway, things are fixed but the problems caused are not. There were dozens of bills processed until the time we figured it out, so Anthem – our insurance company – is still working to fix things. The bills have to be re-submitted and then re-processed. So it’s just really slow.
Then Anthem told me they had their own problem with many of their customers where doctors were processed as “out of network” and not “in network” as required. So Anthem processed about 40 bills as out of network for me and sent me a check covering their portion, so I could cover it with the doctor directly. The problem is these were all in-network. Once again it took me discovering this and bringing it up to Anthem.
I do have to say the people at Anthem have been quite helpful. There are two people who seem to be making their way through our stuff, fixing things. It’s just very, very slow. So even when I get a bill these days, I’m not really sure if I should pay it as I don’t know if it’s the correct amount or not. On the opposite side of the coin, Anthem has snail-mailed me more than 1,000 pieces of paper so far. Most are 1 page of “Explanation of Benefits” and three pages of the same, exact conditions, appeal process, etc. Thanks for killing all those trees, Anthem! No wonder insurance costs are so high.
Anyway, on to the fun stuff. Since the triplets were born there have been 203 separate bills that have been processed to our insurance company. 141 of them have come this calendar year, with the rest coming last year since December 9th.
Of the 141 this year 78 bills that appear to be processed correctly since the start of the calendar year. That leaves 63 bills that have some level of question on them. Some are being processed still, some have been denied and some may still need to be fixed as they are still assumed to be processed as an “out of network” provider.
If we didn’t have any insurance, we’d be on the hook for $5,425,330. Yep, that’s $5.4 million dollars! And this is only through mid-March. Samuel is still in the hospital without a clear end in sight.
This is the amount that the hospitals and doctors have billed the insurance company. Of course, this is never the amount they’ll actually get paid. (This article does a nice job explaining why.) I think the hospitals, doctors and other medical providers are probably getting paid $500k – $750k so far – give or take. That’s still a lot.
Our out of pocket costs are capped at $10k for the year. It’s a lot, but we’ve been saving for many months. But we haven’t paid much yet while we wait for the billing to get straightened out.
So, in closing, if you plan on having triplets, get ready to get your masters in Insurance billing. It’s a lot of work to keep track of all this. And consider getting a second job!