The billing of the medical Insurance

Recently I received a medical bill, with five items (charges). The ten columns are as follow:

  1. Date
  2. Post Date
  3. Code
  4. LOC
  5. Description
  6. Charge
  7. Payment
  8. Adjust
  9. Balance
  10. Pending

I didn’t pay much attention to the headings but to the amounts. By just looking at them with my untrained eyes, two of five items ($1100 and $325) didn’t have insurance adjustment. I kind of expected that all items should have adjusted because we’ve been paying for medical insurance as long as one starts to work. When the agent Marie failed to explain she sent me a new bill.

First bill (May 1)

  1. $325, adjust $216.19, my responsibility $108.81
  2. ..
  3. ..
  4. $1100, my payment of $680, my responsibility $420
  5. ..

 

Second bill (July 30)

  1. $325, adjust $216.19, my responsibility $15.24
  2. ..
  3. ..
  4. ..

The new bills has four charges instead of five on the last bill. So I called again. Agent Kim explained that when it’s paid off (either by insurer or patient), it won’t show on the bill.

Does it sound right? I don’t think so. But it’s not up to me.

The math behind the $15.24 of the second bill is:

  • $1,100 is adjusted by $513.57, commonly known as write off
  • $586.43 (1100-513.57) applied to my original payment of $680
  • $93.57 (680-586.43) applied to $108.81 of the first bill
  • $15.24 (108.81-93.57)

Ok, is there any more complex bill out there? How would a regular consumer understand it??

For the $1,100 charge, the clinic asked for up front payment of $680 before hand. But their contract amount (the amount they are allowed to charge a patient of this insurer) is only $586.43.

  • The clinic should not have charged me more than their contract amount. They have my insurance information.
  • The billing, either a contacted out billing company did it or the clinic itself is flowed because it didn’t pick up the adjustment from my insurance. If I didn’t spend time to read line by line, no one would discover it.

The inadequate billing ability adds frustration to the process.

Here is another bill ..

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