What leverage do I have with my health insurance company?

Question:

After watching the movie Sicko, I am fed up with health insurance. I went in for a routine physical last year, where physicals are supposed to be free based on the health plan I am on with my company, yet I received a bill last week (8 months later) from this doctor's office saying that some of the items were applied to my deductible which I have to pay. This frustrates me, here is the itemized bill:

$15 - Venipunct Routine (the insurance only paid $8)
$180 - Office Visit (the insurance only paid $36)
$20 - Urinalysis (the insurance only paid $7)
$110 - EKG (insurance only paid $38)

So this totals $236. I don't understand what sort of rules my insurance has made in terms of why it would only pay up to a certain amount, I mean I got the physical within the insurance plan network.

I really don't want this to be applied towards my deductible. I am going to call the insurance company. I am fueled with anger and frustration, but do I have leverage? What argument can I make?

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Answer:
$15 - Venipunct Routine (the insurance only paid $8)
$180 - Office Visit (the insurance only paid $36)
$20 - Urinalysis (the insurance only paid $7)
$110 - EKG (insurance only paid $38)

the amounts the Health insurance pd is probably the contracted rate between your insurance and the doc. If the doc is contracted with them.

You need to call you insurance company. I work for one. All insurance companies will pay claims according to what the doctor submits to them.

If the doc is contracted (participating) the doctor billed the claim wrong. If the doctor doesn't have a contract (non participating) then it will be applied towards your ded.

Don't get mad or angry with the insurance, they processed the claim accoring to what YOUR doctor submitted! I see this on a daily basis and i have members yelling at me when we processed the claim correclty!

What type of plan do you have? HMO, POS, PPO, Indemnity? You really need to check your coverage. Most of the time, these visits are not covered at 100%. They are subject to a dedctible or a co-payment. Talk to your benefit rep and sort it out. Better yet, read your policy. That is where you can find out if you have leverage.

If you doctor did, indeed, bill a physical; it should be paid based on your benefits for a physical. That being said, there's an error OR its not a routine physical. Why did they wait 8 months to bill you? Call you insurance & ask how physicals are SUPPOSED to be covered. They will correct the claim if its their error. If the doctor billed a regular/problem visit to your insurance, take it up with the billing staff @ the doctor's office.

I have problems also where my insurance is not covering a great deal of my medical expenses.

What leverage do I have with my health insurance company?

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