Somebody Has to Say It

Don’t get me wrong, I’m soooo very thankful I have health insurance … BUT … every day I am finding out more and more how important it is to know all of the dirty details of your coverage. Know what drugs are covered, what doctors participate in your plan, what hospitals participate, what type of doctors are considered specialists, what procedures are covered (xrays, bloodwork, etc). You also need to understand what your co-pay amount is and your out-of-pocket costs maximum. I’ll talk more about all of this in a later series because insurance companies are one of my biggest pet peeves! 

I recently went to an in-network doctor who referred me for an MRI at out-of-network imaging center. The imaging center agreed up front to accept whatever money my insurance paid them, I would be out no money. I called my insurance to verify this and called the billing office on two separate days at the MRI location and spoke with two different ladies. The day I arrived for the procedure, I once again the front desk girl about the MRI being covered and I would pay nothing. I was told repeatedly by everyone I spoke with that all was well and not to worry because I would not get a bill of any kind.

Note, I’ve been bitten by costly surprises in the past and have learned to be very diligent about asking these type of questions about in-network (participating) or out-of-network (non-participating) and co-pays or out-of-pocket costs.

Well, as fate would have it, “silly me” didn’t even think to ask if the technician that would read the MRI results was in network or if he/she operated under the same rules as the imaging center itself. 

As it turns out, the technician was NOT in-network and did not want to accept my out-of-network benefits as full payment.   Had I known to ask this ahead of time I would not have had the procedure done at this particular location, or would have asked for a different technician to read the results.

I spent 6 days calling back and forth between the MRI imaging center, my insurance company, the referring doctor, and the technician and finally managed to get the technician to accept my benefits with me not having to pay any money. But I should not have had to do this.

I learned the hard way and will not make this mistake again. I will not assume I’m fully covered and will ask questions and take down names and dates of who said what.  

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