Nobody Told Me I Would Get This Bill!?

I can hear the frustration in the voice on the end of the phone. Her little girl was seen because she was crying with ear pain. The doctor removed some wax from her ear so that the ear drum could be seen and a diagnosis made. She was given a prescription for an antibiotic, her little girl got a lolly and a sticker, and they both left—well, relatively happy. But what is this bill she got in the mail? She has insurance after all. And what is this deductible the bill talks about? Nobody told her she would be billed!

For many people, healthcare is a maze of rules and regulations that can be almost impossible to understand. But not being clear on what your policy pays may lead to misunderstandings, and sometimes hard feelings, between you and the doctor’s office that you love.

The one question I’m often asked is: “Why didn’t the doctor or nurse tell me my insurance wouldn’t cover this?” The simple answer is that our clinical staff has no way of knowing the particulars of your individual policy. Yes, they can see that you have Aetna or Cigna. But your Aetna plan can be completely different from your next door neighbor’s Aetna plan. There is no one size fits all coverage.

Another often asked question is: “Why wasn’t this included in the office visit?” The procedures your child may need during a visit take the skill of a clinically trained person. Take the removal of a bit of wax from the ear. It takes clinical skill to reach into a child’s tiny ear canal to remove the wax without damaging the ear canal or eardrum. And it’s not a normal part of an office visit. So you should expect that procedures, labs, flu tests, strep tests, and other services will be a separate charge.

So what can you do to try to relieve your frustration? As a billing manager, the advice I always give to people is—get to understand your insurance coverage. If you receive a bill and think it’s incorrect, call your insurance carrier and ask them to explain it. Look at the explanation of benefits your insurance company sends you. Many times the information there is all you need to understand why you’ve received a statement. And take a look at the back of your statement. We’ve listed a glossary of insurance terms that dovetails with both your statement and your explanation of benefits.

But above all, be assured that our primary concern here at East Cobb Pediatrics and Adolescent Medicine is to do everything necessary to maintain and restore your child’s good health!

Carole Sterling

Billing Manager