Understanding insurance eligible benefits and payment amounts is a massive morass for customers.
My health insurance allows me one physical checkup annually for no charge. Recently, I received a $30 copay bill from a provider for my annual physical checkup. I called the insurance company to confirm there should be no charge. They said yes, but the provider coded it as a regular visit. I found out the code for the annual checkup. I called the provider and they said their records show it was my annual physical checkup. I informed them I was charged and they agreed to resubmit with the correct code.
Hopefully, this will be corrected and I will not pay the $30 bill.
Similarly, I thought I had reached my maximum benefit for my dental plan and started paying cash, at a discount, for my routine preventive visits. It turns out that my that my allowed routine oral exams and preventive cleanings are not counted towards my benefit maximum. I am now working with my dental provider to submit claims and get reimbursed for my cash payments.
When I was younger, I never was close to the maximum benefit or maximum out of pocket (OOP) ceiling. Now that I'm older, I have been reaching those maximums on a regular basis. For the maximum benefit, I sometimes need to delay nonessential services to the next year to have the insurance cover the cost. For the maximum (OOP), all costs are paid by insurance after reaching the OOP and I want to do my medical services earlier to have the covered 100% by insurance.
It seems managing insurance benefit coverage is another complexity as one gets older.
This is not financial advice. Please consult a professional advisor.
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