Collections & Insurance Hassles

The other day I got a bill and a letter in the mail from my fertility clinic.  It said they were planning to send us to collections for the balance of our bill ($1,300).  This wouldn't irk me so much if 1.) the IVF had worked ,2.) if I actually owed it in the first place and 3.) I didn't want to be on the clinic's "good" side for our planned IVF in January - I don't want to be known as the patient that doesn't pay her bills.

Technically, we do owe the $1,300.  This was the balance of all of the ultrasounds and bloodwork prior to retrieval.  I had hit the infertility max on my health insurance with the first visit, so after it was all said and done, I had to pay 100% of the costs, minus the in-network provider discounts.  Why does bloodwork cost so damn much?!

But then we did the retrieval and paid a hefty $6,000 that day.  That was the "retail" price of the retrieval.  I asked to submit it to insurance so we could still get the in-network provider discounts even though we had hit the infertility max.  The billing manager -lets call her Jo - said it wouldn't do any good and that there would be no discounting.  So we paid in full.  We got a receipt.  Then after the whole debacle failed, I decided to call the insurance company to see if Jo was right.  She wasn't, per the customer service rep.  The insurance company even mentioned that it would be "fraud" to not submit the claim.  I told them, I would work with the billing manager again before they sent the network after the clinic.

I talked to Jo.  She still insisted that the discounting would not apply.  I told her that I would like to submit the claim anyway.  She wouldn't do it for me, so I said I would submit the claim to insurance on my own.  After getting all the information, I faxed the claim to the insurance company myself.  After it processed, the explanation of benefits showed that I would have gotten a $2,000 discount!  That means the clinic owes me $2,000.

Now, I'm not a math wiz by any account.  But I do know that $1,300 minus $2,000 equals a refund for me!  So I haven't paid the invoices that have been coming each month.  So after I got the nice, little collection letter, I called Jo.  We played phone tag a couple of times - she left messages saying I had hit the infertility max.  No kidding?!  I already knew that.  So I left a very detailed, but nice, message basically telling her that they owe ME money!  That was last Monday, November 1st.  I haven't heard back from her since then.

I'm debating calling Jo back or just waiting for the next invoice to show my refund!

*UPDATE*: A day after this post, I called Jo to see if she had gotten my message and what she had done with my account.  She said that she had 'resubmitted' some claims (which I'm not sure what else could be claimed) and that she credited my account.  Based upon this, I owe about $100 instead of $1,300.  Definitely progress....but not exactly what I was looking for.  So I told her I would wait for the next invoice to see the detail.  As of 11/21, I'm still waiting to see this invoice!