We got a $147.26 check today from a neighborhood medical clinic. It was a refund for treatment the hubby got when he had a kidney stone.
I'm always happy to cash any check. But this one is a perfect example of what's wrong with the medical industry.
The hubby's ailment was back in December 2013.
Yep. It took more than 20 months for the bill to be completely settled.
When we got the check and statement detailing the payment and refund process, my initial expectation was that it was the insurance company's fault. It wasn't.
Here our billing timeline.
Dec. 18, 2013: The hubby is treated at the clinic and we paid by credit card the $172 that the office administrator figured would be our out-of-pocket portion of the treatment.
Dec. 20, 2013: The clinic files a claim for the full $344 bill with our insurance, which we have through the hubby's workplace.
Jan. 5, 2014: Our insurer notifies the clinic that it would cover $319.26 of the claim, leaving us responsible for $24.74.
Aug. 26, 2015: We get a refund for our $147.26 over payment.
I admit that I bear some responsibility for this delayed refund. I should have paid more attention to the coverage statements our insurer periodically sends us. I didn't, so the clinic got to keep almost $150 of our money for than a year and half. And I'm glad that the clinic just didn't pocket the over-payment since I didn't complain.
A mess of medical money issues: Unfortunately, it's not the only medical billing issue we've had recently.
Earlier this year, I discovered that my dentist had overestimated what I would owe after insurance coverage for a procedure. Since I was heading back to the office for another check-up soon, they just held the money against our dental policy's deductible.
And another specialist that I see routinely sends me bills stamped 30 or 60 days late even though that's the first statement I get from her. When I call, the office manager tells me not to worry, they're just slow getting things in the computer and getting bills out to patients; I'm in no danger of my account being sent to collections.
Still, when I went in for a check-up last week, that same doctor's office said that I owed $27.93. I remembered paying that by check, opened my bank's app on my phone and showed the office manager the cleared check. I had in a hand a statement showing my account paid in full when I left that office.
In these cases, the problem obviously is my medical providers' issues in updating their own records. Other times, though, it's been insurance companies that have been incredibly slow in paying claims to doctors.
Pay attention or pay the price: I bring up my medical providers' collective billing ineptitude because it's a great example of how ultimately it's each person's individual responsibility to double check what insurance covers, what it doesn't, that bills are paid, and that doctors' records accurately reflect those payments.
Paying attention to medical coverage and deadlines is just as important, and perhaps even more so, for folks who get their insurance through the Affordable Care Act marketplaces.
Those of us who get insurance through our workplaces get reminders from the human resources departments about deadlines. We're also reminded of the need to decide on coverage by water cooler conversations about coming policy changes, usually less coverage and higher employee premiums.
But if you're buying Obamacare-mandated coverage on your own, you are, well on your own.
So here are four impending medical and tax deadlines you need to make sure you meet.
Oct. 15, tax return deadline: This is the final filing deadline for taxpayers who got an extension to file their 2014 tax returns. If you got Affordable Care Act coverage through the marketplace and got help paying for it with an advance premium tax, you must file a 2014 Form 1040 and Form 8962 to reconcile that credit amount.
If you don't file last year's return, you won't be able to claim an advance premium tax credit to help you pay for your 2016 Obamacare coverage.
Nov. 1, open enrollment starts: This date might seem like a long way off, but it can take time to gather the information you'll need to enroll and research your coverage options if you're a first-time customer.
Returning enrollees also need to look at whether they need to update financial and personal information that could affect the cost of and tax credit help for your existing coverage.
Jan. 1, 2016, new health care coverage starts: Your new coverage starts on this day. Carefully review the details of your plan to make sure it’s the correct one and, if you changed carriers, that your medical records were transferred to your new provider.
If you need to cancel your new plan for any reason, cancellation can take effect as soon as 14 days from the date you cancel. Note, however, that your health care provider will collect premiums for these last two weeks of coverage.
Jan. 31, 2016, open enrollment ends: You must decide on ACA-approved coverage by this day. If you don't, you won't be able to sign up for coverage on the public exchange until the start of the next open enrollment period on Oct. 1, 2016, unless you qualify for special enrollment.
Special enrollment is allowed if you experience a major life event, such as such as losing your job, changing jobs, getting married or having a child. Each of these events also will affect how much you’ll pay for an insurance plan.
Deadlines likely to remain firm: In 2014 and 2015, Obamacare deadlines were extended for many. But that was because the system was just getting started and there were initial bugs, both on the insurance and tax side, to work out.
This time, I expect the system to hold to these dates. So note them on your calendars and meet them, or it could cost you.
Much higher 2016 ACA penalties: And when I say it could cost you, I'm not kidding or exaggerating.
In 2016, the penalty for not having health care coverage jumps to $695 per adult and $347.50 per child under 18. That's more than double the 2015 penalty amounts. The only good news is that there is a family maximum penalty of $2,085.
Or the noncoverage penalty could be 2.5 percent of your annual household income above the tax-filing threshold.
The larger of those two amounts is the penalty.
Don't make it easier for the IRS to collect these higher amounts by missing the ACA deadlines.
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