Deductible amounts changed and now I owe $2100 than originally billed
Hi all! I am pretty stressed and confused abt a current situation and while I will definitely speak to both my doctor/billing office and insurance company, I just wanted insight from more knowledgeable people and perhaps recommendations for any recourse I might have available.
I'll try to do my best to summarize! I have a high-deductible Anthem PPO plan through my employer. I'm aware my deductible is very high, and I have to pay whatever the contracted amount between the insurer and the hospital/physicians is. On April 15, I had a breast MRI done given my immediate family history of breast cancer (mother) and other factors that put me over the 20% risk mark. I've avoided the MRI precisely bc I know it's expensive, but if there's one level between 'highly recommended' and 'forced upon me', that's basically what the doctors were saying abt my need for this screening exam. I was told it was standard of care, but I know it's not thought of that way by insurers, which is a whole other problem.
I received the claim for this service on April 24. The total charges were $4,011.25. The deductible amount was $623.79, and the total due from me was $623.79. Not cheap by any means, but within what I expected based on the first breast MRI I had a few years ago. I can afford this amount, set up a payment plan with the hospital billing office, all good.
But today, four months later, and I see that my current balance has quadrupled. Checking my insurer's website, I reviewed the claim history and I see a new one was issued on 07/19/2024 for this same service. Total charges are still $4,011.25 but now the amount towards deductible is $2,726.41, so that's the amount due from me. When I tried to call, they only told me that there was a duplicate claim and the earlier one was denied. But I don't think that is true – that first claim stood for 4 months, I've started paying my bills, I have the original claim and doctor's statement as proof of what was billed. Two claims were not submitted at the same time.
Obviously I'm upset, bc that's a staggering jump and I found out about it purely by coincidence of checking my online account. I think insurance is going to tell me that Anthem did an internal review, but this difference is crazy to me. Does anyone have experience with this? Do I have any shot of appealing the claim and settling on that original lesser amount? I have all the documentation as backup thankfully, but I dunno if that will do much good. Any insight, feedback or explanation would be greatly appreciated, I'm freaking out here! thanks so much 🙂
submitted by /u/jujubeans8500
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