Claim What’s Yours!

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Too often we have to go through someone else’s policies and procedures and forms and instructions to explain a mistake that someone else has made. And if we don’t follow a specific and convoluted process for the refund of our own money, we can never assume the company will themselves realize it and fix it with a surprise check for us in the mail.


The below two stories result in positive outcomes, but only after going through a long and frustrating process with each one to claim what was rightfully mine.



Doctors, Insurance Companies, and Claims Oh My!


Back in January 2017, we took our son to the eye doctor for an exam and the charge ended up being $84.00. At that time personnel there told me it was a “special” type of an exam and the insurance does not fully cover it. Unfortunately, I did not have any document to dispute it so I paid the charge. Next, I submitted a claim to my insurance company.


My wife received a call in early March from the eye doctor stating they received a check from the insurance company, instead of me! When I called my insurance company they said that that they sent it to the eye doctor because they have an agreement only to send payments to them.


So then I called the eye doctor a couple of days later was on hold for a few minutes after explaining the situation, they told me that they sent the reimbursement check back to the insurance company and are working on how the payment should be delivered to me.


A couple days later I received a voicemail from my insurance company and the agent stated that the eye doctor is voiding the check they received and will submit a claim with the correct coding to the insurance company.


Then the insurance company will cut another check for them. Then the eye doctor will credit my account back.


The following week I called the eye doctor again and then I couldn’t get a hold of anyone.


Now let’s fast forward to May. My most recent call involved speaking to someone who said that they submitted the claim to insurance but it came back saying they didn’t input the correct insurance codes….again so when am I getting my money back? Bank rate is saying to be patient in this case and allow 30 days, but it’s been way over 100!


Summertime is here, as a matter of fact, it was June 29th when I called for an update, the Doctor’s office submitted the paperwork to the insurance company but hadn’t heard back from them. And no one followed up with me until I called to check myself.


I followed up on July 31st – still nothing from the eye doctor, but called my insurance regarding another matter and they informed me that they sent the check to my eye doctor back in May 2017 so they’ve had my funds in their office at least one month!


A few days later to my surprise a check was in my mailbox and dated for July 31, 2017. The refund received over six months later!


check simple money man



Physical Therapy Funds


My son receives Physical Therapy once a week. I filled out an application for copay funding and was approved by the state. The funding was received in a lump sum check to cover a year’s worth of copay. When this was received, the Physical Therapy provider didn’t credit the existing copay amounts we already paid during the year.


So ofcourse I had to call them count our visits and calculate the copay refund we were owed. After 30- minute phone call and 30 days later we received two checks totaling $300 (one for $240 and the second for $60 – apparently they had to break it out into two payments due to the way their accounting is set-up). It really made me wonder though if I hadn’t called and explained that my funding check covered the whole year and that I was owed a refund, would they really have sent me a check on their own?


Medical bills, in general, have a high error rate as Nerd Wallet found that 49% of Medicare claims have errors and Medical Billing Advocates of America found errors up to 80%. And ofcourse the Medical Billing Advocates of America CEO said the errors are “usually not in favor of the patient”.


Whenever we receive a medical bill now (and it’s fairly often) we make sure of the date of service, the work that was done and if the portion is indeed not covered based on our health plan data. A couple of times my wife (who by the way I really give a lot of credit to for calling providers and being put on hold, transferred etc.) found that the billing department said “oh that bill was sent by error” or “please just ignore it because it shows you have paid already”. What the heck, should she be happy that we don’t have to pay or mad that she was on hold for a useless call for a mistake made by the provider?



Caution: Hotel Trigger Happy to Charge


So I booked a hotel in Miami a few months ago. They said you can pay when you arrive at the hotel and I said sure that’ll work.


A couple of days after the booking there was a charge for over $200 from the hotel on my credit card. It wasn’t an authorization, rather an actual charge. Even though the hotel personnel said they would not charge my card until I arrived, they did. I figured I would point it out upon my arrival and don’t bother to call them.


A couple weeks later I saw a deal for the same hotel, same time frame, OCEAN BALCONY ROOM and for a lot cheaper – over $150 cheaper. So I immediately canceled my original booking and booked at this new lower rate. I got the cancelation email which stated the booking was canceled free of charge.


The moral of this bonus story is to make sure to check your credit card statement whenever you give your information; even if the recipient says they’re simply holding it just in case.




Do you all have a strategy to obtain a rightfully due refund in an efficient manner?  Can you think of an instance when it felt like it would be impossible to get a refund/reimbursement?





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