A few months ago, my four-year-old son Benjamin bit off and swallowed a prong from a plastic fork. Ben didn’t act as if he was in pain afterwards, but my wife, Pam, was concerned – especially because Ben does not yet speak.

Pam called the pediatrician, who instructed her to take Ben to the emergency room at [a local area hospital]. I left work to meet them at the hospital. Ben was triaged, and we waited the obligatory two hours before seeing the emergency room doctor.

The doctor listened to our story for a minute or so, performed a lightning speed examination, and gave us her opinion. She said that she did not know why our pediatrician sent us in the first place. She explained that an x-ray would be useless because plastic does not appear on x-rays. She said that if Ben was not exhibiting unusual behavior – this would pass, pun intended.

Just as the doctor was finishing up her explanation, a clerk entered the examination room to hand us a bill for our $100 insurance co-payment. The timing could not have been more painfully ironic. I don’t regret going to the emergency room, and I fully expected to pay the $100 co-pay for the visit. As they say, it is better to be safe than sorry. Nevertheless, the timing of the clerk’s bad news was a zinger.

A few weeks later, I received a bill from [the hospital]. [The hospital's] rate for the visit was $872, but being under contract, our medical insurance company had a pre-negotiated rate of $642. [Insurance] therefore paid the hospital $542, with my co-payment of $100 making up the difference.

I have no love for insurance companies, especially health insurance companies. But my dislike for unfairness exceeds my dislike for insurance companies so I had to complain. A charge of $872 for a two-minute doctor’s visit didn’t pass the smell test, especially in light of the outcome of the visit.

I phoned [the hospital's] patient relations department and told them the story. Having dealt with customer service departments a few too many times, I had low expectations. I had no specific goal in mind, but my best-case scenario was that they would refund a portion of the bill, even if the refund would be made to the insurance company. After all, if the charge had been as little as $101, I would have been responsible for the first $100.

The customer service agent listened to my story. He truly listened! He promised to investigate further and get back to me. Although it took half a dozen phone calls over the next few months, the hospital credited our account. That was far more than I expected. They did not credit [the insurance company] payment. They explained that [the insurance company] reviews each claim and by paying the claim, [the insurance company] had come to the conclusion that the charges were justified.

A month later when it was time to renew our insurance plan, [the insurance company] raised our premium by 22%. There went the $100 credit from [the hospital]. But, as I have learned, many things are negotiable, including insurance premiums. Our insurance broker negotiated with [the insurance company] and won us a lower insurance premium – a mere 19% increase compared to a 22% increase. We take what we can get.

When asked how often a credit is allowed, [the hospital] indicated that it is a rare occurrence, and it is done on a case-by-case basis.

If you need an insurance broker who knows the ins and outs of insurance and who will level the playing field between you and the insurance company, contact Stan Belikoff at (215) 918-0978.

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