My story is all too familiar to those who have lingered too long in the sun. During my annual skin screening, the dermatologist scraped off a piece of skin and sent it to a laboratory to determine if it was cancerous.

I should note here that patients really don't have a choice about which lab the dermatologist -- or any medical provider -- uses. When the lab found nothing wrong, it notified my doctor who notified me.

And then the fun started. The lab mailed me a "bill" requesting payment for the portion that Medicare didn't cover. The big red letters at the top of the page read, "Make Check Payable To" and in the middle, also in red, "Detach And Return Top Portion With Your Remittance."

Red-letter day

When I get a bill like this I usually just pay it. Like everyone else I value my credit rating and, in the back of my mind, there's always a recurring nightmare that some nasty creditor will damage my score because of a bill I overlooked.

On the contrary, my wife isn't as quick to just pay.

"Wait a minute," she said. "Wasn't this bill already paid in full?"

She combed through our files to find my Medicare supplemental insurance company's "Benefits at a Glance." Sure enough, she found that both Medicare and my supplemental insurer had indeed paid in full -- and well before the lab mailed the bill.

Perfect timing

So we reconstructed the timeline. My dermatologist took the scraping for biopsy on Sept. 13 and the supplemental insurance claim was processed on Oct. 19, which meant that both Medicare and my supplemental insurer had paid in full by that point. But on Nov. 15 the lab sent a "bill" anyway, which arrived in the mail on Nov. 21. In other words: The lab had been fully paid before it ever sent the bill.

When my wife called to give the lab's billing department an earful, the customer service rep said that it wasn't really a "bill," but instead a "courtesy" to remind us how much we still owed.

"There are only two problems with that," my wife told her. First, your lab has already been paid. And second, if we hadn't remembered that both Medicare and our supplemental insurer sent payment we would have paid you again, which would have been a "courtesy," but not for us.

It would, however, have been a courtesy to the lab since we would have put more money in its pocket. That money might, or might not, have been returned. My guess: It wouldn't.

I suppose that technically the lab was within its legal rights. Further down the second page of this so-called "bill," it read, "We have submitted to your secondary insurance." But by that point, what had been submitted had already been paid.

Moral and immoral

There are those, many of them senior citizens, who have trouble keeping track of which bills to pay, particularly when it is their health insurers that are supposed to pay.

So here's my question for insurance regulators: Should labs, hospitals, doctors or other medical providers be allowed to send a faux bill -- or a "courtesy" -- even before they find out if the patient's insurance will cover the cost?

Guess it's just another case of buyer beware.

The moral of the story:

  • Keep all medical paperwork until the issue is resolved.
  • Make sure that your bill hasn't already been paid in full, particularly if you have more than one insurer.
  • Receipt of a bill doesn't necessarily mean that you owe any money.

Remember the words of President Ronald Reagan: "Trust, but verify."