My wife and I utilized the services of a chiropractor who happened to be out of network with my insurance provider (will name in an edit if it is important). My Explanation of Benefits says that out-of-network services will be covered 70% (and so I have to pay the 30%). There are no limits and hitting the deductible is not the issue here.
Our insurances are like (acronyms instead of real names):
Wife - WIP (Wife's Insurance Primary through her employer) and MI (My employer provided insurance as her secondary)
Myself - MI (Mine as my only/primary insurance)
MI works such that the patient has to pay the provider and will be reimbursed through a check based on what was supposed to be covered by them. So when I got my reimbursement here is what I got per service.
Chiropractor bill: $125 (for both me and wife)
MI's Cheque received for me: $14.XX - This is clearly much less than 70% of $125. So I looked at their split up. From the $125 they marked close to $100 as not covered or not applicable and then paid $14 (which I am assuming is 70% of what they deem is the eligible service cost ~$20).
MI's Cheque received for wife: WIP covered some amount and then passed it to MI. MI sent a check of $45-$50 for the remaining. This is very odd to me. If the insurance deemed only $20 as payable and paid 70% of it then how is it that they paid more towards my wife's bill?
How does this work? I have had stressful calls with MI, at the end of which, they don't explain anything and refuse to try to give information.
It'd be great if I could also get advice/suggestions on the next steps to salvage this situation because this added a bulk of unexpected and uncalculated expense to our family.