I learned something very interesting when I worked for a company that paid its own claims. The claims are generally paid in the order they arrive. So if a big bill gets to the carrier and you haven't met your deductible, they will apply it toward your deductible. Then the next one that comes in might be paid because you met the deductible with the previous huge one. It was a bugger for people who were reaching their policy maximum because the providers who got their claims in first got paid, and the ones who dragged their feet got denied because the member had met their policy maximum. I've also worked for two Fortune 500 health plans and I can say with certainty that it's a huge help if you are familiar with your plan - deductible, co-pay, out of pocket and all that stuff. Someone from the physician's office can call the 800 number but they frequently have to plow through a lengthy menu of phone prompts to get the information they need.
I had a high-deductible health plan for a little while. It was expensive but relatively easy to manage- I paid for everything and submitted claim forms. I think the Affordable Care Act is going to have more people confused and uncertain about their coverage and benefits for awhile until the payors and providers figure out what the laws require, and it all gets sorted out.
This is how we used to coach patients to respond to the contractor shell game. Say to the provider: No no no no. That was emergency department care. Payable at in-network level under prudent layperson rule. I want Dr. XYZ's care to continue to be paid at the in-network level for continuity of care purposes. What do I have to do to make sure that's done? What else can you do to help me get that done?
Then call your insurance. If you contact the payor yourself they might send the claims back for reprocessing at the higher level. The squeaky wheel gets the oil, so squeak!.