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I will call the insurance company, but thought I'd ask here to figure out what I'm missing.

My DD went to a doctor in a different state. On our EOB it says that because we were in network there was a $200 savings on the exam. It also stated that no payment was made to the provider for the exam. The exam was $200. The provider has billed for the $200. 

So, what is up? I can see that the provider wasn't paid, but our insurance says we shouldn't owe the $200 since it was in-network.

What am I missing?

Kelly

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4 minutes ago, SquirrellyMama said:

I will call the insurance company, but thought I'd ask here to figure out what I'm missing.

My DD went to a doctor in a different state. On our EOB it says that because we were in network there was a $200 savings on the exam. It also stated that no payment was made to the provider for the exam. The exam was $200. The provider has billed for the $200. 

So, what is up? I can see that the provider wasn't paid, but our insurance says we shouldn't owe the $200 since it was in-network.

What am I missing?

Kelly

Have you met your deductible yet?

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4 minutes ago, Longtime Lurker said:

Have you met your deductible yet?

No, but I don't think we need to for this visit. Not all things need to have the deductible met, but...maybe this service does. I'll look into that. Good thought, thank you.

Kelly

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1 hour ago, SquirrellyMama said:

I will call the insurance company, but thought I'd ask here to figure out what I'm missing.

My DD went to a doctor in a different state. On our EOB it says that because we were in network there was a $200 savings on the exam. It also stated that no payment was made to the provider for the exam. The exam was $200. The provider has billed for the $200. 

So, what is up? I can see that the provider wasn't paid, but our insurance says we shouldn't owe the $200 since it was in-network.

What am I missing?

Kelly

Is it an EOB or a bill?  The EOB can state how much the whole thing cost - before the insurance kicked in.  What really matters is the actual bill.

insurance companies have contracts with drs about how much they can charge for their time.  Many will charge more if there is no insurance, and some will even try to charge more than the insurance company allows.  The biggest benefit of insurance are the discounts of negotiated rates.  It's possible the drs office originally was charging $400, and with a $200 'savings', they are billing you that $200.

Did the provider send the bill BEFORE the insurance company settled 'their side'?  has the co-pay/deductible been met? (if not, charges are applied to the deductible.)

 

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10 hours ago, gardenmom5 said:

Is it an EOB or a bill?  The EOB can state how much the whole thing cost - before the insurance kicked in.  What really matters is the actual bill.

insurance companies have contracts with drs about how much they can charge for their time.  Many will charge more if there is no insurance, and some will even try to charge more than the insurance company allows.  The biggest benefit of insurance are the discounts of negotiated rates.  It's possible the drs office originally was charging $400, and with a $200 'savings', they are billing you that $200.

Did the provider send the bill BEFORE the insurance company settled 'their side'?  has the co-pay/deductible been met? (if not, charges are applied to the deductible.)

 

We have both the bill and EOB. The amount charged for the exam was $200. The EOB says the network savings is $200 and that we don't owe anything for the exam. 

The bill from the provider says we owe $200 for the exam.

The EOB says that we owe nothing for the deductible, this should be a no deductible exam. 

I'll call the insurance and update.

Kelly

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1 hour ago, SquirrellyMama said:

We have both the bill and EOB. The amount charged for the exam was $200. The EOB says the network savings is $200 and that we don't owe anything for the exam. 

The bill from the provider says we owe $200 for the exam.

The EOB says that we owe nothing for the deductible, this should be a no deductible exam. 

I'll call the insurance and update.

Kelly

yeah. I'd absolutely call.   

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