Sharon in SC Posted February 8, 2009 Share Posted February 8, 2009 Reader's Digest version - dh had to go to the ER with a stomach bug two days before New Year's Day. Twice, both times for IV fluids. Total bill before insurance - $3200. Total bill after insurance - $2200. For Petey's sake - what do we carry insurance for?! The reason cited on the insurance statement (for not paying more than they did) was basically that the hospital was charging for more than they (insurance co) allowed for for those services. Does anyone have any words of wisdom for us in better understanding how all this works?!?! Quote Link to comment Share on other sites More sharing options...
Word Nerd Posted February 8, 2009 Share Posted February 8, 2009 Reader's Digest version - dh had to go to the ER with a stomach bug two days before New Year's Day. Twice, both times for IV fluids. Total bill before insurance - $3200. Total bill after insurance - $2200. For Petey's sake - what do we carry insurance for?! The reason cited on the insurance statement (for not paying more than they did) was basically that the hospital was charging for more than they (insurance co) allowed for for those services. Does anyone have any words of wisdom for us in better understanding how all this works?!?! Is this based only on the explanation of benefits from your insurance provider, or did you receive an actual bill from the hospital indicating that you still owe $2200? Quote Link to comment Share on other sites More sharing options...
Holly IN Posted February 8, 2009 Share Posted February 8, 2009 The way you said it : NO you are not responsible for the bill. You only pay what the insurance says for you to pay. If the hospital is making you pay what the insurance is not paying due to the allowed charge then you need to call your insurance and tell them that. From my past experience being on both sides of the fence...hospital is supposed to write off what the insurance says is more than allowed for charge. You should only be responsible for your co-pay and deductable that the insurance says you owe. Call your insurance and they will advise you as to how to handle the hospital charging you for the difference. Did you get an EOB yet? If so then it should state on there what YOU owe according to the insurance company (not the hospital). Holly Quote Link to comment Share on other sites More sharing options...
Barb_ Posted February 8, 2009 Share Posted February 8, 2009 Reader's Digest version - dh had to go to the ER with a stomach bug two days before New Year's Day. Twice, both times for IV fluids. Total bill before insurance - $3200. Total bill after insurance - $2200. For Petey's sake - what do we carry insurance for?! The reason cited on the insurance statement (for not paying more than they did) was basically that the hospital was charging for more than they (insurance co) allowed for for those services. Does anyone have any words of wisdom for us in better understanding how all this works?!?! Depends on your policy. Do you have point of service, or an HMO/PPO with deductible? Barb Quote Link to comment Share on other sites More sharing options...
Barb_ Posted February 8, 2009 Share Posted February 8, 2009 Did you get an EOB yet? If so then it should state on there what YOU owe according to the insurance company (not the hospital). Holly That is good advice. If the hospital is a preferred provider for the ins. co. and has agreed to accept assignment of benefits, the remainder will be written off after copay. But if the hospital was out of network of if Sharon has a point of service contract, she could be responsible for the balance. Barb Quote Link to comment Share on other sites More sharing options...
TraceyS/FL Posted February 8, 2009 Share Posted February 8, 2009 Yup, make sure it was a contracted hospital.... if it was, then you don't have to pay the difference! Quote Link to comment Share on other sites More sharing options...
Sharon in SC Posted February 8, 2009 Author Share Posted February 8, 2009 Is this based only on the explanation of benefits from your insurance provider, or did you receive an actual bill from the hospital indicating that you still owe $2200? Both - the EOB indicated why the ins co only paid what they did and we received an official bill from the hospital for the $2200. Incidentally, the EOB indicated we should "expect to be billed" a grand total of $400. :-{ Quote Link to comment Share on other sites More sharing options...
Sharon in SC Posted February 8, 2009 Author Share Posted February 8, 2009 The way you said it : NO you are not responsible for the bill. You only pay what the insurance says for you to pay. If the hospital is making you pay what the insurance is not paying due to the allowed charge then you need to call your insurance and tell them that. From my past experience being on both sides of the fence...hospital is supposed to write off what the insurance says is more than allowed for charge. You should only be responsible for your co-pay and deductable that the insurance says you owe. Call your insurance and they will advise you as to how to handle the hospital charging you for the difference. Did you get an EOB yet? If so then it should state on there what YOU owe according to the insurance company (not the hospital). Holly I just posted above - the EOB indicated we should be billed for "$400". I do plan to call the ins co in the morning.... Quote Link to comment Share on other sites More sharing options...
Sharon in SC Posted February 8, 2009 Author Share Posted February 8, 2009 That is good advice. If the hospital is a preferred provider for the ins. co. and has agreed to accept assignment of benefits, the remainder will be written off after copay. But if the hospital was out of network of if Sharon has a point of service contract, she could be responsible for the balance. Barb The EOB specifically cites this hospital as "preferred provider". I'm encouraged after reading your post! Quote Link to comment Share on other sites More sharing options...
Sharon in SC Posted February 8, 2009 Author Share Posted February 8, 2009 (edited) Depends on your policy. Do you have point of service, or an HMO/PPO with deductible? Barb I'm not sure, Barb. I do know, though, that this hospital is recognzied by my insurance co as a "preferred provider" and I do know we have a deductible. Does that answer the ??. Edited February 8, 2009 by Sharon in SC Quote Link to comment Share on other sites More sharing options...
littlebug42 Posted February 8, 2009 Share Posted February 8, 2009 I cannot count the number of times hospitals have tried to do this to me. They are trying to bill you for the part of the bill that they are supposed to write off. I would call the insurance company and confirm what you should actually owe and then call the hospital. I think they hope people don't know what is what with insurance and will just pay it. Quote Link to comment Share on other sites More sharing options...
Barb_ Posted February 8, 2009 Share Posted February 8, 2009 (edited) I'm not sure, Barb. I do know, though, that this hospital is recognzied by my insurance co as a "preferred provider". I went back and reread your first post. This was not an actual bill mailed from the hospital, correct? Just an Explanation of Benefits sent by your insurance company? If this is an EOB from your insurance company, no one is expecting you to pay anything. It is only provided to let you know what has been paid and what has been denied. If this is an actual bill from the hospital in question, then you need to let the billing dept know ASAP that they've accepted assignment and you've been billed in error. Barb Edited February 8, 2009 by Barb F. PA in AZ Quote Link to comment Share on other sites More sharing options...
Barb_ Posted February 8, 2009 Share Posted February 8, 2009 I cannot count the number of times hospitals have tried to do this to me. They are trying to bill you for the part of the bill that they are supposed to write off. I would call the insurance company and confirm what you should actually owe and then call the hospital. I think they hope people don't know what is what with insurance and will just pay it. No, there is nothing sinister to it. Insurance billing is unbelievably complicated and pays very little to those responsible. Generally when mistakes are made it's because underpaid, underqualified people are sending out the bills. Barb Quote Link to comment Share on other sites More sharing options...
Barb_ Posted February 8, 2009 Share Posted February 8, 2009 I'm not sure, Barb. I do know, though, that this hospital is recognzied by my insurance co as a "preferred provider" and I do know we have a deductible. Does that answer the ??. Also, your deductible comes out of the allowed costs, not the total costs. So if the bill was $3500 and they allowed $1000 and you hadn't met your ded. for the year, you'd be responsible for the $1000, but not the remaining $2500. Unless of course, they actually allowed the $3500 as reasonable and customary and the $2500 was actually for the deductible. How much is your ded. per person, per year? Barb Quote Link to comment Share on other sites More sharing options...
Sharon in SC Posted February 8, 2009 Author Share Posted February 8, 2009 I went back and reread your first post. This was not an actual bill mailed from the hospital, correct? Just an Explanation of Benefits sent by your insurance company? If this is an EOB from your insurance company, no one is expecting you to pay anything. It is only provided to let you know what has been paid and what has been denied. If this is an actual bill from the hospital in question, then you need to let the billing dept know ASAP that they've accepted assignment and you've been billed in error. Barb Barb, I *did* receive a bill from the hospital for $2200. But, I've also shared info gleaned from the EOB. EOB indicates I should expect to pay the hospital $400. The actual bill from the hospital indicates I owe them $2200. I'll call in the morning. My question for you is: "Who should I call (ins co or hospital)"? Your post indicates the billing dept at the hospital.... Quote Link to comment Share on other sites More sharing options...
Snickerdoodle Posted February 8, 2009 Share Posted February 8, 2009 My guess is the lady (or gent) at the hospital billing dept. forgot to make the write-off before sending the bill out. I would call them first. Quote Link to comment Share on other sites More sharing options...
Barb_ Posted February 8, 2009 Share Posted February 8, 2009 Barb, I *did* receive a bill from the hospital for $2200. But, I've also shared info gleaned from the EOB. EOB indicates I should expect to pay the hospital $400. The actual bill from the hospital indicates I owe them $2200. I'll call in the morning. My question for you is: "Who should I call (ins co or hospital)"? Your post indicates the billing dept at the hospital.... I wasn't clear whether you'd received only one piece of paper or two. I understand now. Yes, call the billing dept. and tell them that your EOB states you are responsible for $400 and you'd like a revised bill ASAP showing only that amount. That way you know for a fact it has been changed in their system and you aren't surprised by a collections notice down the road. Barb Quote Link to comment Share on other sites More sharing options...
Sharon in SC Posted February 8, 2009 Author Share Posted February 8, 2009 I wasn't clear whether you'd received only one piece of paper or two. I understand now. Yes, call the billing dept. and tell them that your EOB states you are responsible for $400 and you'd like a revised bill ASAP showing only that amount. That way you know for a fact it has been changed in their system and you aren't surprised by a collections notice down the road. Barb Thank you!!! We'll sleep a little better tonight. :-P Quote Link to comment Share on other sites More sharing options...
TraceyS/FL Posted February 8, 2009 Share Posted February 8, 2009 Thank you!!! We'll sleep a little better tonight. :-P Sharon - i always like to call the insurance company. Under the "i'm just calling to verify this..." tactic. We actually got copies of all our employees EOBs to check them, about 80% of them were wrong. But the contract between the hospital and the insurance company states the amount to be paid, the hospital is wrong in trying to correct it - and some insurance companies like to know who is doing it. SOO, i'd call the ins co first, then the billing dept. Quote Link to comment Share on other sites More sharing options...
littlebug42 Posted February 9, 2009 Share Posted February 9, 2009 No, there is nothing sinister to it. Insurance billing is unbelievably complicated and pays very little to those responsible. Generally when mistakes are made it's because underpaid, underqualified people are sending out the bills. Barb All i know is that over a period of 8 months, I had to have one ultrasound a month which were 100 % covered by my plan. I had them at the same hospital each time. I received a bill after every single ultrasound for the amount that they were supposed to write off. Once or twice is an oversight, 8 times is no longer an oversight. Good luck getting it all straightened out. Quote Link to comment Share on other sites More sharing options...
Holly IN Posted February 9, 2009 Share Posted February 9, 2009 Sharon - i always like to call the insurance company. Under the "i'm just calling to verify this..." tactic. We actually got copies of all our employees EOBs to check them, about 80% of them were wrong. But the contract between the hospital and the insurance company states the amount to be paid, the hospital is wrong in trying to correct it - and some insurance companies like to know who is doing it. SOO, i'd call the ins co first, then the billing dept. Always call the insurance company first then call the hospital. Sadly hospitals do try to do this. Even dr's do this as well. I had a pediatrician whose billing staff kept billing me for the write offs. I called the insurance company every single time and the insurance company told me they are cancelling their contract with that dr. They adviced me to stop seeing her and find another dr. So I did that. That was 10 years ago. Insurance companies want to know when the drs and hospitals are doing this. Holly Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You can post now and register later. If you have an account, sign in now to post with your account.