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re: **updated Need advice on how to address ER visit bill
Posted on 1/3/16 at 6:32 pm to Tigerpaw123
Posted on 1/3/16 at 6:32 pm to Tigerpaw123
EOB States:
Charge: $15,178.40
Ineligible: Code: 49 $4159.63 w/ $1053.01 deductible applied
Ineligible: Code: A5 $9965.76
Owe to provider: $11,018.77
*Code A5: services not medically necessary
*Code 49: Provider has agreed not to bill you for this ineligible amount
BCBS of Mississippi
Charge: $15,178.40
Ineligible: Code: 49 $4159.63 w/ $1053.01 deductible applied
Ineligible: Code: A5 $9965.76
Owe to provider: $11,018.77
*Code A5: services not medically necessary
*Code 49: Provider has agreed not to bill you for this ineligible amount
BCBS of Mississippi
This post was edited on 1/3/16 at 9:02 pm
2
Posted on 1/3/16 at 7:03 pm to mandevilletiger34
I'm no expert on this but I have had a few procedures /ER visits for my wife/kids. I've seen my insurance(which is a Blue) deny several charges as double charges, unnecessary and incorrect code. To me it appeared they were double submitting the same code. When I called the provider they said they appeared double because they had to find the correct code. In summary according to the online EOB I was owing like $3,000 on this last round but I ended up paying like $400.
You may just want to wait until the hospital billing finishes going back and forth with your insurance. You'll get bills and then you can call them and straighten it out if there even is a problem.
Provider/insurance company billing procedures are suspect at best to me.
You may just want to wait until the hospital billing finishes going back and forth with your insurance. You'll get bills and then you can call them and straighten it out if there even is a problem.
Provider/insurance company billing procedures are suspect at best to me.
Posted on 1/3/16 at 8:33 pm to mandevilletiger34
Are the codes reversed?
As written, looks like the $9,965.76 you won't be responsible for, the $1,053.01 you will owe, and the $4,159.63 is up in the air.
It may be a billing error. They may have entered the wrong diag code on the bill and that's why the insurance is kicking it out. It would be very strange for an ER test to not be medically necessary.
But you also said you have a co-pay on ER visits? So why are you not only being charged the co-pay? Or is the co-pay only after the deductible is covered?
As written, looks like the $9,965.76 you won't be responsible for, the $1,053.01 you will owe, and the $4,159.63 is up in the air.
It may be a billing error. They may have entered the wrong diag code on the bill and that's why the insurance is kicking it out. It would be very strange for an ER test to not be medically necessary.
But you also said you have a co-pay on ER visits? So why are you not only being charged the co-pay? Or is the co-pay only after the deductible is covered?
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