- My Forums
- Tiger Rant
- LSU Recruiting
- SEC Rant
- Saints Talk
- Pelicans Talk
- More Sports Board
- Fantasy Sports
- Golf Board
- Soccer Board
- O-T Lounge
- Tech Board
- Home/Garden Board
- Outdoor Board
- Health/Fitness Board
- Movie/TV Board
- Book Board
- Music Board
- Political Talk
- Money Talk
- Fark Board
- Gaming Board
- Travel Board
- Food/Drink Board
- Ticket Exchange
- TD Help Board
Customize My Forums- View All Forums
- Show Left Links
- Topic Sort Options
- Trending Topics
- Recent Topics
- Active Topics
Started By
Message
**updated Need advice on how to address ER visit bill
Posted on 1/3/16 at 5:58 pm
Posted on 1/3/16 at 5:58 pm
2 weeks ago I had to bring my wife into the er with severe pains in her lower abdomen. ER looked at her and said they had to perform a CT scan to determine if her intestines were ruptured or inflamed. We were in there for about 4 or 5 hours and they determined she had a severe c.diff infection from antibiotics she was taking for a sinus infection.
Our insurance is $250/ER Visit, $7500 deductible for individual
We got the bill from the insurance company today saying that they would only pay $1100 and we are responsible for $11,000 because the tests the ER ran were not necessary.
How are we supposed to know in the middle of an ER visit if we should have rejected the tests because they were not necessary? Shouldn't what the docs order be considered necessary, they are the doctors...
I have no idea what to do next. Do we appeal to insurance???
**update: just got hospital bill. It is not itemized, just says we owe the 11k.
What/where should I go next?
Our insurance is $250/ER Visit, $7500 deductible for individual
We got the bill from the insurance company today saying that they would only pay $1100 and we are responsible for $11,000 because the tests the ER ran were not necessary.
How are we supposed to know in the middle of an ER visit if we should have rejected the tests because they were not necessary? Shouldn't what the docs order be considered necessary, they are the doctors...
I have no idea what to do next. Do we appeal to insurance???
**update: just got hospital bill. It is not itemized, just says we owe the 11k.
What/where should I go next?
This post was edited on 1/13/16 at 12:22 pm
8
Posted on 1/3/16 at 6:02 pm to mandevilletiger34
Talk to the billing people at the hospital and let them guide you through the appeal process.
Posted on 1/3/16 at 6:16 pm to mandevilletiger34
No where near your expenses but had carrier deny a prescription, too soon to 're-fill, and got absolutely no resolution....something about their pathways/methods. Told her fine but in the event of an untoward outcome we'll 're-visit their pathways/methods and next time we'll just skip the visit to the doctor and call them direct given they know so much in the first place....welcome to socialized medicine the American way.
Posted on 1/3/16 at 6:18 pm to mandevilletiger34
I'm no expert but I'd be calling the billing department at the facility and politely be asking questions. YOU are not who can determine what is medically necessary ... the treating physician is.
What company? And surely $11,000 isn't "allowed and customary charges" even if the ins doesn't think it was medically necessary. Meaning, the hospital and ins company have agreements on charges and what's actually "owed" is less than $11K. Right? At least that's how ours works (BCBS Louisiana)
What company? And surely $11,000 isn't "allowed and customary charges" even if the ins doesn't think it was medically necessary. Meaning, the hospital and ins company have agreements on charges and what's actually "owed" is less than $11K. Right? At least that's how ours works (BCBS Louisiana)
Posted on 1/3/16 at 6:19 pm to mandevilletiger34
That does not sound right, are you sure you are reading the EOB right? Wait till you get a bill from the hospital.
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
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 7:51 pm to mandevilletiger34
Wait and see what the hospital ends up writing off. Until then, just because eob says you owe something doesn't mean the hospital won't write it off and not bill for it.
Posted on 1/3/16 at 8:07 pm to wfallstiger
quote:
.welcome to socialized medicine the American way.
No, welcome to greedy capitalist insurance companies. It's time for single payer and that payer needs to be the government that doesn't have a financial incentive to f**k you over.
Posted on 1/3/16 at 8:08 pm to mtcheral
quote:
Wait and see what the hospital ends up writing off.
Why would they write it off if they can get the customer to pay it?
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?
Posted on 1/3/16 at 8:37 pm to mandevilletiger34
My wife went in a little over a year ago for the same thing. Her colon was ruptured so I guess our tests were deemed necessary as she was taken into surgery. I also have BCBS.
Also you need to watch out for some of the doctors that work at hospitals. Just because you are at a BCBS hospital does not mean all of the doctors there are BCBS doctors.
I would wait until you get the bill from the hospital. I had a test recently that the majority of the cost was my responsibility but when I got the bill, the doctor charged me what the insurance company paid.
Also you need to watch out for some of the doctors that work at hospitals. Just because you are at a BCBS hospital does not mean all of the doctors there are BCBS doctors.
I would wait until you get the bill from the hospital. I had a test recently that the majority of the cost was my responsibility but when I got the bill, the doctor charged me what the insurance company paid.
This post was edited on 1/3/16 at 8:43 pm
Posted on 1/3/16 at 8:48 pm to mandevilletiger34
You know, this kind of story kills me. How can the average person be expected to navigate this system with any degree of certainty? How can you make informed decisions if the system is so complicated it makes your head spin? It's just depressing. On the other hand, I'm glad your wife is good.
Posted on 1/3/16 at 9:22 pm to WPBTiger
It's just crazy how they can deem it medically unnecessary when it is ordered by a doctor? It's not like we are in the er for fun...the doctor ordered the scan to rule out that the colon was ruptured.
Posted on 1/3/16 at 9:24 pm to Lsupimp
If they start demanding payment I'd get an attorney involved.
Posted on 1/3/16 at 11:28 pm to TJG210
Check with your medical benefits department at your company.
If the hospital and BC have a contract, then the hospital must accept the insurance determination. You do not owe.
eta to add: call the Insurance Commissioner in LA. I'm sure he is a good republican and will get the hospital to back off.
If the hospital and BC have a contract, then the hospital must accept the insurance determination. You do not owe.
eta to add: call the Insurance Commissioner in LA. I'm sure he is a good republican and will get the hospital to back off.
This post was edited on 1/3/16 at 11:30 pm
Posted on 1/4/16 at 9:19 am to Mr.Perfect
quote:
Why would they write it off if they can get the customer to pay it?
Because it could possibly be balance billing and that's a big no-no, at least in Louisiana.
Posted on 1/4/16 at 9:36 am to mandevilletiger34
A doctor's job is 1) to fix the patient. That's it. He's not concerned about what some insurance company computer somewhere will later say about it. The cynic in me says that the number 2) job might be to increase revenues!
It is a bizarre, crazy, insanely complicated system we have. There are hundreds of thousands (if not more) health care plans each of which have their own little quirks concerning what and how they pay.
Nothing beyond basic preventive care is clear to the patient until after the fact. Estimates are nonexistent. Prices are insanely inflated (which are then just cut back down either by the insurance contact or by negotiating a cash discount).
Unless you are so wealthy that you don't even need to watch or track your spending, it's a problem for everyone.
It is a bizarre, crazy, insanely complicated system we have. There are hundreds of thousands (if not more) health care plans each of which have their own little quirks concerning what and how they pay.
Nothing beyond basic preventive care is clear to the patient until after the fact. Estimates are nonexistent. Prices are insanely inflated (which are then just cut back down either by the insurance contact or by negotiating a cash discount).
Unless you are so wealthy that you don't even need to watch or track your spending, it's a problem for everyone.
Posted on 1/13/16 at 9:31 pm to LSUFanHouston
bump
Posted on 1/13/16 at 9:37 pm to mandevilletiger34
Honestly, just don't pay and make then write some off. Go through the process to do what is right formally but there is no reason you should have to pay that much.
Worst case you negotiate an amount you are willing to pay and tell them to FO for the rest.
Worst case you negotiate an amount you are willing to pay and tell them to FO for the rest.
Page 1 of 2
Popular
Back to top
Follow TigerDroppings for LSU Football News