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**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 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 8:37 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 1/13/16 at 9:39 pm to mandevilletiger34
Request an itemized statement, they have to give you that if you ask for it.
If you call the billing department of the hospital and complain, they'll like adjust it for you.
If you call the billing department of the hospital and complain, they'll like adjust it for you.
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