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Message
Emergency Room Co-Pay?
Posted on 10/13/15 at 8:22 am
Posted on 10/13/15 at 8:22 am
If you have a health insurance plan that states Emergency room visit is 100% after $100 co-pay. And all charges presented to your insurance company are listed as "Emergency Room Facility" am I correct in thinking that even though the bill is listed at a little over 5k that my obligation is still just $100?
Called the insurance company to verify what seems like an easy question and surprisingly they could not give me information on this until the bill is put through the system and paid. Trying to figure out if I'm looking at having to paying out the deductible or just this copay.
Called the insurance company to verify what seems like an easy question and surprisingly they could not give me information on this until the bill is put through the system and paid. Trying to figure out if I'm looking at having to paying out the deductible or just this copay.
13
Posted on 10/13/15 at 8:23 am to Catman88
You are only responsible for the $100... do not pay anything else
Posted on 10/13/15 at 8:23 am to Catman88
quote:
Emergency room visit is 100% after $100 co-pay.
Do you have to meet a deductible first? If not, then yes, you only owe $100.
Posted on 10/13/15 at 8:24 am to Napoleon
quote:
Do you have to meet a deductible first?
this...I can't imagine you don't need to
Posted on 10/13/15 at 8:24 am to Catman88
I would bet on whether all of the procedures that get coded in fall under true "emergency room" procedures. The emergency room is very abused these days. Just because you believe your situation is an emergency, doesn't mean it really is.
Posted on 10/13/15 at 8:25 am to Catman88
I hate insurance. Prayers sent. Based on your information I think you're thinking right. When did this happen? The insurance company might not have gotten your claims yet. Maybe call the hospital billing and ask them about it since they have to do the billing?
Either way when you do get billed you can take your sweet arse time and figure it all out.
Either way when you do get billed you can take your sweet arse time and figure it all out.
Posted on 10/13/15 at 8:26 am to Catman88
quote:
until the bill is put through the system
Why would you call them before they've run it through their system?
Posted on 10/13/15 at 8:26 am to Catman88
Have you met your deductible for the year? If not, then you will be billed for services up to the remaining amount. The remainder will be covered by insurance.
Posted on 10/13/15 at 8:27 am to Catman88
Oh and in general don't pay anything until all claims are processed and you've reviewed the explanation of benefits from your insurance company.
Posted on 10/13/15 at 8:27 am to Catman88
jesus baw how'd you spend 5 grand in the ER?
Posted on 10/13/15 at 8:29 am to Catman88
$100 is for the visit. Usually you get it back if it's a true emergency. However, any services given to you after the initial examination are going to be applied to your deductible. Meaning you will probably owe something.
Example: you go in complaining of chest pain...$100 copay. The doctor determines you need open heart surgery...you get your $100 back but then the cost of the surgery goes through your deductible so you would owe money there.
Example: you go in complaining of chest pain...$100 copay. The doctor determines you need open heart surgery...you get your $100 back but then the cost of the surgery goes through your deductible so you would owe money there.
Posted on 10/13/15 at 8:30 am to Catman88
If you have met your deductible, whatever that is, then yes you only pay the 100
If you have not met your deductible, then you will have to pay whatever is left on it for the year.
If you have not met your deductible, then you will have to pay whatever is left on it for the year.
Posted on 10/13/15 at 8:31 am to Catman88
My insurance has a similar clause. My ER co-pay is $125. I owe nothing else to the hospital.
However, the physician that saw you in the ER will need to be paid. Depending on your deductible and if the physician service provider is in-network, you will owe them as well. My local hospital has a provider that is not in network, so for my last trip to the ER, I owed them $750.
Good luck!
However, the physician that saw you in the ER will need to be paid. Depending on your deductible and if the physician service provider is in-network, you will owe them as well. My local hospital has a provider that is not in network, so for my last trip to the ER, I owed them $750.
Good luck!
Posted on 10/13/15 at 8:31 am to MrLarson
I see the charges in their system. They have not processed it yet though. One concern is first trip to the emergency room was denied because they apparently filed it wrong. That trip resulted in an overnight - outpatient 22 (not sure what that means) stay in the hospital. I figure that one would cause the deductible to kick in where I would owe the 1500 of that 2500 bill. (Not sure though what happens since they have to re-file it) The second trip was emergency room only and all billing is showing emergency room charges. Not sure what happens now since the deductible wasn't paid for the first visit yet. Just trying to plan ahead.
Posted on 10/13/15 at 8:38 am to BeerMoney
quote:
Oh and in general don't pay anything until all claims are processed and you've reviewed the explanation of benefits from your insurance company.
I have had occurrences where the wrong insurance has been billed. The bill would have been lower, but I probably would have been screwed in the end if I hadn't noticed the error. Review everything.
Also, when paying, call the hospital to pay. They'll probably give you 10% off to pay upfront if you mention that you may have to go on payment plan.
This post was edited on 10/13/15 at 8:39 am
Posted on 10/13/15 at 8:59 am to Topwater Trout
You probably have a deductible and have to pay the first $500-2500 each year.
Posted on 10/13/15 at 9:41 am to ULSU
Do you by chance have state ogb insurance. We just ran into this for an er visit. 150 copay then we have to meet our 1200 deductible. Still getting bills from that. Also my wife got a 388 dollar bill for bloodwork from her doctor. Thanks Obama.
Posted on 10/13/15 at 9:50 am to gsvar2004
Not sure what state ogb insurance is.
My EOB states:
Emergency Services in an Emergency Room
Copay waived if admitted directly to Hospital from Emergency room
100% after
$100 copay
PPO $1,500 per participant / $4,500 per family;
Non-PPO $2,500 per participant / $7,500 per family.
Does not apply to expenses paid at 100%.
PPO and Non-PPO deductibles are separate.
My EOB states:
Emergency Services in an Emergency Room
Copay waived if admitted directly to Hospital from Emergency room
100% after
$100 copay
PPO $1,500 per participant / $4,500 per family;
Non-PPO $2,500 per participant / $7,500 per family.
Does not apply to expenses paid at 100%.
PPO and Non-PPO deductibles are separate.
Posted on 10/13/15 at 9:52 am to gsvar2004
quote:
Do you by chance have state ogb insurance. We just ran into this for an er visit. 150 copay then we have to meet our 1200 deductible. Still getting bills from that. Also my wife got a 388 dollar bill for bloodwork from her doctor. Thanks Obama.
The biggest scam is maternity coverage. Unless everything happens in the same calendar year the deductible resets on January 1. And mama and baby each have to meet their own deductible.
I'm sure people are grateful to have it if they run into any complications but for a routine pregnancy and delivery insurance is a colossal waste.
Posted on 10/13/15 at 9:53 am to Catman88
Insurance through the states Office of Group benefits. It's for state employees and teachers. Our premium is 588 (a120 dollar increase) and we have a newly added 1200 deductible. Plus all our copays went up. While this is still better than most, with my wife being a teacher, the benefits should make up for the shitty pay, and it's not
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