Wibblypig

My insurance company have paid for several hospital bills recently. I have just received a bill from the hospital saying I owe them a lot of money After comparing it to my insurance statements it turns out the hospital are billing me for the 'discount' they give my insurance company!! Is this normal? It hasn't happened with any of the other departments at the hospital (so far!), just radiology!

Should I speak to my insurance company first? Or just call the billing dept at the hospital?

Jerseygirl

Yes call the insurance company. A doctor's office tried that on just after we moved here. I called the insurance company and was told it was in fact illegal for them to do that. He asked me to hold on while he got the docs office on the line. After a lot of spluttering the docs office hung up and I was told it was all sorted and to forget about the bill. Of course this may be a state rule...I don't know.

sir_eccles

Normal? Yes, so normal it has a name "balance billing"

http://well.blogs.nytimes.com/2010/0...t-have-to-pay/

Do be careful in differentiating the amount you may owe as part of your deductible and this "balance".

Giantaxe

And it looks like it may still be legal in Florida:

http://www.pathxlis.com/insights-and...ion-(florida)/

mwdake

If the charge is $1000 but the insurance company only allows the hospital to charge $600 but you have a co-pay and a deductible then you would only have to pay the difference between the $600 and what the insurance paid which would the co-pay and deductible.
The hospital cannot also charge you for the $400 difference between what their charge is and what the allowed charge is for your contract.

Bob

All depends on the state, some allow, some don't.

Still worth calling the insurance company about it first, then the hospital. They probably try it on regardless expecting most people to just roll over and pay or not question it.

md95065

An added complication is that, while the rest of the hospital may be considered to be "in-network" by your insurer the radiologist may be "out-of-network" ...

After any kind of significant hospital stay you can also expect random bills from people that you have never seen or heard of to trickle in for the next few months (and, in some cases, years ...).

RoadWarriorFromLP

If the hospital and doctors are in your "network", then you will owe whatever is considered to be patient responsibility, such as co-pays and your share of the fees. To the extent that you've already paid those, you owe nothing more than that.

If the providers are NOT in your network, then they can charge you full price, and just apply the insurer payments to their bills. The insurer can decide what the service is worth (and will invariably decide that the cost should be a fraction of what it is), but that only determines what the insurer is willing to pay, not what the provider is obligated to accept.

Your first call should be to your insurer, to determine whether the bills are coming from providers in your network. If they aren't in your network, then you may owe the money and you'll want to start negotiating the bills.

Duncan Roberts

That was my first thought. Any provider can and will balance bill you if they are out of network.

Rete

the same with my daughter. she had to pay whatever the hospitalization did not cover. If the charge was $100 and the hospitalization paid $25, she had to pay the $75 out of pocket.

Wibblypig

Thanks everyone.

I should have said according to the EOB's I owe nothing. I have an HRA account, which the money came out of, so no co-pay or deductible in this case.

It's definitely 'In network', I had to get approval from the insurance company for one of the procedures as it's classed as surgery (biopsy). I can definitely see your point though, if it was 'out of network'.

I have spoken to the insurance company (Cigna), who have confirmed that I don't owe anything and are currently trying to get through to the hospital billing dept to sort it out (or tell them where to shove it hopefully).

I will let you know what the insurance company say when they call back.

Wibblypig

The insurance company just called back to say they have sorted it out and I should get a bill for $39, but they have sent that to be paid out of the HRA account also, so I actually owe nothing

Basically the hospital were hoping that I would pay it without querying it and get some extra money So to anyone who doesn't know this already - make sure you query and challenge everything, especially when it comes to insurance!

Mummy in the foothills

Well done Wibblypig.
I don't pay any doctor/hospital bills till I get my EOB from the insurance, then I match the doctor bill with the patient share at the bottom. So far we've only ever had one say we owe when we didn't. It took, me the insurance company and the hospital billing dept 2 years to get it sorted.

Jerseygirl

I honestly think they try it on...in the hope you won't notice or will get fed up with all the hassle and pay up.

md95065

You really can't be too careful about the "in network" thing. I got caught out by this a couple of years ago when I had some minor surgery - the hospital, the surgeon and the anaesthetist were all "in network" but it turned out that the "physician assistant" who worked in the surgeon's office, and who I saw for one completely unnecessary 10 minute appointment where she explained to me some (but not all) of the the things that the surgeon had already told me, was, amazingly enough, not "in network" so I ended up with an unexpected bill ...