I have a question on Health Insurance Billing

Question

I recently saw a question that asked: I got billed from the hospital for 3000, the insurance said 1000 was eligible, and that 900 would be paid. All agreed that this individual would need to pay 100 because the hospital billed 3000, but the insurance only allowed 1000 and thus, the hospital had to contractually write-off the 2000.

I have a bill from the hospital, for ease, we will say for 2000. The insurance allowed 1500 and is paying 1300. But the hospital is asking me to pay 700. I don't understand, doesn't the hospital have to contractually write-off the 500?

Answer 1

If the hospital is in-network with your insurance then they should only be billing you $200. Since they are billing you for $700, this is called balance billing.  This typically not permissible when the care provider has a contract with your insurance company. You explanation of benefits from your insurer should show how much you are truly responsible for. If the hospital is truly in-network and they are balance billing you, you should call and discuss this with them. You should also call and advise your insurance company about this so that they can open a case with the providers Representative.  If this provider has a trend of balance billing, the insurance company would take action.

If the provider is non-participating or out-of-network with your insurance, then they do not have to accept the allowed amount as payment and full and have every right to balance bill you since they do not have a contract with your insurance company.

Bottom line is if they are in-network you would owe $200.

If they are out-of-network you would owe $700.

If you are not sure of the providers network status  you should call your insurance company and give them the date of service of the claim, and the name of the hospital and they can tell you if the claim processed in or out of network.

Hope this helps.

Answer 2

Yes.  But a lot of times, they'll make you tell them that.   I suspect they're trying to get extra money that they aren't entitled to.

Answer 3

~~Your insurance will send you an EOB (explanation of benefits) which clearly shows what you are responsible for. Call and request it if you have not received one yet. It is a very common billing error for the difference of the contracted amount to the actual amount billed is not written off, going to the patiens's responsibility. Always pay after you receive your EOB or get the  breakdown directly from your insurance, they can tll you over the phone.~~

Answer 4

It depends on the insurance and what type of contract the hospital has with the company with medicare they have to write it off if they accept medicare assignments but it is best to call your insurance company and ask them and then contact the billing department of the hospital

Answer 5

Without knowing what your benefits are, this is hard to answer. You should have gotten an EOB (explanation of benefits) from your insurance telling you what was billed, what was allowed, what is the provider's responsibility (their contractual write-off) and what you owe. If the provider is billing you for more than the EOB statesm call them and tell them to make the adjustment. You would be suprized how often this gets missed.  

Answer 6

Only if you have a network/ppo plan and the hospital is in-network. If you have an "any provider" plan, an indemnity plan or you're seeing and out of network provider you'll be "balance billed" which means you're still responsible for the balance of the bill.

The hospital or provider only writes off the difference when they've agreed to take a certain amount. If they've made no such agreement then you're responsible.

That's why you never want to go with a plan that allows you to see any provider because you never catch a break and will almost always be balance billed. AND, that's why you never go out of network (or why when they say it's 60% it's not) because they only cover a smaller percentage of a fraction of the bill. In other words. If they bill $2000 and the insurance company thinks $1500 is appropriate and you only have 60% out of network, they'll cover $900 of a $2000 bill which means they only covered 45% of the bill.