Can someone please explain to me why

[minnieandmickeymouse]

I get bills from the hospital telling me I owe X amount, then when I call my insurance co. up, they tell me they paid 100% and I shouldn't be getting a bill at all and I owe nothing?

This happens all the time!!! It's so frustrating!! I know what Co pays I have and what is suppose to be covered 100%. Some people may actually pay these bills thinking that they really owe, when they don't. Is the hospital trying to scam money out of people?? I don't get it???

 

[ameraumi]

I had that recently and then the hospital would not send me out an updated bill to show a $0 balance. So I make sure now to keep my EOBs from insurance and the bills stapled together just in case they try to come back and say I still owe it.

 

[Heidict]

Have you spoken to anyone at the hospital yet? It's possible that they may have taken an incorrect adjustment on the claim. Did you get an eob from the insurance?

If you haven't called the hospital yet, do that. Find out exactly what they aren't covering. Date of service, cpt code and charge amount. Then you can cross refrence it with your eob or call the insurance back for more info.

 

[MrsPotts]

No the hospital is not trying to scam you!!! That's illegal and there are fines so large that it's not worth it.

It could be your insurance company is slow in paying the hospital. This happens all the time!!! Insurance companies don't want to part with their money so they hang on to it or they themselves are having a cash flow issue. We have noticed this happening more lately.

The hospitals send out computer generated statements each month regardless of whether or not your insurance company has paid. You will know if you're insurance company paid or not, what services were covered and which ones were denied because you will have received an EOB (explanation of benefits) directly from your insurance company in the mail.

Unless the hospital has some pay up front rule, you can wait until you receive the EOB before paying your bill. At my hospital we don't have patients pay up front even when we know a paticular patient may/will become a liability on our books!! Our Charity Care program has grown over the last year....the economy!

 

[minnieandmickeymouse]

Hmmmm, I never get EOB, how come? I get them with the dental insurance, but not these medical bills. We get them when DH orders his diabetes supplies. I don't know.

 

[mikehn]

Some insurance companies dont 'mail' out an EOB anymore. But you can view and print out the EOBs online. For example, my Aetna does this. I wouldnt worry about the bills. It may take awhile for the hospital billing department to reconcile all the activity in your account. Once that's done, the bills will stop.

 

[ajk912]

How about if the insurance company pays their portion, and you mail a check to cover your copay, the check is cashed, and you STILL get a bill saying you owe the copay?

This happened to me just this week. I got another bill for my cardiologist for $60. I called them up and told them to check their records, I mailed this last month and I checked my bank, the check was cashed. She was like, "Oh, we are behind on postings. Call back next month if you get another bill and we'll discuss it." What the heck? I did my part, I paid my bill. You cashed the check. It is no longer my problem. If I get interest charges or another bill, I will be livid.

 

[Heidict]

Some insurance companies dont 'mail' out an EOB anymore. But you can view and print out the EOBs online. For example, my Aetna does this. I wouldnt worry about the bills. It may take awhile for the hospital billing department to reconcile all the activity in your account. Once that's done, the bills will stop.

Don't ignore the bills!! Please. Ignoring it could just wind up a bigger mess. People assume that the bill is a mistake and don't do anything about it, then the next thing you know they are getting collection letters. I see this ALL the time.

Don't assume that things will just work out. Call the hospital and talk to someone. They are the ones who sent you the bill and they are the only ones who can explain why they sent it to you. Even if your insurance says you don't owe anything and not to pay it, call the hospital!!!! I just can't stress that enough. The insurance is not the one who will have to dig themselves and possibly their credit out of the hole if it gets ignored and sent to collections.

 

[cajunlace]

My problem is that the hospital keeps calling me to send more money. I pay them every month but they are not satisfied with the amount. They want more. I told them so do I!!! At least I pay them monthly. I could see if I wouldn't pay at all but I never miss a month.

 

[1stluvispooh]

Since I use to do the insurance for an eye doctor and I'm always yelling at my DH for paying for things that insurance will cover. (I think I have a permanent credit at the dentist) The big reason why this happens is that the insurance is slow to pay. The Dr. office or hospital see's a balance and sends out a bill. In the mean time the insurance sends a payment. Basiclly the cross in the mail. So I would call the hospital before I paid anything because chances are that the insurance has already paid or better yet and call the insurance company to find out if they have sent payment.

 

[dismom2]

I can tell you from personal experience that medical bills can have a lot of mistakes in them---and often. My dad is extremely careful about checking all bills, and I can't tell you how many errors he has found. He has been charged for services that were never rendered, or for things never used. You need to check your bills VERY carefully. I also have had MANY mistakes on medical bills. I was sent a bill for nearly $1,000 once, years after it was already paid. I had to dig through a ton of old paperwork to find receipts to prove I paid every cent, and make a lot of long, frustrating phone calls to the insurance company and the doctors office before it was straightened out. That's just one example---the worst one. But, there have been many error on other bills. Some insurance companies are much better than others when it comes to accuracy. I also have an issue with my co-pay's with one doctor's office. Every single time I go there I pay my correct co-pay, then get a bill saying I owe more, which I do not. I have spoken to the manager, I have talked to them until I am blue in the face, but it keeps happening. One of the girls there just tells me "I have to go by what my computer says", even though it's totally WRONG and I have to prove it each and every time. I really don't know what their problem is.

Just be careful and make sure you check everything well.

 

[MoniqueU]

Is it common now for Dr's in network to charge more then the insurance will pay? I got a EOB that stated that my insuarance paid 600 of a 700 dollar bill for a 20 minute appt at a Podiatrirst times 2 visits that is 1400 hundred dollars of which my insurance will pay 1200. I feel my insurance is being MORE then generous, those are outrageous charges. I can self pay for urgent care for 80 dollars for the same amount of time, all this was for was for a toothpick stuck in a foot, one a general consult and the second time he could actually see it and pulled it out. It wasn't rocket science. Do I really owe the podiatrist another 200 bucks on top of my copay? That is insane, I have never had that happen before and feel both myself and my insurance company are being ripped off. I do owe the hospital 100 bucks for my copay for when my son went in 3 nights in a row, I will make payments for that once I find the right envelope after the insurance pays their part, but I better not be overcharged there too beyond what my insurance will pay. I think I have good insurance but these charges these people are charging are insane.

 

[GeorgeG]

My wife worked many years for both a doctor and a dentist. A lot of her job was doing insurance. From what she tells me, many of the people doing the insurance billing at hospitals and doctors' offices simply don't know what they're doing. She has even considered becoming a patient advocate for people who have trouble with incorrect medical billing.

I don't know if things have changed, but years ago the medical insurance company I had (a major one) would typically deny any and all claims the first time, but pay the second time the claim was submitted. I have to wonder how many millions of dollars that company saved by people not following through and just paying.

 

[bicker]

A lot of the problem stems from how many different ways different bills get paid. The complexity of billing, coverage, and electronic funds transfers is overwhelming. The question is whether we are all willing to pay yet-even-more for every medical service to higher someone who is well-versed in every different angle of medical billing. For smaller services, that would be prohibitively expensive, and that could substantially reduce the availability of affordable medical care. Even for larger services, is having such a dedicated expert going to pay off, in the long-run? It is worth it to the business? If not, then it would be unreasonable to expect the business to expend one cent more, for something that does nothing but represent more cost.

There is no good answer: Take away the complexity, and you lose your choice of how you want to pay, how many different insurance options there are. Sure, things would be simpler if everyone had insurance, and had the same insurance policy, but that's not practical and many people think that that would be a bad thing. Our national is no where near the point where this issue can be addressed, because none of the available options for resolving it are acceptable to enough people. When no options are generally acceptable, then the status quo wins, every time.

 

[ajk912]

Is it common now for Dr's in network to charge more then the insurance will pay? I got a EOB that stated that my insuarance paid 600 of a 700 dollar bill for a 20 minute appt at a Podiatrirst times 2 visits that is 1400 hundred dollars of which my insurance will pay 1200. I feel my insurance is being MORE then generous, those are outrageous charges. I can self pay for urgent care for 80 dollars for the same amount of time, all this was for was for a toothpick stuck in a foot, one a general consult and the second time he could actually see it and pulled it out. It wasn't rocket science. Do I really owe the podiatrist another 200 bucks on top of my copay? That is insane, I have never had that happen before and feel both myself and my insurance company are being ripped off. I do owe the hospital 100 bucks for my copay for when my son went in 3 nights in a row, I will make payments for that once I find the right envelope after the insurance pays their part, but I better not be overcharged there too beyond what my insurance will pay. I think I have good insurance but these charges these people are charging are insane.

This happened to me once, as well, with a podiatrist. I thought the doctors were supposed to write off the difference of between what they feel their services are worth, and what the insurance company pays? Isn't that part of the contract?

I ended up paying it on mine. And I NEVER used that guy again. I could have fought it, but I did not.

 

[Nancy]

Is it common now for Dr's in network to charge more then the insurance will pay? I got a EOB that stated that my insuarance paid 600 of a 700 dollar bill for a 20 minute appt at a Podiatrirst times 2 visits that is 1400 hundred dollars of which my insurance will pay 1200. I feel my insurance is being MORE then generous, those are outrageous charges. I can self pay for urgent care for 80 dollars for the same amount of time, all this was for was for a toothpick stuck in a foot, one a general consult and the second time he could actually see it and pulled it out. It wasn't rocket science. Do I really owe the podiatrist another 200 bucks on top of my copay? That is insane, I have never had that happen before and feel both myself and my insurance company are being ripped off. I do owe the hospital 100 bucks for my copay for when my son went in 3 nights in a row, I will make payments for that once I find the right envelope after the insurance pays their part, but I better not be overcharged there too beyond what my insurance will pay. I think I have good insurance but these charges these people are charging are insane.

If they have contracted rates and are in network then that difference is a write off for them, call the insurance they can send out a balance bill letter. Sometimes people in the billing department don't read the EOB correct and think they can charge for the write off amount.

Also, a lot of times plans will have an HRA with them (usually high deductible plans) and the doctors get the EOB saying paient owes $$$ and they send the bill. In the meantime the claim is rolling over to the HRA and the bill gets paid. It is just that payment/bill crossed in the mail.

 

[Heidict]

Is it common now for Dr's in network to charge more then the insurance will pay? I got a EOB that stated that my insuarance paid 600 of a 700 dollar bill for a 20 minute appt at a Podiatrirst times 2 visits that is 1400 hundred dollars of which my insurance will pay 1200. I feel my insurance is being MORE then generous, those are outrageous charges. I can self pay for urgent care for 80 dollars for the same amount of time, all this was for was for a toothpick stuck in a foot, one a general consult and the second time he could actually see it and pulled it out. It wasn't rocket science. Do I really owe the podiatrist another 200 bucks on top of my copay? That is insane, I have never had that happen before and feel both myself and my insurance company are being ripped off. I do owe the hospital 100 bucks for my copay for when my son went in 3 nights in a row, I will make payments for that once I find the right envelope after the insurance pays their part, but I better not be overcharged there too beyond what my insurance will pay. I think I have good insurance but these charges these people are charging are insane.

First and foremost, was the doctor participating with your insurance? If so, then they have to adjust the difference less any deductible's, copays or co-insurance that you would be responsible for. Talk to your insurance to find out what is really your responsibility or access one of your eob's for your responsibility. If the office still tries to get you to pay, contact your insurance again and request that they contact the md on your behalf. Often times they will also do 3 way call so everyone can talk together and it can get settled.

If the doctor is out of your network or does not have a contract with your insurance then you are responsible for any balance left over after the insurance paid what they feel is a resonable and customary amount for the service provided. However, $700 for a new patient consult is a bit ridiculous and I have seen some crazy figures before.

 

[janey99]

Don't ignore the bills!! Please. Ignoring it could just wind up a bigger mess. People assume that the bill is a mistake and don't do anything about it, then the next thing you know they are getting collection letters. I see this ALL the time.

Don't assume that things will just work out. Call the hospital and talk to someone. They are the ones who sent you the bill and they are the only ones who can explain why they sent it to you. Even if your insurance says you don't owe anything and not to pay it, call the hospital!!!! I just can't stress that enough. The insurance is not the one who will have to dig themselves and possibly their credit out of the hole if it gets ignored and sent to collections.

Totally off topic, Heidict, but who is the guy in your sig? I have always wondered!

Jane

 

[Heidict]

Totally off topic, Heidict, but who is the guy in your sig? I have always wondered!

Jane

Kevin Durand. That is him as Keamy in LOST. The avitar pic is of him in Smoking Aces.

 

[janey99]

Kevin Durand. That is him as Keamy in LOST. The avitar pic is of him in Smoking Aces.

He's not too hard on the eyes is he? I don't recognize him and I thought he might be your real life DH (lucky you!).

Jane