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Nerds Rule! | Could you answer this health insurance question? |
I recieved a health insurance bill post surgery. It gives me:
1. Submitted charges- 3,000
2. Ineligible amount- 2,000
3. Deductible applied- $0.00
4. Covered amount- 1,000
5. Rate
6. Benefit- 900.00
What does the benefit mean? Do I have to pay anything out of pocket?
Additional Details
It also says (My insurance companies name) discount do not bill patient. |
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nurse ratchet
 |
It appears to me to be this;
The hospital submitted a bill for $3000. The PPO payment agreement for this procedure is $1000, so the hospital has have to write off the $2000 that is considered ineligible. That leaves a charge of $1000. The insurance company paid $900 toward that, so you now owe $100 to the hospital. Since none was applied toward your deductible, I have to assume you had a $100 co-pay for this procedure. |
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Lori S
|
Without knowing what your benefits are, it would appear that you owe $100. (Provided the $2,000 was a contractual adjustment). There should be a column that specifies what the patient's responsibility is. If not, contact your insurance company directly. |
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sarah314
|
The medical provider should bill you for $100.
The insurance company allowed $1000 for the procedure. Anything above and beyond that would be a contractual writeoff for the provider. The insurance company paid $900, which leaves a $100 balance for you.
If the medical provider bills you for any different amount, you should definitely ask for further clarification. |
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stephenweinstein
 |
1. Benefit is the amoun that they paid.
2. That document from the insurer is an "explanation of benefits", not a bill. Have the hospital or doctor send you a bill. |
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~♠♥CJ♥♠~
 |
I would have to agree with Lori S and nurse ratchet. Sounds like of the contracted rate of $1,000, the insurance is going to pay $900 and your copay will be $100 (and then the provider would write off the remaining $2,000). If you want to be certain, you should contact your insurance company. |
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Apple
|
It looks like you'll be paying $2100.
Your total bill was $3000 - you have some services that were ineligible for coverage according to your plan ($2000).
The only eligible services your insurance will cover is $1000; but it looks like they only cover 90% of that, which is common. (A lot of times they will only cover 75%, so you may have a decent plan in that respect.)
On the bright side, it also appears that you have already met your deductible for the policy period.
Sorry for what appears to be bad news. |
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