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Ashley | Health Insurance Question? |
So my husband was in the emergency room a few months back and he has health insurance. They sent us a bill for about 1700 dollars but said do not pay, that they have filed it with our insurance company.
Our insurance company then sent us a note that they had paid about 800 dollars of what they think it should be and the hospital may or may not drop the remaining charges. If they did not, then I could file a claim with them.
I then got a bill from the hospital for the remaining balance, which was over half of it. They said I was responsible for the rest of it, so I quickly filed a claim with my insurance for the remaining balance. They said it takes 3-6 weeks.
I am soooo upset with this situation. My husband pays good money for his healthcare and for us to be billed over half of the balance and get an 800.00 bill is just crazy. If they do not settle we are going to drop them.
What are the chances of this getting resolved, has anyone experienced this before, It is United Healthca Additional Details Well I believe it was a medical emergency, being he woke up and was unable to breathe and the health clinic was not open being their hours are 9-5. We had to pay a 100.00 deductible. I cannot believe they are only paying a bit of this bill as much as we pay them for insurance monthly. |
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fec2010@yahoo.com
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Ashley, sorry you are dealing with this, but we'll need more information before we can help. What is your deductible? It would not be unusual to have one for something like this. That's the portion you have to pay before the insurance pays.
Just pull out the policy or call United. They will explain the policy. Just keep the faith that a large insurer like that will, in the end, pay the right amount, and you will be asked to pay the right amount. Your responsiblity now is to understand what those amounts are and make sure there's no error.
If you are left with a bill and its a financial hardship, the hospital's billing office will work with you and accept monthly payments as low as you want. Get to know someone there, and just explain you cannot pay any more. In the end, they will be happy they had someone willing to pay!
One more note, the average hospital bill is now $26,000 and 4 days. So insurance is usually more helpful as at some point, most policies start paying 100% after the deductible! |
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Lori S
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There is not enough info inyour question to answer. Part of the balance could be due to your deductible and co-insurance. But it could be that the hospital did not deduct their portion of the contracted rate that they have with the insurance. Look at your EOB (the explanation of benefits from the insurance company). There should be the total amount, the amount applied to the deductible and/or co-ins, the discount (the amount the hospital should write off) and the balance due from the patient.
How much your insurance company pays is up to how the co-ordination of benefits clause reads. Say for example your benefit is 80%. If your husbands is the same, your insurance will probably pay nothing. They usually will pay UP TO their normal benefit, but will probably not pay the entire balance. |
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Left Footed
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Is it an HMO? Usually, the hospital would have to accept whatever the insurance company offers to pay, which is usually the UCR (usual/customary rates) minus any co-pay or deductible your husband may have.
Does he have a co-pay or deductible? |
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Husker41
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You'll probably have to pay it unless the hospital drops the charge, which is unlikely. But for now, relax & let the insurance company work on it. They may get it reduced somewhat.
Yes, I have United also. |
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d_k8049
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you should go through all term and condition before taking health plan and should understood between the line .then no problem will occurred . |
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T'yr
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The accuracy of this answer will vary from state to state.
As a broker, I am not fond of United Health Care. I offer it if my clients ask me to, or if the client is looking for nation-wide coverage that isn't Blue Shield or Blue Cross. Their claims department is slow, cumbersome and difficult to work with. It should be noted that one of UHC's acquisitions (PacifiCare) is currently under review by the California Department of Insurance, and if found guilty of the charges the commissioner levelled against them, face more than a billion dollars in penalties for... you guessed it: mis-handling claims.
However, the reality is that, if the reason your husband went to the ER wasn't deemed a medical emergency and the hospital was out of network... or if you have a deductible that will apply... or if your co-insurance is 50% that you will have to pay the hospital, though they will likely work out an arrangement with you if that puts you in a place of financial hardship.
Medicine is expensive from start to finish: training the doctors, buying the equipment, staffing the hospital and keeping it clean, maintaining the equipment, etc. etc. etc. and I think it is an unfortunate thing that HMOs have taught us that our bodies are only worth a $20 copayment per visit.
There is an excellent chance that your problem will be resolved, but whether or not that resolution is to your liking is impossible to determine with the information you've provided. Talk to the broker who sold you the plan: it is his or her JOB to help you in situations like this. |
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src50
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What you think is "crazy" is not relevant; its what your policy covers that matters. Read the coverage details. |
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