Last year my child was transferred from the emergency room to an another facility via an ambulance service. The ambulance has a very high charge for their services, and was listed as being unreasonably high, but they were still paid based on a negotiated rate. Here are the details.
Ambulance Claim:
Amount billed: $1,771.00
Provider discount: $1,179.10
Allowable amount: $591.90
Amount not payable: $0.00
Deductible: $0.00
Benefit percentage paid by plan: 80%
Other insurance paid: $0.00
Amount paid by plan: $473.52
Copay amount: $0.00
You Pay: $118.38
(There’s another smaller portion to the bill, but it’s only about $60, so I’m not worried about that line item.)
In the claim, it states, “Network status: Your claim was processed at the in-network level of benefits.”
Additionally, in the EOB, it states, “908 The amount billed by your provider exceeds the reasonable allowable amount. Should you receive a bill from your provider indicating that you owe the disallowed amount, please contact Change Healthcare at 1-866-295-0770. Please refer to Claims and Appeal Procedures in your Benefit Booklet. Your Claim was processed at the In Network Level of Benefits. This is a High Deductible Health Plan”
The bill I’ve received from the ambulance company is for $1,350.37 which is the amount billed minus the insurance payment without any price adjustment. I had initially called Change Healthcare months ago who said they were working on it, but I just received a letter stating that the ambulance service is about to send my bill to collections. I then spoke with the ambulance company, and they have not heard from anyone about the bill so far, there is no negotiated rate with my insurance company, and the $1350 bill is the amount I owe.
What are my next steps here, and are there any keywords I can use to be more effective while on the phone?
Thank you for any advice!
submitted by /u/ThePoetaytoe
[link] [comments]Last year my child was transferred from the emergency room to an another facility via an ambulance service. The ambulance has a very high charge for their services, and was listed as being unreasonably high, but they were still paid based on a negotiated rate. Here are the details. Ambulance Claim: Amount billed: $1,771.00 Provider discount: $1,179.10 Allowable amount: $591.90 Amount not payable: $0.00 Deductible: $0.00 Benefit percentage paid by plan: 80% Other insurance paid: $0.00 Amount paid by plan: $473.52 Copay amount: $0.00 You Pay: $118.38 (There’s another smaller portion to the bill, but it’s only about $60, so I’m not worried about that line item.) In the claim, it states, “Network status: Your claim was processed at the in-network level of benefits.” Additionally, in the EOB, it states, “908 The amount billed by your provider exceeds the reasonable allowable amount. Should you receive a bill from your provider indicating that you owe the disallowed amount, please contact Change Healthcare at 1-866-295-0770. Please refer to Claims and Appeal Procedures in your Benefit Booklet. Your Claim was processed at the In Network Level of Benefits. This is a High Deductible Health Plan” The bill I’ve received from the ambulance company is for $1,350.37 which is the amount billed minus the insurance payment without any price adjustment. I had initially called Change Healthcare months ago who said they were working on it, but I just received a letter stating that the ambulance service is about to send my bill to collections. I then spoke with the ambulance company, and they have not heard from anyone about the bill so far, there is no negotiated rate with my insurance company, and the $1350 bill is the amount I owe. What are my next steps here, and are there any keywords I can use to be more effective while on the phone? Thank you for any advice! submitted by /u/ThePoetaytoe [link] [comments]Read Morer/HealthInsurance