Hi all,
Hoping someone might be able to help me here because this is stressing me out quite a bit. I am based in NY in case that is helpful. Background: I receive a regular monthly infusion and the problem I am detailing in this post is a recurring issue on my bills for the infusions.
On my insurance EOB for each infusion, there are surcharges associated with some of the line items. Most of them appear to be covered by my insurance company (under PLAN PAID section of the EOB), but a few are listed under my RESPONSIBILITY TO PROVIDER/AMOUNT YOU OWE list. In particular, the ones that I am responsible for are associated with charges applied to my coinsurance. See below for the footnote associated with these particular charges.
The issue is that it appears that my provider is not charging me for the surcharges even though they are listed under my RESPONSIBILITY TO PROVIDER/AMOUNT YOU OWE list of the EOB . The bigger issue is that the drug manufacturer copay assistance program I am enrolled in is refusing to pay for my infusions because there is a discrepancy between the insurance EOB AMOUNT YOU OWE total vs. the bill from my provider since my provider is not charging me these surcharges.
I spoke to someone at my provider’s billing office and they had no explanation and were not helpful. I am dreading calling my insurance company because I am guessing they will just tell me to call the provider. Regardless, I plan on calling them in the morning.
Does anyone have any ideas on what might be going on here? Having a chronic illness is stressful enough and having to navigate all of the insurance BS just adds to the stress. If anyone could provide insight, I would be very appreciative.
Thanks in advance!
FOOTNOTE ASSOCIATED WITH THE SURCHARGE LINE ITEM ON EOB:
YW – THE PLAN WILL PAY THE 9.63% SURCHARGE AS REQUIRED BY THE NEW YORK HEALTH CARE REFORM ACT ON BENEFITS PAID AND ANY COPAY APPLIED. THE PATIENT MAY BE RESPONSIBLE FOR PAYING THE 9.63% SURCHARGE ON ANY CHARGES APPLIED TO THE DEDUCTIBLE AND PATIENT COINSURANCE. THESE SURCHARGE AMOUNTS ARE INCLUDED IN THE AMOUNT SHOWN AS “PATIENT RESPONSIBILITY”. THE PATIENT IS ALSO RESPONSIBLE FOR THE 9.63% SURCHARGE ON ANY NON-COVERED CHARGES. THE FOLLOWING RATES ARE EFFECTIVE FOR THE PRIOR DATE RANGES INDICATED: PRIOR TO 7/1/03 – 8.18%; 7/1/03 THROUGH 12/31/05 – 8.85%, 1/1/06 THROUGH 3/31/09 – 8.95%.
submitted by /u/Aggressive_Oven_436
[link] [comments]Hi all, Hoping someone might be able to help me here because this is stressing me out quite a bit. I am based in NY in case that is helpful. Background: I receive a regular monthly infusion and the problem I am detailing in this post is a recurring issue on my bills for the infusions. On my insurance EOB for each infusion, there are surcharges associated with some of the line items. Most of them appear to be covered by my insurance company (under PLAN PAID section of the EOB), but a few are listed under my RESPONSIBILITY TO PROVIDER/AMOUNT YOU OWE list. In particular, the ones that I am responsible for are associated with charges applied to my coinsurance. See below for the footnote associated with these particular charges. The issue is that it appears that my provider is not charging me for the surcharges even though they are listed under my RESPONSIBILITY TO PROVIDER/AMOUNT YOU OWE list of the EOB . The bigger issue is that the drug manufacturer copay assistance program I am enrolled in is refusing to pay for my infusions because there is a discrepancy between the insurance EOB AMOUNT YOU OWE total vs. the bill from my provider since my provider is not charging me these surcharges. I spoke to someone at my provider’s billing office and they had no explanation and were not helpful. I am dreading calling my insurance company because I am guessing they will just tell me to call the provider. Regardless, I plan on calling them in the morning. Does anyone have any ideas on what might be going on here? Having a chronic illness is stressful enough and having to navigate all of the insurance BS just adds to the stress. If anyone could provide insight, I would be very appreciative. Thanks in advance! FOOTNOTE ASSOCIATED WITH THE SURCHARGE LINE ITEM ON EOB: YW – THE PLAN WILL PAY THE 9.63% SURCHARGE AS REQUIRED BY THE NEW YORK HEALTH CARE REFORM ACT ON BENEFITS PAID AND ANY COPAY APPLIED. THE PATIENT MAY BE RESPONSIBLE FOR PAYING THE 9.63% SURCHARGE ON ANY CHARGES APPLIED TO THE DEDUCTIBLE AND PATIENT COINSURANCE. THESE SURCHARGE AMOUNTS ARE INCLUDED IN THE AMOUNT SHOWN AS “PATIENT RESPONSIBILITY”. THE PATIENT IS ALSO RESPONSIBLE FOR THE 9.63% SURCHARGE ON ANY NON-COVERED CHARGES. THE FOLLOWING RATES ARE EFFECTIVE FOR THE PRIOR DATE RANGES INDICATED: PRIOR TO 7/1/03 – 8.18%; 7/1/03 THROUGH 12/31/05 – 8.85%, 1/1/06 THROUGH 3/31/09 – 8.95%. submitted by /u/Aggressive_Oven_436 [link] [comments]Read Morer/HealthInsurance