EDIT: The denied charges have the code VF “This procedure is not paid separately. RARC Code M15 Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed” I don’t understand what this means?
I was taken to the ER via ambulance, unconscious, in 2020. So this was definitely a medical emergency that I had no way to give consent to what service I received.
My health insurance shows a member cost-share responsibility of about $80. The hospital has billed me almost $2300. The hospital and my insurance state very clearly in their policies that I cannot be balance billed for out of network er services, I can only be charged the in-network cost sharing amount.
I keep going back and forth between insurance/hospital who are talking me in circles! Insurance says they covered what their contract allowed for the ER stay but are denying all the lab tests that were run. How is this allowed when their policy clearly states that ER visits are covered at in-network rates? I have Ambetter through the health insurance marketplace.
Is there such a thing as a middle man I can work with that can help me talk to insurance/the hospital so I can actually understand what’s going on and work this out?
tl;dr: Insurance is denying parts of my ER visit and I’m being billed $2300 more than what my member cost-sharing portion says on my EOB. I don’t understand what to do.
submitted by /u/SadYogiSmiles
[link] [comments]EDIT: The denied charges have the code VF “This procedure is not paid separately. RARC Code M15 Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed” I don’t understand what this means? I was taken to the ER via ambulance, unconscious, in 2020. So this was definitely a medical emergency that I had no way to give consent to what service I received. My health insurance shows a member cost-share responsibility of about $80. The hospital has billed me almost $2300. The hospital and my insurance state very clearly in their policies that I cannot be balance billed for out of network er services, I can only be charged the in-network cost sharing amount. I keep going back and forth between insurance/hospital who are talking me in circles! Insurance says they covered what their contract allowed for the ER stay but are denying all the lab tests that were run. How is this allowed when their policy clearly states that ER visits are covered at in-network rates? I have Ambetter through the health insurance marketplace. Is there such a thing as a middle man I can work with that can help me talk to insurance/the hospital so I can actually understand what’s going on and work this out? tl;dr: Insurance is denying parts of my ER visit and I’m being billed $2300 more than what my member cost-sharing portion says on my EOB. I don’t understand what to do. submitted by /u/SadYogiSmiles [link] [comments]Read Morer/HealthInsurance