My wife went to the ER for some issues which resulted in 2 Anesthesiologist claims being out of network with her primary insurance. The claims were later processed as In network with her Primary insurance but used Medicare rates for deductible. The total amount billed was $1,890.00, the amount applied to the deductible was $319.99. The EOB says our responsibility is $1890
When her secondary insurance got the claim they only paid the $319.99. The Anesthesiologist is In network with them and has a member price of $ 1,323.00. We met max out of pocket on the secondary insurance. Under the amount you may owe it says $0.
Do I have to worry about getting balanced billed? Both policies are employee plans. I called our secondary insurance shortly after the ER visit and asked them what happens if a claim is OON with the primary and in network with them, and was told they will process the claim as if it’s in network with them. This does not seem to be the case, unless the provider just has to accept the medicare rate that the primary insurance calculated.
submitted by /u/sheik482
[link] [comments]
My wife went to the ER for some issues which resulted in 2 Anesthesiologist claims being out of network with her primary insurance. The claims were later processed as In network with her Primary insurance but used Medicare rates for deductible. The total amount billed was $1,890.00, the amount applied to the deductible was $319.99. The EOB says our responsibility is $1890 When her secondary insurance got the claim they only paid the $319.99. The Anesthesiologist is In network with them and has a member price of $ 1,323.00. We met max out of pocket on the secondary insurance. Under the amount you may owe it says $0. Do I have to worry about getting balanced billed? Both policies are employee plans. I called our secondary insurance shortly after the ER visit and asked them what happens if a claim is OON with the primary and in network with them, and was told they will process the claim as if it’s in network with them. This does not seem to be the case, unless the provider just has to accept the medicare rate that the primary insurance calculated.
submitted by /u/sheik482 [link] [comments]Read Morer/HealthInsurance