►Thank you kindly for your time and interest!
tl;dr below.
My husband had a couple of cardiologic procedures at an in-network hospital.
The hospital charged the insurance $5,000 for the first procedure and $1,000 for the second procedure.
My insurance paid $0.00 for the first procedure because the hospital failed to get a pre-authorization for that procedure.
My insurance paid $0.00 for the second procedure, but it does not say anything about not getting a pre-authorization.
The insurance only states that we are not responsible for the charge on the second procedure.
The insurance does not so plainly state that we are not responsible for the first, more costly procedure.
This is the line-by-line breakdown for the first and second procedures:
Date: 08/18/2021
Provider: NJ Hospital
Amount Billed: $5,000
Your Plan Paid: $0.00
Copay: blank
Deductible: blank
Amount Not Covered: blank
What You Owe: $0.00
Claim Detail: Payment for this service is reduced or the service is not paid. Your health benefit plan requires an authorization for this service. There is not one on file to match this service.
and
Date: 08/18/2021
Provider: NJ Hospital
Amount Billed: $2,000
Your Plan Paid: $0.00
Copay: blank
Deductible: blank
Amount Not Covered: blank
What You Owe: $0.00
Claim Detail: This service is not paid. You are not responsible for this charge based on the provider’s contract.
At the Total line, the EOB reads
Your total cost share is $0.00. This includes any applicable deductibles, coinsurance copayments, and any other amounts not covered by your health plan, including any amount paid by another carrier. You may receive a bill from your health care professional or facility if you have not yet paid this amount.
We have no other carrier.
tl;dr: Can the hospital bill us because the insurance does specifically state that we are not responsible for the first, more costly procedure as it states for the second procedure?
submitted by /u/MerryMermaid
[link] [comments]
►Thank you kindly for your time and interest! tl;dr below. My husband had a couple of cardiologic procedures at an in-network hospital. The hospital charged the insurance $5,000 for the first procedure and $1,000 for the second procedure. My insurance paid $0.00 for the first procedure because the hospital failed to get a pre-authorization for that procedure. My insurance paid $0.00 for the second procedure, but it does not say anything about not getting a pre-authorization. The insurance only states that we are not responsible for the charge on the second procedure. The insurance does not so plainly state that we are not responsible for the first, more costly procedure. This is the line-by-line breakdown for the first and second procedures: Date: 08/18/2021 Provider: NJ Hospital Amount Billed: $5,000 Your Plan Paid: $0.00 Copay: blank Deductible: blank Amount Not Covered: blank What You Owe: $0.00 Claim Detail: Payment for this service is reduced or the service is not paid. Your health benefit plan requires an authorization for this service. There is not one on file to match this service. and Date: 08/18/2021 Provider: NJ Hospital Amount Billed: $2,000 Your Plan Paid: $0.00 Copay: blank Deductible: blank Amount Not Covered: blank What You Owe: $0.00 Claim Detail: This service is not paid. You are not responsible for this charge based on the provider’s contract. At the Total line, the EOB reads Your total cost share is $0.00. This includes any applicable deductibles, coinsurance copayments, and any other amounts not covered by your health plan, including any amount paid by another carrier. You may receive a bill from your health care professional or facility if you have not yet paid this amount. We have no other carrier. tl;dr: Can the hospital bill us because the insurance does specifically state that we are not responsible for the first, more costly procedure as it states for the second procedure?
submitted by /u/MerryMermaid [link] [comments]Read Morer/HealthInsurance