I am taking care of someone with an expensive disease. I’ll call them Patient. Today, Patient received a letter from their secondary insurer. It says the “outpatient benefit for this calendar year has been met.” They’re very worried because of how costly treatment will be in the future.
I understand that these things happen, but here’s where I’m confused. The letter says the total billed charges are ~9500 USD for a service done by Patient’s surgeon, but the surgeon’s office sent a bill last month with the exact amount. This is what it looks like:
Description Charge Payment/Adjustment Patient Balance
Surgical Procedure 9200 300
Adjustment 6200
Insurance Payment 2700
Surgical Supplies 300 300
As you can see, the original bill was ~9500. But after the adjustments, only 3300 was owed and the insurance payed 2700. If the surgery center sent a bill that was already negotiated and partially paid, then why is the secondary being billed with the full charge? Especially when Patient already paid their balance of 600?
In my opinion, I feel like something is wrong. I would really appreciate it if someone could clarify the situation. Is there something I’m not understanding? My plan of action is to call Patient’s primary insurance to verify their payment. Then I will call the secondary insurance to see why they were charged that amount. Am I going about it the right way? Thank you in advance.
submitted by /u/fitting_formula
[link] [comments]
I am taking care of someone with an expensive disease. I’ll call them Patient. Today, Patient received a letter from their secondary insurer. It says the “outpatient benefit for this calendar year has been met.” They’re very worried because of how costly treatment will be in the future. I understand that these things happen, but here’s where I’m confused. The letter says the total billed charges are ~9500 USD for a service done by Patient’s surgeon, but the surgeon’s office sent a bill last month with the exact amount. This is what it looks like:
Description Charge Payment/Adjustment Patient Balance
Surgical Procedure 9200 300
Adjustment 6200
Insurance Payment 2700
Surgical Supplies 300 300
As you can see, the original bill was ~9500. But after the adjustments, only 3300 was owed and the insurance payed 2700. If the surgery center sent a bill that was already negotiated and partially paid, then why is the secondary being billed with the full charge? Especially when Patient already paid their balance of 600? In my opinion, I feel like something is wrong. I would really appreciate it if someone could clarify the situation. Is there something I’m not understanding? My plan of action is to call Patient’s primary insurance to verify their payment. Then I will call the secondary insurance to see why they were charged that amount. Am I going about it the right way? Thank you in advance.
submitted by /u/fitting_formula [link] [comments]Read Morer/HealthInsurance